Breast Lift (Mastopexy)
A breast lift (mastopexy) is a cosmetic procedure to remove loose skin and restore a youthful shape and position to breasts that have stretched or sagged over time. Breast tissue is not removed to a significant degree. Skin is removed and the breast tissue is repositioned to improve the position of the nipples and create a rounder and more aesthetically pleasing breast shape. Asymmetries between the breasts can also be addressed during a breast lift.
Who is a candidate?
A breast lift is done for a woman who is happy with the current size/volume of her breasts but dissatisfied by sagging and a loss of the round shape. It can be performed in combination with an implant for patients who desires larger, fuller breasts - this is called an Augmentation Mastopexy. Likewise, a breast lift can also be done to tighten and reshape the remaining breast tissue in individuals seeking to remove their implants.
Breasts may sag for a number of reasons:
- Aging and natural loss of skin elasticity- These factors are often affected by heredity
- Pregnancy and breastfeeding
- Changes in weight
- Breast Implants
The changes typically seen vary from person to person. The breast is composed of varying amounts of glandular and fatty tissues. These may soften and deflate after breastfeeding or with age. The skin can thin and lose its elastic capacity to spring back. The areolae may widen and spread as the breast stretches. Breast lifting techniques are tailored to address these specific changes and must be selected based on the individual circumstances.
There are so many variations and techniques that have been described to accomplish the same goals: elevated nipple position, smaller and rounder areolae, elimination of redundant skin, and improved shape. Many surgeons describe a proprietary or brand of lift that they utilize, but all are variations on the same basic plastic surgical principles. The location of the incisions will determine the final scars.
- Circumareolar- Also called a Benelli-type, or” doughnut” lift, this type of lift uses an incision around the nipple and areola to remove excess skin and to reposition the nipples. It provides a limited lift and should be used only for minor skin excess. Aggressive lifting using this technique can result in a widened and irregularly shaped areola that can be difficult to fix.
- Vertical- The vertical or “lollipop” lift is a more extensive lift that takes the incision around the areola and extends it toward the inframammary crease of the breast. There are several variations of this procedure and it can be extended into the crease as a “J” extension.
- Wise Pattern- This is often called an “anchor pattern” or inverted “T” lift and is the most common lift for patients with excess skin in both vertical and horizontal directions. The lift is extended into the inframammary crease towards the midline and out toward the armpit depending on the degree and severity of skin excess.
- Augmentation Mastopexy- Combines a lift with an implant to reposition the nipple/breast and enhance the fullness of the upper breast.
- Mastopexy with Implant Removal +/- Fat Grafting- Patients wanting removal of their implant may opt for a lift to correct the resulting deflation from the stretched-out skin. In some instances, fat may be used to restore some volume without replacing an implant.
Typical Recovery: Surgery is done on an outpatient basis- an overnight stay is not required. Pain and discomfort are minimal. Medication is administered during the surgery to facilitate recovery and minimize discomfort. Patients are given a prescription for oral pain medication, which is typically used during the first few days following surgery. A bra is typically placed immediately after surgery to provide support and to help with swelling. Activity is restricted during the first week to allow the incision time to heal. Exercise and heavy lifting may be limited for several weeks.
Risks of Breast Lift Surgery: As in any surgery, cosmetic surgery carries with it certain risks. The risk of pain, bleeding, infection, and reactions to anesthesia may occur. There are risks specific to breast lifting that include the risk of changes in nipple sensation(numbness), interference with breast feeding, asymmetry, and insufficient upper pole fullness. Every patient has a baseline amount of asymmetry related to the width of the chest, underlying rib cage and even breast and skin quality. These asymmetries can carry into and affect the final result.
The skin may continue to stretch even after the procedure has healed resulting in some degree of relapse. This depends on the quality of the skin and whether an implant is being placed.
All lifts carry a risk of injury to the nipple. This risk is increased in those who have previously had a lift or in situations where the circulation to the skin is impaired, such as in patients who use nicotine or have other medical conditions.