Breast Augmentation Facts

Cosmetic surgery is growing in popularity every day as more patients turn to this practice to give them the body they have always dreamed of having. Surgical breast procedures are some of the most reliable and popular methods of achieving what women consider “the perfect breasts.” While all cosmetic breast augmentation operations share certain common elements, the specific techniques and materials used vary greatly from one procedure to the next. Choosing which procedure is right for you is one of the most difficult aspects of the entire cosmetic breast surgery process.

The main two things to consider when choosing an augmentation procedure are the implant placement and the location of the entry incision. Breast implant placement is the actual anatomical site where your prostheses will be surgically inserted within your body and the two most popular placement choices are the submuscular or subglandular. They can be accessed by an incision placed around your nipple, under your breast fold, through your underarm, or through your navel. Deciding between the possible entry incisions and anatomical placement options already gives you many choices to consider when designing an augmentation procedure. Adding the variable of breast implant type makes the process very confusing and that is where Dr. Brent Moelleken M.D., F.A.C.S., can help. Double board certified in cosmetic surgery, by choosing Dr. Moelleken you will experience the most advanced techniques and impeccable attention to detail available today.

It may be argued that fashion is fickle but women have coveted larger breasts for centuries. The first surgical breast augmentation was performed in 1890 using paraffin injections. In 1920 this technique was abandoned in favor of fat transplants in which fatty tissue was surgically removed from the patient’s abdomen and buttocks and transferred into their breasts. In the 1950’s polyvinyl “sacs” were frequently used to achieve fuller, more projected breasts. Although invented in the early 1960’s, it wasn’t until the 1980’s that the silicone implant became popular. Today, the most commonly used implants have a silicone shell but are filled with a salt-water solution known as saline.

While the motivation may vary as to why women seek breast augmentation surgery, some of the more common reasons include:

  • To increase breast size
  • To improve overall body contour, balance, and proportions
  • To achieve an enhanced appearance, size, or definition following pregnancy or weight loss
  • To restore appearance through reconstruction following breast surgery or injury

As with other cosmetic surgery procedures, the most appropriate candidates for breast augmentation surgery are those who are looking for improvement, not perfection.

Breast Lift Facts

Breast lift surgery, technically known as mastopexy, is used to correct what most people call “sagging” breasts. A breast lift may be performed by itself or in conjunction with a breast augmentation and the insertion of breast implants. Whether you need a breast lift, breast augmentation, or a breast augmentation with lift will be determined during your consultation with Dr. Moelleken. He will take specific measurements to determine where your nipple and areola are positioned relative to your breast crease or inframammary fold. He will then use those measurements to determine if fullness can be accomplished with breast implants alone or if a breast lift is also required to help restore your breasts to their youthful appearance.

Types of Breast Sag

Before considering the types of breast lift options, it is good to understand the conditions that require a breast lift.

The three conditions that plastic surgeons consider “sagging breasts” are:

  • Ptosis: This is the medical term for breasts that sag far enough that the nipple and areola are out of position relative to your breast crease.
  • Empty Sac Syndrome: This refers to a breast that has lost fullness due to age, genetics, breastfeeding, etc. The nipple and areola have not fallen in relation to your breast crease.
  • Pseudptosis: Like the Empty Sac Syndrome, pseudoptosis is a condition where your breasts lack fullness. In this case, your breasts may appear full below the nipple but they lack fullness above the nipple.

Types of Breast Lift (Mastopexy)

Dr. Moelleken may determine that you require a breast lift to restore your youthful appearance and if so, the best type for you will be determined by the degree of ptosis exhibited in your breasts.

The types of breast lift procedures include:

  • Crescent Breast Lift: This procedure is also known simply as a crescent lift or a nipple lift. This is a simple breast lift that corrects mild, or Grade I, ptosis. During this surgery, Dr. Moelleken will remove a crescent shaped piece of tissue above your areola before he raises your nipple to a higher position.
  • Benelli Breast Lift: The Benelli breast lift is also known as a Doughnut mastopexy, Circumareola breast lift, and Apex breast lift. The Benelli is typically considered less invasive than other types of breast lifts and it will correct mild to moderate ptosis in the Grade I or Grade II range. Dr. Moelleken will remove a doughnut-shaped piece of tissue from around your areola before re-attaching the remaining tissue to your areola.
  • Vertical Mastopexy Breast Lift: Also known as the Lollipop breast lift, LeJour lift, and Modified Benelli, the Vertical Mastopexy provides more lift than the Benelli for those with moderate or Grade II ptosis. During this procedure, Dr. Moelleken will remove a doughnut-shaped piece of tissue just like in the traditional Benelli breast lift. In addition, he will make a straight incision from under your areola to your breast crease. The Vertical Mastopexy provides more lift than the Benelli, but less than the Full Mastopexy.
  • Full Mastopexy Breast Lift: The Full Mastopexy breast lift is also known as an Anchor lift or the Inverted-T. This breast lift will correct severe Grade III ptosis. In this procedure, Dr. Moelleken will make an anchor-shaped incision that starts at the base of your areola and travels to the bottom of your breast where it meets your ribcage. Dr. Moelleken will cut out a crescent-shaped piece of skin above where your breast meets your rib cage. He will then remove and re-position your nipple so that is sits in a more youthful position.

You may benefit from a breast lift if you have one of the following conditions:

  • The feeling that your breasts sag bothers you
  • Your breasts have lost shape and volume
  • Your breasts have become elongated
  • Your nipples fall below your breast crease
  • Your nipples and areolas point downward
  • You have stretched skin and enlarged areolas
  • One breast is lower than the other


Dr. Moelleken counsels numerous patients on how they can achieve better cleavage when considering a breast augmentation with lift. Increased cleavage is easily attained with this procedure however the outcome depends on the type of cleavage you want. According to the Merriam Webster online dictionary, the word cleavage is derived from the word cleft: usually V-shaped indented formation: a hollow between ridges or protuberances. There are two types of cleavage: Medial cleavage and Upper Pole Fullness. Upper pole fullness is when a patient attains cleavage as a result of their breasts being close together at the upper part of their breasts while Medial cleavage is when they achieve closeness at the midline. With his years of experience, Dr. Moelleken takes great care to give you the exact amount of cleavage you desire.

Breast Augmentation with Lift Procedure

Breast augmentation with lift, or augmentation-mastopexy, is designed to correct the two most common changes that occur in breast appearance following childbirth and pregnancy: loss of breast volume, and the stretching out of your breast skin. The procedure is also commonly performed for major weight loss patients including those who have had bariatric surgery with gastric banding or gastric bypass. Obesity followed by major weight loss usually produces breast changes that are very similar to those seen after successive pregnancies and this effects the breast skin quite severely. While there are patients who can achieve an acceptable cosmetic result from augmentation or mastopexy alone, many have a combination of breast volume loss and skin excess that requires simultaneous augmentation and mastopexy.

Traditionally, surgeons performed breast augmentation and mastopexy surgery in stages; usually mastopexy first followed by augmentation at a later date. Currently, surgeons have adopted a non-staged, single surgery approach to augmentation and mastopexy. The results of simultaneous augmentation mastopexy are as good as or better than a staged approach and patients prefer a single procedure for obvious convenience.

On the day of your surgery, Dr. Moelleken will mark you for your procedure in the standing position so that the ptosis or “sagging” is easily observed. You will then be comfortably anesthetized and surgery will begin. The breast implant or augmentation is performed before the breast lift. The pockets for the implants are created, the implants are placed into the pockets and then you are elevated to a sitting position. This ensures the placement and symmetry of the implants are correct. Once the placement of the implants is within the desired range, Dr. Moelleken will start the breast lift. Depending on the type of lift you are having, the area may be remarked to adjust for the implant volume.

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For the different types of lifts the procedure will occur as follows:

  • Concentric or Benelli – For this type of lift a sized circle marking device is used to create a template for the new areola shape. A larger circle is marked out around the inner circle in a higher position. The skin and tissue are undermined to allow for proper motion. The skin is excised between the two circles and Dr. Moelleken then “connects” the two circles, using a “purse-string” technique to tighten and lift the areola to the new higher position. This technique is excellent to decrease the size of a large areola and provides a lift of the areola complex. This lift will not lift the entire breast and is for minor ptosis or “sagging”. In days past, this technique was aggressively used, with poor results. Many of Dr. Moelleken’s revisional surgeries are conversions of old Benelli repairs to Wise pattern or limited anchor type incisions.
  • Vertical or “Lolipop” – For this type of lift, the same sized circle marking device is used for the new areola shape. A larger circle in a higher position and an elliptical shape that extends down from the areola to the breast crease is then marked out, often referred to as a “keyhole” pattern. Again, the skin and tissue are then undermined to allow for repositioning. When the lower portion is closed at the different levels this pushes and lifts the internal breast tissue and implant up to a higher position. This multilevel closure acts like an internal support bra adding fullness to the top of the breast. The vertical technique reduces the size of a large areola, lifts the areola complex and lifts the entire breast for moderate to minimal ptosis or “sagging”. This technique does not provide enough lift for severe ptosis or “sagging”.
  • Full or Standard – For this technique, again, the circle marking device is used to create a template for the new areola shape. A higher circle, two vertical lines extending down from the circle to a large crescent shape following the lower edge of the breast crease is marked onto the skin. This is often referred to as a “boat-anchor” pattern. All the skin within the markings is excised and tissue around the shape is undermined to allow for proper motion and repositioning. Dr. Moelleken uses a multilevel closing technique providing additional support to the higher, repositioned tissue. This technique provides lift for moderate to severe ptosis or “sagging” of the breast while lifting and reducing the size of the areola.

Most mastopexy procedures create a scar around the border of the areola (called a ‘circumareolar’ scar), a vertical scar from the bottom of the areola to the inframammary fold, and in some cases, a curving scar in the inframammary fold. Dr. Moelleken is very proactive about treating healing surgical incisions in order to reduce the likelihood of a problematic scarring and these methods will be discussed during your consultation. The reality is that many patients will have perfectly acceptable augmentation mastopexy scars without any specific postoperative intervention, but there is no way to identify in advance which patients may develop problem scars.

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120 S Spalding Dr #110 Beverly Hills, CA 90212 | (310) 273-1001

601 E Arrellaga St #103 Santa Barbara, CA 93103 | (805) 898-9299

moelleken plastic surgery logo
120 S Spalding Dr #110 Beverly Hills, CA 90212 | (310) 273-1001
601 E Arrellaga St #103 Santa Barbara, CA 93103 | (805) 898-9299
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