Breast Lifts or Mastopexy are performed to improve the look of sagging breasts. This ptosis (sag) can be due to a number of factors- ageing,effects of gravity, pregnancy and breast feeding and genetics. They may be performed with or without the use of implants to achieve the desired results.
Minor sag can be improved with implants however the general rule is that if the nipple has sagged below the breast crease level then a lift is necessary to improve the positioning of the nipple.
A quick test involves putting a pencil underneath the breast fold and looking in the mirror. If the nipple sits on or below the line of the pencil you may be a candidate for this procedure.
There are several diferrent types of lifts performed
The full breast lift involves an incision along the crease underneath the breast, incisions around the areola, and a vertical incision between the areola and the base of the breast. This incision is sometimes called an anchor incision or inverted T. This traditional technique is widely used because it consistently produces the desired shape and position of the breast on the chest wall. In this technique, excess skin is removed, the breast is elevated and frequently, the size of the areola is reduced. This approach allows maximal change to the breast.
Below shows the incisions. The left shows the end scar, and the right shows the area of skin removed.
The scars fade over time but remain visible in most cases
Modified or limited breast lifts were developed to produce the intended results with less scarring.
These techniques use fewer incisions. The potential drawback is that there can be less change made to the breast’s shape. Modified mastopexies are frequently done together with breast augmentation.
A popular form of the modified breast lift is the Benelli breast lift, otherwise known as the concentric mastopexyor donut lift. In this procedure, a ring of skin is removed from around the areola, limiting the scar to this area.
Below shows the incisions. The left shows the end scar, and the right shows the area of skin removed.
A modified version is the crescent lift. This technique also removes a ring of tissue from around the areola, but more tissue is taken from the area above the areola, raising the nipple and areola on the chest wall. Below shows the incisions. The left shows the end scar, and the right shows the area of skin removed.
Another technique, the lollipop lift involves an incision around the nipple and areola, with a vertical scar extending to the crease underneath the breast.
Below shows the incisions. The left shows the end scar, and the right shows the area of skin removed.
Another variation involves the “donut lift” together with the removal of excess skin from underneath the breast.
The best candidates for breast lift
Breasts of any size can be lifted, but the results may not last as long in heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn’t interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.
Mastopexy does leave noticeable, permanent scars, although they’ll be covered by your bra or swim suit.
In some cases poorly healed wounds can remain open and unhealed for some time. Poor healing and wider scars are more common in smokers. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
Planning your surgery
In your initial consultation, it’s important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient–and every physician, as well–has a different view...
The surgeon will examine your breasts and measure them while you’re sitting or standing. He or she will discuss the variables that may affect the procedure–such as your age, the size and shape of your breasts, and the condition of your skin–and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they’ll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He or she should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.
Preparing for your surgery
Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery. You’ll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Breast lifts are usually performed under general anesthesia, which means you’ll sleep through the operation. In selected patients–particularly when a smaller incision is being made–the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and will feel minimal discomfort.
Mastopexy usually takes one and a half to three and a half hours.
If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
After your surgery
After surgery, you’ll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon. Generally drains (long, thin, flexible, plastic tubes) are placed during surgery to help remove any excess fluid from the breasts. These are usually removed the following day or soon after surgery.
Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.
Compression bras help to aid in the healing process by supporting the wound and breast. They are designed to give you the best post-operative outcome and encourage blood flow to the tissues. Some surgeons prefer patients to wear it night and day, others may reccommend something different. Make sure you discuss this with your surgeon prior to surgery.
You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting back to normal
Healing is a gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don’t hesitate to call your surgeon. These might include fever or large lumps/clots under the skin.
Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly.
Your new look
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear low-cut tops.