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Breast Lift / Mastopexy

What is this procedure?

A breast lift, also known as mastopexy, raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. It is a surgical procedure performed by a plastic surgeon to change the shape of your breasts. During a breast lift, excess skin is removed and breast tissue is reshaped to raise the breasts.

Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well.

A breast lift can rejuvenate your figure with a breast profile that is more youthful and uplifted. A woman's breasts often change over time, losing their youthful shape and firmness. These changes and loss of skin elasticity can result from: Pregnancy, Breastfeeding, Weight fluctuations, Aging, Gravity, Heredity.

You might choose to have a breast lift if your breasts sag or your nipples point downward. A breast lift might also boost your self-image and self-confidence.

What is the advantage of this procedure?

Improved self-confidence: For many women, drooping breasts (whether due to aging or pregnancy and nursing) may make them feel insecure about the shape of their body. A breast lift procedure can restore their breasts to a fuller, perkier shape.

More youthful appearance: Breasts that have become droopy due to age may make patients look and feel older than they would like. Undergoing a breast lift procedure may make women feel more youthful and attractive.

A finishing touch after weight loss: Patients who have worked diligently to improve the shape of their body through regular exercise and a sensible diet may be surprised to find that their skin may not automatically conform to their new body shape. They may be unhappy with loose, flabby skin. Because the breasts may be one of the first places to show dramatic weight loss, they may also droop. A breast lift procedure allows patients to proudly show off the results of their hard work with rejuvenated, youthful breasts.

Ability to breast feed following a breast lift: Because the incisions to move the areola and nipple do not interfere with the breast’s milk glands and ducts, patients will be able to breast feed even after undergoing breast lift surgery.

Fuller appearance without augmentation: A breast lift procedure may make the breasts look as though they have been augmented, when in fact they have just been raised to produce a firmer, fuller appearance. This may be beneficial for patients who do not wish to undergo a breast augmentation procedure.

Who needs this procedure?

You may be a candidate for breast lift surgery if:

  • You are physically healthy and maintain a stable weight
  • You do not smoke
  • You are bothered by the feeling that your breasts sag or have lost shape and volume
  • Your breasts have a flatter, elongated shape or are pendulous
  • When unsupported, your nipples fall below the breast crease
  • Your nipples and areolas point downward
  • You have stretched skin and enlarged areolas
  • One breast is lower than the other

Breast Changes

As you get older, your breasts change — losing elasticity and firmness. There are many causes for these kinds of breast changes, including:

Pregnancy. During pregnancy, the ligaments that support your breasts might stretch as your breasts get fuller and heavier. This stretching might contribute to sagging breasts after pregnancy — whether or not you breast-feed your baby.

Weight fluctuations. Changes in your weight can cause your breast skin to stretch and lose elasticity.

Gravity. Over time, gravity causes ligaments in the breasts to stretch and sag.

A breast lift can reduce sagging and raise the position of the nipples and the darker area surrounding the nipples (areolae). The size of the areolae can also be reduced during the procedure to keep them in proportion to the newly shaped breasts.

Your breasts sag — they've lost shape and volume, or they've gotten flatter and longer
Your nipples — when your breasts are unsupported — fall below your breast creases
Your nipples and areolae point downward
Your areolae have stretched out of proportion to your breasts
One of your breasts falls lower than the other

Breast-feeding is a consideration as well. Although breast-feeding is usually possible after a breast lift — since the nipples aren't separated from the underlying breast tissue — some women might have difficulty producing enough milk

While a breast lift can be done on breasts of any size, women with smaller sagging breasts will likely have longer lasting results. Larger breasts are heavier, which makes them more likely to sag again.

Are there non-surgical treatments?

InMode’s BodyTite is an FDA approved device can lift and firm breasts without leaving any scars. By delivering bipolar radio-frequency (RF) energy to the skin’s surface and underlying tissues, it tightens skin and ligaments, builds collagen, and liquefies fat, leaving breasts newly pert. BodyTite uses a tiny internal cannula (an ultrathin rod), which is inserted into various points on the breast—at the fold and around the areola—to safely and precisely heat the area from the inside out, not just the outside in. As the cannula moves through the breast, a small round electrode traces its path on the surface of the skin, concentrating that rejuvenating RF energy between the two parts of the device.

The one- to three-hour procedure (larger breasts take longer) is typically done under local anesthesia or IV sedation, and is considered to be minimally invasive. Though patients can go back to work the same day, some doctors recommend lying low for a few days to ride out the discomfort. You can expect up to two weeks of bruising and swelling, as well as temporary redness and tenderness.

Non-surgical breast lifts are a little different from augmentations. This procedure involves the use of a high definition diffused laser light called Coolbeam. The laser light is absorbed by the water in the skin cells around the breast tissue.

The best candidates for non-surgical breast lift are women who are physically healthy, psychologically stable, and realistic in their expectations. Most clients are 30 or older, but if sagging is a problem earlier on, you can still opt to have this procedure at a younger age.

And the nearly non-existent recovery time makes this treatment worth it. There is some temporary redness and swelling for the first few days, but you can go back to work immediately.

The disadvantage, of this option compared with a traditional breast lift is that the amount of lifting is limited to a few centimeters. Also this non-surgical treatment can not address heavy breasts.

The results of non-surgical breast lifts are long-lasting and range from three to five years, or longer. As with similar subtle procedures, you will still look like yourself, only better. The skin will appear softer and firmer after each treatment.

What is the surgical treatment like local or sedation?

Anesthesia is an essential part of any surgical procedure and must be performed safely. For breast lift surgery, you may choose among several options. General anesthesia is the deepest form of anesthesia. You are asleep, feel no pain, and will not remember the procedure. This is the type of anesthesia that is recommended for more extensive procedures and those involving the placement of breast implants.

An intermediate form of anesthesia, the laryngeal mask airway (LMA), is a relatively new technique. This technique is similar to twilight sleep in that you are breathing on your own, but the method of sedation differs. With an LMA, you actually breathe anesthetic gases administered by the anesthesiologist, rather than receive intravenous sedation via your intravenous line. These anesthetic gases cause you to sleep during the procedure. At the completion of the procedure, the gases are turned off and you wake up from your sleep. You will feel no pain, and you will not remember the procedure.

Deep intravenous sedation, also called twilight sleep, is a combination of local anesthetic administered at the surgical site and intravenous sedation administered by the anesthesiologist. You breathe for yourself, but you are in a deep sleep throughout the procedure. You should feel no pain, and you should not remember the procedure. This is the most common type of anesthesia used for breast lift surgery.

If you need only a very minor lift, this may be performed with local anesthetic injected at the surgical site with or without the addition of an oral sedative. You will be awake for the procedure and will remember it, but you will feel no pain because of the use of local anesthetics at the surgical site.

How long does it take?

Techniques used to remove breast skin and reshape breast tissue vary. The specific technique your plastic surgeon chooses will determine the location of the incisions and the resulting scars.

Your doctor might make incisions:

  • Around the areolae — the darker area surrounding the nipples.
  • Extending downward from the areolae to the breast creases.
  • Horizontally along the breast creases

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

There are three common incision patterns:
Around the areola
Around the areola and vertically down from the areola to the breast crease
Around the areola, vertically down from the breast crease and horizontally along the breast crease

Step 3 – Reshaping your breasts

After your doctor makes the incisions:
The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
The nipple and areola are repositioned to a natural, more youthful height.
If necessary, enlarged areolas are reduced by excising skin at the perimeter.
Excess breast skin is removed to compensate for a loss of elasticity.

Step 4 – Closing the incisions

After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed. Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time. Many women desire the smallest scar possible. However, your plastic surgeon will recommend the incisions which best suit your anatomy. Listen to your surgeon and do not diminish your result by demanding an incision that will not be appropriate for you.

Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.

Step 5 – See the results

The results of your breast lift surgery are immediately visible.

How long has it been around?

While descriptions of reduction mammaplasties can be seen as early as Paulus of Aegina (625-690 AD), not until the late 19th century was emphasis placed on correcting ptosis of the breast. Much of the history of mastopexy parallels that of breast reduction, since both attempt to alter the shape of the breast and the skin envelope. Most of these procedures involved elevation of the breast mound using suspension techniques. Techniques that transposed the nipple-areola complex (NAC) as a vascular pedicle were described by Morestin and used by Lexer. Thorek was credited with the first report of a free nipple graft. Hollander first reported the lateral oblique resection resulting in an L-shaped scar. Schwarzmann described the use of periareolar de-epithelialization to preserve the neurovascular supply of the NAC. By the 1930s, most of the essential technical elements of the mastopexy had been developed.

Further evolution in the mastopexy resulted in refinement of technique and analysis. Aufricht advocated preoperative planning using a geometric system and stressed the concept of the skin envelope defining the final breast shape. Wise defined the preoperative geometric marking system most commonly used today. Gonzalez-Ulloa first advocated mastopexy with augmentation for ptosis with hypoplasia or atrophy. Goulian described the use of the dermal mastopexy, and Regnault presented a classification system for breast ptosis and a description of the B mammaplasty.

Johnson, among others, has used Marlex mesh to lift the breast parenchyma. Auclair and Mitz carried on that thought and described the use of an absorbable mesh insertion onto the anterior surface of the gland as internal support for the repair of mammary ptosis in mastopexy. Benelli reported the use of the periareolar round block or purse string mammaplasty.

Procedures to recreate breast fullness using autologous tissue either primarily or after breast prosthesis explantation have been described by Weiss and Ship using the dual pedicle dermoparenchymal mastopexy and the deepithelialized transverse rectus abdominis muscle pedicle, as well as by Flowers. Hall-Findlay used a medial-based pedicle modification of the vertical scar approach first described by Lassus (1970) as superior pedicle and popularized by Lejour (1994) with the use of breast liposuction. In 2002, Graf and Biggs described a modification of the vertical approach that places an autologous tissue flap deep to a strip of pectoralis muscle to improve shape and maximize longevity of the lift.

Hidalgo introduced a further modification of the vertical approach with using a Y-scar vertical mammaplasty as an alternative to reduce further scar burden. Khan described a vertical scar bipedicle technique, a combination for minimal scarring and robust blood supply to the NAC, as a further option for mastopexies. Loustau et al used the Owl-technique combined with the inferior pedicle in mastopexies. This technique carries the advantage of the conization effect from the vertical reduction described by Lassus combined with a short L–shaped vertical-horizontal scar, and also uses the inferior pedicle flap described by Ribeiro. Singh et al advocate a Z-mammaplasty technique.

What are the complications?

Breast lift risks include:

  • Anesthesia risks
  • Bleeding or hematoma formation
  • Infection
  • Poor healing of incisions
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Breast contour and shape irregularities
  • Breast asymmetry
  • Fatty tissue found deep in the skin might die (fat necrosis)
  • Fluid accumulation
  • Potential partial or total loss of nipple and areola
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all of your questions directly with your plastic surgeon.

Risks

A breast lift poses various risks, including:

Scarring. While scars are permanent, they'll soften and fade within one to two years. Scars from a breast lift can usually be hidden by bras and bathing suits. Rarely, poor healing can cause scars to become thick and wide.

Changes in nipple or breast sensation. While sensation typically returns within several weeks, some loss of feeling might be permanent. Erotic sensation typically isn't affected.

Irregularities or asymmetry in the shape and size of the breasts. This could occur as a result of changes during the healing process. Also, surgery might not successfully correct pre-existing asymmetry.

Partial or total loss of the nipples or areolae. Rarely, the blood supply to the nipple or areola is interrupted during a breast lift. This can damage breast tissue in the area and lead to the partial or total loss of the nipple or areola.

Difficulty breast-feeding. While breast-feeding is usually possible after a breast lift, some women might have difficulty producing enough milk.

Like any major surgery, a breast lift poses a risk of bleeding, infection and an adverse reaction to anesthesia. It's also possible to have an allergic reaction to the surgical tape or other materials used during or after the procedure.

What is the recovery like?

Wound care is minimal because subcuticular skin closure is used and Steri-Strips are left in place until they come off by themselves. Reinforcement is achieved with the use of Medipore tape to support the breast. The tape can be left in place for 2-3 weeks. Three weeks of some type of postoperative mammary support is recommended.

What can you do to speed up recovery?

During your breast lift recovery, dressings or bandages will be applied to the incisions after the procedure is completed.

You'll need to wear an elastic bandage or support bra to minimize swelling and support your breasts as they heal.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include:

  • How to care for your breasts following surgery
  • Medications to apply or take orally to aid healing and reduce the potential for infection
  • When to follow up with your plastic surgeon.
  • Specific concerns to look for at the surgical site or in your general health

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual breast lift recovery period.

Do you need to rest up afterwards and for how many days?

IMMEDIATELY AFTER. After the procedure has been completed, you will be required to wear a specialized bra and support bandages that will help to reduce swelling and bruising in the operated area. We provide a recovery protocol, including supplements, vitamins, and anti-bruising medications, that must be followed to promote rapid and effective healing. It is also important to get ample amounts of rest during this time in order to keep the body in top health.

1 WEEK. During this time, patients should avoid strenuous activity. Most women are able to return to work after the initial 7 days, but every patient’s healing will be unique.

2 TO 3 WEEKS. At this time, most patients are able to resume light physical activity once cleared by Dr. Chiu. Most swelling and bruising should have subsided, which will provide you with an idea of what the final results will entail.

4 TO 6 WEEKS. At this point, all swelling and bruising will have subsided, and the final results will be apparent.

After a breast lift, your breasts will likely be covered with gauze and a surgical support bra. Small tubes might be placed at the incision sites in your breasts to drain any excess blood or fluid.

Your breasts will be swollen and bruised for about two weeks. You'll likely feel pain and soreness around the incisions, which will be red or pink for a few months. Numbness in your nipples, areolae and breast skin might last for about six weeks.

In the first few days after a breast lift, take pain medication as recommended by your doctor. Avoid straining, bending and lifting. Sleep on your back or your side to keep pressure off your breasts.

Avoid sexual activity for at least one to two weeks after the breast lift. Ask your doctor when it's OK to resume daily activities, such as washing your hair, showering or bathing.

Drainage tubes may be placed near your incisions and are typically removed within a few days. When your doctor removes the tubes, he or she will also probably change or remove your bandages.

Talk to your doctor about when — or if — your stitches will be removed. Some stitches dissolve on their own. Others must be removed in the doctor's office, often one to two weeks after the procedure.

Continue to wear the surgical support bra round-the-clock for three or four days. Then you'll wear a soft support bra for three or four weeks. Your doctor might suggest using silicone tape or gel on your incisions to promote healing.

While you're healing, keep your breasts out of the sun. Afterward, protect your incisions during sun exposure.