Breast Lift with Implants (Mastopexy and Augmentation) Sydney, Australia

Understanding Breast Lift with Implants

Breast lift with implants, sometimes called augmentation mastopexy, combines two procedures into a single operation. The mastopexy component repositions and reshapes existing breast tissue. The augmentation component adds volume using a silicone implant. The procedures are performed sequentially within the same surgical session, with planning that allows them to work together rather than against each other.

The combined approach is more complex than either procedure alone. Tissue that’s been lifted has different blood supply considerations once an implant is placed beneath it. Implant size and projection have to be chosen so the lifted tissue can drape over the implant without bottoming out or distorting the new shape. The incisions used for the lift influence which implant placement options are practical. Each of these factors gets worked out at consultation, and the approach is genuinely tailored rather than templated.

When Lift Plus Implant Is the Right Approach

The combined procedure is most commonly considered when both of the following are present:

• Volume loss or inadequate native volume that you’d like to address. After pregnancy, breastfeeding, or weight loss, many women find the upper pole of the breast appears flatter and the overall volume reduced. A lift alone cannot return that volume.
• Ptosis (sagging) where the nipple has descended to or below the breast crease. An implant alone cannot lift tissue that’s already sitting below the inframammary fold; it sits high on the chest while the breast tissue continues to hang below it, producing what surgeons call a double bubble or Snoopy nose deformity.

If both elements are present, attempting to address only one usually produces an incomplete result. You either get the position back but the breast still looks deflated, or you get the volume back but the tissue still hangs lower than it should.

Understanding Ptosis: The Regnault Classification

Plastic surgeons use a clinical system called the Regnault classification to describe the degree of breast ptosis. Understanding which category you fall into is the first step in working out what surgical approach suits you.

Pseudoptosis

In pseudoptosis, the nipple sits at or above the inframammary fold but breast tissue hangs below. The shape suggests sagging at first glance, but the nipple itself is well-positioned. Pseudoptosis often looks like volume loss in the upper pole rather than true sagging.

For pseudoptosis combined with volume loss, augmentation alone may be sufficient. A full lift is sometimes more than what’s needed.

Grade 1 (Mild Ptosis)

Grade 1 ptosis means the nipple sits at the level of the inframammary fold. For Grade 1 with volume loss, a periareolar (donut) lift combined with a moderate implant typically works well.

Grade 2 (Moderate Ptosis)

Grade 2 ptosis means the nipple sits below the inframammary fold but remains above the lowest point of the breast. For Grade 2 with volume loss, a vertical (lollipop) lift combined with an appropriately sized implant is the most common approach.

Grade 3 (Severe Ptosis)

Grade 3 ptosis means the nipple sits below the inframammary fold and at or near the lowest point of the breast. For Grade 3 with volume loss, an anchor (Wise pattern) lift combined with an implant is typically required. This is also the situation where a two-stage approach (discussed below) is sometimes considered to reduce surgical risk.

When Lift Alone Is Sufficient

If your breast volume is adequate and you want to address only the position, a lift alone is appropriate. The combined procedure adds surgical complexity, recovery time, and implant-specific risks that aren’t necessary if volume isn’t part of what you want to change. See the breast lift page for detail on lift-alone surgery.

When Augmentation Alone Is Sufficient

If you have volume loss but minimal ptosis (pseudoptosis or borderline Grade 1), augmentation alone may give a more complete result with fewer scars. The implant restores upper pole fullness, and modest tissue redistribution often follows naturally without needing a formal lift. See the breast augmentation page for detail on augmentation-alone surgery.

Combined Post-Pregnancy Procedures

Many women considering breast lift with implants have also been thinking about other body changes that pregnancy produces. Abdominal skin laxity, separation of the rectus muscles (diastasis recti), and stretch marks across the lower abdomen are all common.

Where appropriate, these procedures can be combined into a single surgical plan, sometimes referred to as combined post-pregnancy procedures. Whether to combine them depends on overall surgical time, recovery considerations, and your individual health and circumstances. Dr Turner will discuss combined planning at consultation if it’s relevant to what you’re looking to address.

Implant Selection for Combined Surgery

Implant choice in combined lift-and-implant surgery is more constrained than in augmentation alone. The lifted tissue has to drape over the implant naturally, the incisions limit which implants can be placed easily, and the long-term durability of the lift depends partly on choosing an implant size that the tissue can support.

Brand Choice: Mentor and Motiva

Dr Turner uses Mentor and Motiva implants exclusively in combined surgery. Both are TGA-approved and tracked through the Australian Breast Device Registry (ABDR). Mentor implants have over 35 years of clinical data and a well-established safety profile. Motiva implants use a softer silicone gel and a SmoothSilk surface, with technologies like the Q Inside microchip for traceability.

For combined surgery specifically, the choice often comes down to tissue characteristics. Patients with thinner tissue coverage at the upper pole sometimes do better with the slightly softer feel of Motiva. Patients with adequate coverage may use either brand depending on their preference. The decision is worked through case by case at consultation.

Size Selection

Implant size in combined surgery is typically more conservative than in augmentation alone. The lifted tissue has finite capacity to support implant weight, and oversizing the implant accelerates ptosis recurrence. As a rule, the implant chosen for combined surgery is one that adds meaningful upper pole fullness without overwhelming the skin envelope.

In clinic, we use the same Volume Sizing System used for augmentation, sterile sizers placed inside a sports bra, to give you a sense of what a given volume will look like on your frame. The discussion about size in combined surgery includes a clear explanation of why a slightly smaller implant often produces a longer-lasting result than a larger one.

Shape: Round vs Anatomical

Round implants are used for most combined cases. Modern cohesive gel round implants no longer balloon at the upper pole the way earlier generations did, and they tolerate small amounts of rotation without affecting the result. Anatomical (teardrop) implants can give a particular shape where the lower pole needs more projection than the upper, but they need to stay oriented correctly, and rotation can cause asymmetry that’s harder to correct in lifted tissue.

Profile and Projection

Profile selection in combined surgery considers how the implant will sit within the lifted tissue. Higher profile means more forward projection in a narrower base, which can suit narrower chests. Lower profile spreads the same volume over a wider base. Profile choice in combined surgery often leans slightly lower than in augmentation alone because the lifted tissue benefits from spreading rather than projection.

Surface

Smooth implants are used in the majority of combined surgery cases. Modern textured options like Siltex are classified as microtextured and have a substantially lower long-term safety signal than the recalled macrotextured options of earlier generations. For most patients, smooth is the preferred choice. Textured options are considered when there’s a specific clinical reason.

Why Implant Choice Differs in Combined Surgery

Three factors push implant choice in combined surgery toward more conservative options than augmentation alone:

1. Long-term tissue support. Lifted tissue is doing structural work it didn’t do before surgery. An oversized implant accelerates the gradual descent of that tissue over years.
2. Vascular considerations. The lift has already required careful preservation of blood supply to the nipple-areola complex. Larger implants increase pressure within the breast pocket, which can affect tissue viability in the early healing phase.
3. Skin envelope capacity. The skin has been reshaped to fit a specific volume. Oversizing places tension on the closure that affects scar quality and increases the risk of wound healing complications.

The implant size that makes sense in augmentation alone is rarely the right size in combined surgery. This conversation needs to happen explicitly at consultation rather than be assumed.

Am I a Suitable Candidate?

Suitability for breast lift with implants depends on your anatomy, your physical health, your psychological readiness, your understanding of the scar trade-off that comes with the lift component, and your understanding of the implant-specific considerations that come with the augmentation component.

Anatomical Considerations

You may be a candidate if:

• Your breast development is complete (typically age 18 or older)
• Your nipple sits at or below the inframammary fold (Grade 1 ptosis or greater)
• You have lost breast volume that you’d like to restore, or have always had inadequate native volume
• You have adequate soft tissue coverage to support an implant
• Your skin and tissue quality can support both the lifted shape and the implant weight
• You’re at or near a stable, long-term weight

Pregnancy and significant weight changes after a combined procedure will reduce the durability of both the lift and the implant position. There’s no medical reason to defer surgery if your family is incomplete, but some women prefer to wait until after their final pregnancy to maximise long-term durability.

Lifestyle and Health Factors

You’ll need to be:

• In good general health, with conditions like diabetes well-controlled
• A non-smoker, with smoking and vaping ceased for at least six weeks before and after surgery
• Free of active infection or wound healing conditions
• Realistic about scarring (scar burden is the same as breast lift alone, which is more than augmentation alone)
• Prepared for an extended recovery, particularly with the combined procedure

Smoking and combined breast surgery do not mix. Nicotine constricts the small blood vessels that supply the nipple-areola complex during healing, and the consequences of compromised blood supply include partial or complete loss of the nipple. The risk is higher in combined surgery than in lift alone because tissue has already been mobilised for the lift before the implant adds further pressure to the healing breast.

The Two-Consultation Process and Cooling-Off Period

Since the AHPRA cosmetic surgery reforms came into effect in July 2023, every patient considering cosmetic combined breast surgery must:

1. Obtain a GP referral before the first consultation
2. Attend a minimum of two consultations with Dr Turner before surgery is booked. Dr Turner conducts these consultations personally
3. Undergo a psychological assessment to confirm readiness for surgery
4. Wait at least seven days between your final consultation and your surgery date. This is the cooling-off period mandated by AHPRA.

For combined surgery specifically, the two-consultation process is particularly important. The decision involves more variables than either procedure alone, and the trade-offs benefit from time to consider rather than a same-day commitment.

How Is Combined Surgery Performed?

Breast lift with implants is performed under general anaesthetic in a fully accredited private hospital, with a specialist anaesthetist providing care throughout. The combined procedure typically takes between 3 and 5 hours depending on the lift incision pattern and implant placement chosen. This is meaningfully longer than either procedure alone.

Most patients are discharged the same day. Some prefer an overnight stay and that’s available, particularly given the longer surgical time and combined recovery considerations.

Incision Pattern Options

The incision pattern for combined surgery follows the same logic as breast lift alone, with the addition that the chosen pattern also influences how the implant is placed.

Periareolar (Donut / Benelli)

The periareolar lift uses a single incision around the border of the areola. Suited to mild ptosis (Grade 1) when combined with a moderate implant. The scar hides well in the natural pigment transition, but the small incision limits the implant size that can be placed comfortably through this approach.

Vertical (Lollipop / Lejour)

The vertical lift uses incisions around the areola and a vertical line down to the inframammary fold. Suited to moderate ptosis (Grade 2) combined with an implant. The vertical incision provides good access for implant placement and produces a result with well-preserved breast shape.

For most Grade 2 patients having combined surgery, the lollipop pattern represents the best balance of result, scar burden, and implant access.

Anchor (Wise Pattern)

The anchor lift uses three incisions: around the areola, vertical to the inframammary fold, and horizontal along the inframammary fold itself. Suited to severe ptosis (Grade 3) combined with an implant. The anchor pattern provides the most extensive access for both tissue work and implant placement, and is the only approach that consistently corrects severe ptosis at one operation.

The trade-off is the most extensive scar pattern of the three. For patients with Grade 3 ptosis combined with volume loss, anchor pattern is typically the right answer despite the scar burden, because attempting to correct severe ptosis with a smaller scar pattern produces less satisfactory results and more revision surgery.

Implant Placement

In combined surgery, dual plane placement is used in the majority of cases. The upper portion of the implant sits beneath the pectoralis major muscle, providing additional soft tissue coverage at the upper pole. The lower portion sits behind breast tissue alone, which produces more natural lower pole behaviour and allows the lifted tissue to drape over the implant correctly.

Subglandular placement (above the muscle) is used less commonly in combined surgery because it provides less coverage at the upper pole and can produce more visible implant edges in lifted tissue. Submuscular placement (entirely beneath the muscle) is rarely used in combined surgery because it doesn’t allow the lower pole tissue to drape correctly over the implant.

The Internal Bra Technique

The Internal Bra is particularly valuable in combined surgery. The lifted tissue is doing structural work above an implant that adds weight and pressure to the lower pole. Without internal reinforcement, the combination accelerates the gradual descent of tissue over years.

By adding an absorbable mesh or biological scaffold during the combined procedure, the lifted shape is supported from inside. The scaffold integrates with surrounding tissue over 12 to 18 months and is gradually absorbed, leaving behind reinforced collagen structure that maintains the new position for longer.

For combined surgery, the Internal Bra is recommended in the majority of cases rather than the minority. The mechanical demands on the lifted tissue plus implant arrangement genuinely benefit from internal support. Dr Turner discusses Internal Bra suitability case by case at the planning stage, but the threshold for using it in combined surgery is lower than in lift alone.

Sequence of Surgical Steps

The combined procedure runs through a defined sequence:

1. Pre-operative marking with the patient awake and standing
2. General anaesthesia and antiseptic preparation
3. Incision based on the chosen lift pattern
4. Mastopexy component: tissue mobilisation, nipple-areola complex repositioning on its superomedial pedicle
5. Pocket dissection for implant placement (dual plane)
6. Triple antibiotic pocket irrigation
7. Implant placement using the Keller Funnel for no-touch insertion
8. Internal Bra placement where indicated
9. Tissue redistribution and reshaping over the implant
10. Layered closure with absorbable sutures
11. Surgical bra application in theatre

The sequence matters because it’s designed to minimise tissue handling and bacterial contamination at each stage. ABDR registration completes the implant tracking process for long-term safety surveillance.

One-Stage vs Two-Stage Approach

Most combined surgery is performed as a single one-stage procedure, where lift and implants are placed in the same operation. This is the standard approach because it produces a defined endpoint with a single recovery period.

A two-stage approach (lift first, implants several months later, or implants first followed by a lift) is occasionally considered when:

• Severe ptosis combined with thin tissue creates an unacceptable risk of nipple-areola complex compromise from a single-stage procedure
• The patient is unsure about implants and prefers to assess the result of lift alone before deciding
• A previous failed combined procedure has produced tissue compromise that requires staged correction

For most patients, one-stage produces the cleaner long-term result with one recovery rather than two. Two-stage adds total recovery time, total cost, and prolongs the period between surgery and final settled result. Dr Turner discusses staging at consultation when the clinical situation warrants.

Dr Turner’s Surgical Protocol

Several elements are followed for every combined breast lift with implant procedure Dr Turner performs:

1. Pre-operative IV antibiotics by the anaesthetist
2. Antiseptic skin preparation with chlorhexidine
3. Precise marking of incision lines and new nipple position while the patient is awake and standing
4. Preservation of the superomedial pedicle to maintain nipple-areola blood supply
5. Triple antibiotic pocket irrigation with cefazolin, gentamicin, and povidone-iodine
6. Glove change and re-prep before implant handling
7. Keller Funnel insertion of the implant for no-touch placement
8. Internal Bra placement where indicated (most combined cases)
9. Tissue reshaping over the implant with internal sutures
10. Layered closure with absorbable sutures
11. Surgical bra application in theatre
12. ABDR registration for long-term implant tracking

What you should look for in any surgeon you consult is consistency: someone who can articulate exactly what they do at each stage and why, particularly for combined surgery where the protocol is more involved than either procedure alone.

Recovery and Aftercare

Recovery from combined breast surgery is more involved than either procedure alone. The actual surgery is between 3 and 5 hours. The recovery is a phased process that runs across several months, slightly longer than breast lift alone because two procedures are healing simultaneously.

First Week

The first 48 to 72 hours are the most uncomfortable. You’ll experience tightness across the chest from both the lifted tissue and the muscle work for implant placement, soreness around the incisions, and significant swelling. Pain is typically managed with prescription medication for the first 5 to 7 days, then over-the-counter analgesia.

You’ll need someone at home with you for at least the first 24 to 48 hours. No driving for at least 10 days, longer if you’re still taking opioid pain medication. Sleeping on your back with your head elevated on two or three pillows is recommended for the first three weeks.

A surgical bra is worn 24/7 from theatre, removed only briefly for showering after day 3.

Weeks 2 to 6

Most patients return to office-based work after 14 days, slightly longer than breast lift alone. Heavier lifting (over 5kg), upper body exercise, and any activity that engages the pectoral muscle is restricted for eight weeks rather than the six recommended for breast augmentation alone.

Swelling subsides progressively. The breast shape continues to settle and refine through this phase. The high, tight appearance immediately after surgery softens as the tissue relaxes and the implant settles into its final position.

Long-Term Settling

Final shape settling continues for 6 to 12 months as scars mature, tissue softens, and the implant settles fully (drop and fluff). The lifted shape and the implant position both find their long-term equilibrium during this period.

The lifted shape continues to be supported by the Internal Bra (if placed) for 12 to 18 months as the scaffold integrates with tissue. After that point, the long-term result is what you’ll see going forward, with gradual softening over years as is normal for any breast surgery result.

Scar Management

Scars on the breast typically take 12 to 18 months to mature. During that time:

• Silicone scar therapy (gel or sheet) starting at 3 weeks post-op
• Sun protection over the scar for 12 months
• Massage techniques as instructed at follow-up
• Laser scar treatment may be available if scars become hypertrophic

Dedicated scar care is more important after combined surgery than after most other procedures because the visible scar burden is the same as breast lift alone. The investment in daily silicone therapy and sun protection over 12 months produces visibly better long-term scars than no intervention.

Return to Work and Exercise

Follow-up appointments are scheduled at 1 week, 1 month, 3 months, 6 months, and 1 year, all in person at the Sydney clinic.

Risks and Complications

Combined breast surgery carries the risks of both component procedures plus risks specific to the combined approach. Understanding these is essential before any decision is made.

General Surgical Risks

These apply to any surgery performed under general anaesthetic:

• Adverse reaction to anaesthetic agents
• Infection at the incision site
• Bleeding or haematoma formation
• Wound healing problems
• Deep vein thrombosis (rare with appropriate prevention)

Combined Procedure-Specific Risks

• Scarring concerns: scars are permanent. Some patients heal with thin, fine scars that fade well. Others develop hypertrophic or keloid scars that remain raised and visible. The scar burden is the same as breast lift alone, which is more than augmentation alone.
• Capsular contracture: scar tissue around the implant tightens, causing firmness, distortion, and sometimes pain. Combined surgery has slightly higher capsular contracture rates than augmentation alone, around 6 to 8% over 10 years versus 5% for augmentation alone.
• Recurrence of ptosis: lifted tissue with an implant beneath has more mechanical demand than lifted tissue alone. Some recurrence over a 10 to 15 year window is normal. The Internal Bra technique reduces but does not eliminate this risk.
• Implant malposition: the implant settles in the wrong position. May require revision surgery. Combined surgery has slightly higher malposition rates than augmentation alone because the lifted tissue is healing simultaneously.
• Bottoming out: the implant gradually descends below the breast crease over time. More common in combined surgery than augmentation alone, which is why Internal Bra technique and conservative implant sizing both matter.
• Changes in nipple sensation: approximately 15 to 20% of patients experience some change. Most resolves over 12 months. Permanent change occurs in around 10% of cases. Higher than augmentation alone because of the nipple-areola repositioning.
• Loss of nipple-areola complex: rare with the superomedial pedicle technique, but a recognised risk particularly in smokers or patients with severe ptosis requiring extensive repositioning. The risk is slightly higher in combined surgery than in lift alone.
• Implant rupture: silicone implants can rupture from trauma or over time. Modern cohesive gel means leakage is contained within the capsule rather than dispersing.
• Effects on breastfeeding: approximately 15 to 20% of women report reduced milk supply after combined surgery, similar to breast lift alone.
• Need for revision surgery: approximately 15 to 20% of combined surgery patients undergo revision surgery within 10 years, slightly higher than either procedure alone because the combined surgery has more potential failure points.

How Dr Turner Reduces Risk

Risk reduction is built into the surgical protocol:

• Triple antibiotic pocket irrigation reduces capsular contracture rates
• Keller Funnel placement reduces bacterial contamination of the implant surface
• Smooth implants are used preferentially based on long-term safety data
• Superomedial pedicle technique preserves nipple-areola blood supply and sensation
• Internal Bra placement supports long-term durability for combined surgery (most cases)
• Conservative implant sizing reduces mechanical demand on lifted tissue
• Smoking cessation is required for at least six weeks before and after surgery
• Patients are screened for risk factors before surgery (weight stability, condition control)
• ABDR registration provides traceability if any future safety signal emerges with a specific implant model

No surgeon can eliminate risk, particularly for combined surgery. What we can do is apply each evidence-based step that reduces it.

Long-Term Considerations

Durability of Combined Results

The durability of breast lift with implants is generally similar to either procedure alone, though the combined nature means more variables affect long-term results. Most well-performed combined procedures maintain meaningful improvement in shape, position, and volume for 10 to 15 years or longer, with gradual softening over time.

Several factors influence durability:

• Weight stability (significant fluctuation accelerates ptosis recurrence and implant position changes)
• Future pregnancies (pregnancy stretches breast tissue regardless of surgical history)
• Daily bra support (consistent support, particularly during exercise, reduces tissue strain)
• Implant size (larger implants accelerate ptosis recurrence)
• Skin and tissue quality (genetics matter)
• Internal Bra reinforcement at the time of surgery (most combined cases)

Implant Replacement and Future Surgery

Modern silicone implants do not have a fixed expiry date. The historical 10-year replacement myth has been replaced with monitoring-based recommendations: regular review, MRI or ultrasound surveillance from 5 to 6 years onwards as recommended by the FDA, and replacement only when clinically indicated.

For combined surgery patients, the question of future surgery sometimes arises around the 10 to 15 year mark, not because the implant has reached an expiry but because gradual changes in tissue or implant position may benefit from revision. This is the exception rather than the rule, and many patients keep the same implants and overall result for 15 to 20 years or longer.

Consult with Dr Scott J Turner in Sydney

Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at his Bondi Junction and Manly clinics in Sydney. Surgery is performed at accredited private hospitals in Sydney, including Bondi Junction Private Hospital, Delmar Private Hospital in Dee Why, and East Sydney Private Hospital.

Every consultation is conducted personally by Dr Turner. There are no patient representatives or coordinators standing in for the surgeon. A minimum of two consultations is required before any surgery is booked, in line with AHPRA requirements. Consultations are unhurried, focused on careful clinical assessment, and structured around honest discussion of what surgery can and cannot achieve in your specific situation.

If you’re considering breast lift with implants, the next step is to obtain a GP referral and book an initial consultation. Contact the practice on [email protected] or via the contact page to begin the process.