Breast Lift Surgery (Mastopexy) with Implants

Augmentation mastopexy (a breast lift with implants) is priced per patient, not from a list. What changes the figure is how much skin has to be removed, which lift pattern is used, the implant selected, how long you are under anaesthetic, whether the operation is done in one stage or two, and whether you stay overnight.

You will receive a written, itemised quote after your consultation, before any surgery date is confirmed. It separates the surgeon’s fee, the anaesthetist’s fee, the surgical assistant’s fee, the hospital fee, implants, garments and the follow-up appointments included. A cooling-off period applies before booking, as required for cosmetic surgery in Australia. If the operation is staged, you will be quoted for both stages up front so there is no surprise at the second.

A GP referral is required.

Medicare does not cover a breast lift performed with implants. Item 45558 covers correction of bilateral breast ptosis by mastopexy, but it specifically excludes any procedure in which a breast prosthesis is inserted. This matters for your out-of-pocket cost: with no Medicare item, your private health fund will not contribute to the hospital admission either, because funds follow the Medicare item. If you are comparing a lift alone against a lift with implants, this is a real difference in what you pay, and it is worth raising at consultation.

This is the most common question at consultation, and the honest answer is that it depends on which problem you are actually trying to solve. Position and volume are two different things.

A lift (mastopexy) changes position. It removes excess skin and repositions the breast tissue and the nipple–areola complex higher on the chest wall. It does not add volume. In fact, because skin is removed and the breast is tightened, some patients feel their breasts look slightly smaller afterwards even though nothing has been removed.

An implant adds volume, particularly in the upper part of the breast, which is where volume is often lost after pregnancy, breastfeeding or significant weight loss. An implant on its own will not lift a breast that sits low; it fills the existing envelope and can make a droop more obvious rather than less.

So the question is not which procedure is better. It is whether you want position corrected, volume restored, or both. If it is both, augmentation mastopexy combines them — at the cost of a more complex operation with a higher rate of revision surgery than either procedure performed alone, and no Medicare rebate.

There is a third option worth knowing about: a lift combined with fat grafting rather than an implant. This adds a more modest amount of volume using your own fat, avoids an implant and the lifelong possibility of implant-related revision surgery, but requires enough donor fat and gives a smaller, less predictable volume increase. Dr Kumar will tell you which of these he thinks is realistic for your anatomy, including when he thinks none of them will give you what you are describing.

Every breast lift leaves permanent scars. That is the trade-off patients are really weighing up, so it is worth being specific about where they go. The pattern is chosen from how much skin has to come out and how far the nipple–areola complex has to move — not from preference, and a smaller scar pattern cannot correct a larger amount of droop.

1) Vertical (short scar or “lollipop”)
Around the nipple–areola complex and vertically down to the inframammary fold, occasionally with a short horizontal extension along the breast crease. A more limited scar pattern, suitable for moderate amounts of excess skin.

2) Inverted T (anchor or Wise pattern)
Around the nipple–areola complex, vertically down to the fold, then horizontally along the breast crease. A longer scar pattern, generally required where there is a greater degree of excess skin — which is commonly the case after significant weight loss.

3) Benelli (periareolar)
An incision around the areola only, reducing areolar skin while lifting the breast. Suitable for small amounts of lift and sometimes combined with implant placement.

4) Crescentic (mini lift)
Limited to the upper half of the areola, used in specific clinical situations where only a very small change in nipple position is required.

Scars usually sit within the bra and swimwear line, but they are permanent, they take 12 to 18 months to fade and settle, and healing varies — some people form thickened, raised or pigmented scars. Smoking, diabetes and higher BMI all make wound healing problems more likely, and the junction of the vertical and horizontal limbs of an inverted T is the point most prone to delayed healing. Dr Kumar will mark the expected pattern on you at consultation so you can see where the scars will fall before you decide.

In most breast lifts the nipple–areola complex stays attached to the underlying breast tissue and its blood supply, and is moved up on that tissue rather than detached. The size of the areola is usually reduced at the same time, since a stretched areola is part of what patients dislike.

Sensation. Altered nipple sensation is common in the first weeks to months and usually recovers. A proportion of patients are left with permanently reduced sensation, and a smaller number with increased sensitivity or numbness that does not fully return. This risk rises with the amount of lift required and with larger implants, because the nerves are stretched further. There is no technique that eliminates it.

Breastfeeding. Because the nipple stays connected to the underlying ducts and tissue in a standard lift, many women are able to breastfeed afterwards — but it cannot be guaranteed, and some women who have never had surgery are also unable to. If you are planning a pregnancy, it is worth saying so at consultation: pregnancy and breastfeeding will change the breast again, and some patients prefer to wait.

Free nipple graft. Rarely, where the degree of ptosis is very marked — which does occur after major weight loss — the nipple–areola complex has to be removed and replaced as a graft. This reliably loses sensation and the ability to breastfeed, and the colour of the grafted areola can change. Dr Kumar would discuss this with you before surgery if he thought it was likely in your case; it is not something decided on the day without warning.

Yes, and it is a common reason for seeing a plastic surgeon. Implants do not stop the breast ageing. Over time the skin and the supporting tissue stretch under the weight of the implant, and the breast tissue can slide down over it — so a patient who had an augmentation ten or fifteen years ago may now need a lift, a change of implant, or both.

At consultation Dr Kumar will want to know when the implants were placed, what they are, whether you have the implant card or operation record, and whether anything has changed — firmness, shape, discomfort, or a difference between the two sides. Depending on findings, an ultrasound or MRI may be requested, particularly if the implants are older or a rupture is suspected.

The options are usually one of: a lift around the existing implants; implant exchange with a lift; or removal of the implants with a lift and, in some patients, fat grafting to replace some of the lost volume. Explantation with a lift has become a more frequent request, and it is a reasonable choice — but the result depends heavily on how much breast tissue is left and how stretched the skin is, and it will not look like the breast before the implants were ever placed.

Revision surgery on an already-operated breast carries a higher risk of wound healing problems and of nipple blood supply problems than first-time surgery, because the previous operation has already interrupted some of the blood supply. That is the main reason Dr Kumar sometimes recommends staging a revision rather than doing everything in one operation.

Augmentation mastopexy can be performed in one operation or staged as two, and this is one of the more important decisions made at consultation.

The reason it is not always done in one sitting is that the lift and the implant pull in opposite directions. The lift tightens the skin envelope; the implant expands it. Combining both at maximum in a single operation puts tension on the wound and on the blood supply to the nipple–areola complex, which is what drives the higher revision rate this operation has compared with a lift or an augmentation performed alone.

Where Dr Kumar judges that risk to be significant — a large amount of excess skin, poor skin quality, a previous operation on the breast, a smoking history, or substantial weight loss — he may recommend staging: the lift first, then the implant at a second operation once the tissues have healed and settled. That means two operations, two anaesthetics, two recovery periods and two sets of fees, quoted up front. The trade-off is a lower risk of wound healing and nipple blood supply complications, and a more predictable final shape.

Recovery. Surgery is performed under general anaesthesia by a specialist anaesthetist in an accredited private hospital. A single-stage procedure usually involves an overnight stay; a second-stage implant is often day-only. Expect soreness, swelling and bruising for the first one to two weeks, a support bra worn day and night for around six weeks, and no strenuous exercise, heavy lifting or overhead work for about six weeks. Many patients doing desk-based work return after two weeks. Shape continues to settle for three to six months, and scars for 12 to 18 months.

Risks. As well as the general risks of surgery and anaesthesia, this operation carries risks of wound breakdown, infection, bleeding, altered or lost nipple sensation, partial or complete loss of the nipple–areola complex, asymmetry, implant-related problems including capsular contracture, rupture, malposition and BIA-ALCL, and the need for revision surgery. Breast implants are not lifetime devices. These are discussed in full at consultation and in the risks section of this page.

Current evidence does not indicate that a breast lift (mastopexy) changes a person’s risk of developing breast cancer, and breast augmentation has not been shown to increase that risk either.

Screening is a different question. Because breast tissue is repositioned and in some cases partially removed, a new baseline mammogram is generally recommended around 12 months after surgery, so that future scans are compared against your post-operative anatomy rather than your pre-operative one. Tell the radiographer you have had breast surgery and, if you have implants, that you have implants — additional implant displacement views are used so that more of the breast tissue is seen. Implants can obscure some tissue on a standard mammogram, so this matters.

Surgery can also produce benign changes such as scar tissue, fat necrosis and calcifications that show up on imaging and occasionally prompt further views or a biopsy. This is a recognised consequence of any breast surgery rather than a sign of a problem, but it is a reason to keep your operation records.

Continue with BreastScreen NSW or your usual screening schedule as advised by your GP. Surgery is not a reason to stop screening.

Most people take about two weeks off work, then gradually return to most activities over the following four weeks. Lifting and exercise are built up after the six-week review, and most patients are cleared for full activity at 12 weeks.