Breast Implants or Breast Lift?


Hi! I am Dr Michael Szalay and today I am going to talk about breast lift.

Often I will see patients who wish to have breast implants, but would get a better result with a breast lift.

When considering which procedure is more appropriate for someone, important factors are how loose the breasts are, where the nipples are located and the final size and position the patient wishes to achieve.

Some causes of loose breast tissue can include breast feeding, weight loss and developmental differences.

Many women are fine with the idea of a breast lift in order to achieve a better position and shape of their breasts. Some however are not keen for a breast lift because it entails extra costs and incision lines.


Some women may be suitable for either implants or a lift, depending on the final outcome they are seeking.

These women often have loose breast tissue but a good nipple position. The aim in these cases is to pick an implant which is large enough to fill out the loose breast tissue. If this doesn’t occur, then loose tissue can drape off the implant ( “snoopy” or “waterfall effect”).

Polyurethane implants can be helpful in this situation as they hold their position better than other implants and are less likely to stretch the already loose breast tissue.

Sometimes, the breast tissue might be so loose that a very large implant is required to fill it out. If the size of this implant is larger than the patient is willing to have, then she would be better suited by a breast lift.


There are 3 main types of incisions for breast lifts:

  • Peri-areolar (“doughnut”) mastopexy

This type of breast lift is primarily aimed at lifting the nipple and is mainly used when the nipple is low but the breast is not excessively loose.

An incision is made around the areola and the nipple can be lifted up to 2 to 3cm. A periareolar mastopexy is usually used in combination with an implant.

  • Vertical ( “lollipop”) mastopexy

This type of breast lift is the most common type and is used when there is loose breast tissue as well as a low position of the nipples.

An incision is made around the areola as well as down the middle of the front of the breast. Both the nipple and the breast can be lifted significantly with this technique.

  • Anchor Lift

This is a more extensive version of the vertical lift. This technique is used when the breast tissue is very loose as might occur after massive weight loss.

An incision is made around the areola, down the front of the middle of the breast and also in the crease below the breast.


It is possible to have a breast lift without implants if you are just seeking firmer breasts in a higher position with a better nipple position. All of these things can be achieved with just a breast lift.

Following a lift alone however, the breast will be lacking upper fullness. Many women choose to have implants as well as a lift in order to achieve upper fullness.


Breast Implants : Revision Surgery


Hi! I am Dr Michael Szalay and today I am going to talk about revision surgery after breast implants.

Sometimes it is necessary to perform revision surgery after breast implants. Helpful information about complications after breast implants has been gathered by Allergan and Mentor, the 2 largest breast implant manufacturers in the world. They have conducted  10 year studies on patients who have had breast implants. Here are the 4 most common reasons why revision surgery may be necessary:

1. Capsular hardening

This refers to hardening and contracture of the capsule around the breast implant. It can result in pain, abnormal shape and abnormal position of the implant. Capsular hardening rates have been listed by Allergan as 19% at 10 years for their standard smooth and textured implants.

The use of polyurethane implants dramatically reduces the capsular hardening rate to 1%.

2. Rupture

Rupture refers to a tear or hole in the outer shell of the breast implant. Various studies estimate the risk at about 1% per implant per year. So, because each patient has 2 implants, the risk after 10 years may be about 20%. There is no evidence that this rate is different for different types of implants.

3. Implant Malposition

This can refer to :

  • the implant moving out of place eg dropping too far (“bottoming out”)
  • the implant rotating if it is a teardrop shape  eg it might turn on its side and look abnormal
  • the implant flipping over on itself if it is round, which also looks abnormal

The Allergan study indicates an implant malposition rate of 7% for their standard smooth and textured implants.

In my experience, polyurethane implants have a much lower malposition rate of about 2%.

4. Breast Sagginess

This can occur for various reasons including ageing, breast feeding and weight fluctuation. It can also occur due to the weight of the implant stretching the breast tissue which occurs more commonly in the following patients:

1/ Those who have loose breasts to begin with.

2/ Those who fail to properly support their breasts after implants.

3/ Those who have large implants.

In my experience, breast stretching is less likely with polyurethane implants as they hold their position better than standard smooth or textured implants.


Whilst revision surgery may be necessary with any breast implant, the use of polyurethane coated implants significantly reduces  re-operation rates.