One of the more common problems encountered in cosmetic breast surgery is sagging, or ptosis. There are several components of ptosis. The main problem is that there is too much skin for the amount of breast volume. This allows the nipple to sit below the inframammary crease and creates contact between chest skin and breast skin on the underside of the breast. It also creates a long distance from the collarbone to the nipple. Under these circumstances the breast skin is thin and unable to hold up the weight of the breast.
The condition may be corrected by reducing the amount of skin, increasing the breast volume, or a combination of the two. Using an implant alone is useful only for very minor degrees of ptosis. If the ptosis is moderate, then breast lifts and implants may be combined in a single operation. In cases of severe ptosis, it is most predictable and has the least risk if the lift is performed first, then a breast augmentation is performed at least three months later.
The main problem in performing a lift at the same time as placing implants is the limitations of the skin. A woman has sagging of the breast partly because the skin is too weak to hold up the weight of the breast. The additional weight of the implant will cause the breast to sag more. Also in performing a lift the breast is further weakened by incisions at the bottom of the breast. This is exactly where more strength is needed, not less. It takes about 6 weeks after an operation for the tissues to regain their strength. Performing a lift at the same time also increases the risk of infection and capsular contracture because of the increased contact between breast tissue and the implants.