• Length of Surgery: 3 hours
• Anesthesia: General
• Outpatient vs Inpatient: Outpatient (Ambulatory)
• Recovery Time:5-7 days

This procedure intends to improve the overall appearance of the breast by enhancing the shape, volume, and position of the breast. In this procedure,  excess skin is removed, and then the tissue is tightened to reshape and lift the breast and nipple-areola complex. Then the breast upper pole and cleavage is volumized and enhanced by either inserting a breast implant or injecting fat from your own body. 

The consultation is divided into 5 parts: 

1) Health and Medical History Evaluation

A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery.  Dr. Couto will emphasize the importance of avoiding nicotine products (e.g cigarette, nicotine patch, vape, etc), having blood sugar levels well controlled if the patient has a history of diabetes, and the importance of adequate body weight. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results.  Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.  

2) Discuss with the Patient About Surgical Goals

Dr. Couto has a deep discussion with the patient to learn about their concerns and  goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet our patient’s expectations.  We focus on learning whether the patient is interested in just lifting the breast or if she is also interested in adding volume with an implant or fat transfer. We always like to emphasize to the patient that a breast lift does not increase volume, it just strictly lifts and reshapes the breast and nipple-areola complex. If in addition to lifting the breast, the patient is interested in volumizing the breast and enhancing the cleavage, then a breast augmentation with a lift is required. 

3) Breast Analysis, Surgical Recommendations 

A comprehensive breast analysis is performed. In this part of the consultation, our goal is to determine if the procedure can be performed in a single operation or if it needs to be divided into two operations: breast lift followed by a breast augmentation 2-3 months later. In order to answer that question, we examine the size, skin quality, and most importantly, the degree of droppiness of your breasts. Furthemore,  we identify any existing breast or chest asymmetries, and evaluate the contour and proportion of the breasts in relation to the body.  After the examination, Dr. Couto discusses with the patient his recommendation and explains in detail everything involved with the procedure and its recovery. 

4) Breast Implant Selection

In this type of surgery it is crucial to select a size and type of  breast implant that is precise for your anatomy. Choosing the incorrect implant could result in a suboptimal aesthetic result or even lead to complications. Therefore, using the information obtained from the breast analysis and taking in consideration the patient’s desired breast size and aesthetic goal, we guide the patient to select the correct implant. Furthermore, we use 3D-imaging technology to select breast implants. This 3D simulation system enables us to determine the correct breast implant size/shape and show the patient how the breasts could look with the selected implants. 

5) Pricing and Scheduling Information

Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure(s) discussed during the consultation and also discuss the steps involved to book the procedure with us.

As the name suggests, the breast augmentation and lift is a two-part procedure: breast augmentation is performed first, followed by the breast lift. This procedure can be performed either as a single or two stage approach.

Part I: Breast Augmentation 

In a breast augmentation with a lift, Dr. Couto typically performs a dual-plane breast augmentation (hyperlink), a technique popularized by his mentor, Dr. William P. Adams Jr. An approach that has been shown to provide consistent results and the lowest complication rate.  Using this technique, the superior aspect of the implant is placed behind the pectoralis muscle, and the lower part of the implant directly behind the breast.

Part II: Breast Lift

Skin Incisions: 

A common concern of a patient seeking a breast lift is the location and size of the scar. The principal cause of a droopy breast is the presence of excess lax skin. In order to reshape and lift the breast and nipple in optimal position, that loose skin needs to be removed and tighten. This will produce a scar that is typically well concealed, and most importantly, outweighs the benefit of a rejuvenated breasts appearance. Once the skin incisions are made and the excess skin is excised, Dr. Couto will restore the shape and position of the breast to one that is rounder, fuller, and younger. 

There are three types of skin incision techniques that Dr. Couto uses to perform a breast lift:

• Periareolar Skin Incision: This technique consists in placing a scar around the border of the areola. This method is useful when there is a mild descent of the nipple, and when we are interested in reducing the diameter size of the nipple-areola complex. 
• Circumvertical Skin or “Lollipop” Incision: This is a combination of the periareolar incision and a vertical incision that runs from the inferior aspect of the areola to the breast crease. This technique is used when there is moderate degree of nipple areola descent. The purpose of the vertical incision is to remove horizontal excess skin; thus, shaping the breast into a narrower and perkier breast.
• Wise Skin Pattern or “Anchor” Incision: This technique follows the same path as the keyhole incision, but also has a short horizontal incision along the breast crease. This incision is used in cases where there is significant sagginess and droppiness of the breasts and nipples. This additional horizontal incision enables the surgeon to remove the excess skin of the inferior pole of the breasts, and thus treat the breast in all dimensions, vertically and horizontally. Ironically, this is the scar that most people are worried about, but it hides well in the breast crease.

A breast augmentation and lift with mesh support is a modified technique, where soft tissue support is added to slow down the aging changes that will naturally occur after surgery. Following any breast surgery, the skin will continue to age and the breasts will continue to be exposed to gravity; therefore, with time, the breasts will take their natural course and will descend. An effective way to delay that effect is by adding soft tissue support to the breast. This is achieved with the use of a biological mesh (Galaflex®)  that is placed in the breast at the time of surgery.With time the body absorbs this mesh and leaves in place a reinforced layer of collagen that serves as an internal bra.

 Patient with:

• Breast Droopiness/Sagginess
• Nipple Descent 
• Increase Nipple-Areola Size
• Loss of Breast Volume
• Congenital Breast Deformity
• Constricted/Tuberous Breast

Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient and confirm schedule your post-operative appointments. 

We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products can affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 12 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.

We provide the patient with a detailed postoperative protocol to ensure a  comfortable and quick recovery. Following surgery, it is common to feel soreness and sensitivity around the surgical site; however, this is easily manageable with our postoperative pain regimen medication. Furthermore, we start all our patients in a scar therapy to optimize your scar healing process and obtain the best results.   We recommend our patient to take 5 days of work (less if working remotely) from home) and avoid lifting anything heavier than 7-10 pounds for 4 weeks. Patients can resume their aerobic exercise (e.g. running, walking, spinning) 2 weeks after surgery. However, you will be able to restart your gym exercises and full activities 6 weeks after surgery. The final appearance of your scars will be observed in 1 year after surgery.