FAQ’s – Mastopexy (Breast Lift)
A woman’s breasts may droop as a result of the natural effects of aging, heredity, gravity, pregnancy, breastfeeding or weight loss. A breast lift, also called a mastopexy, is performed to return youthful shape and lift to breasts that have sagged or lost volume and firmness.
What can a breast lift do for me?
Breast lifts rejuvenate the breasts by trimming excess skin and tightening supporting tissues to achieve an uplifted, youthful contour. After a mastopexy, the breasts are higher on the chest and firmer to the touch. Breast lifts can also reposition and reduce the size of the areola—the dark skin surrounding the nipple—which may have stretched or drooped. Breast size does not change after a breast lift, nor does the fullness or roundness in the upper part of the breasts. Women who desire larger, smaller or more rounded breasts may want to consider a breast augmentation or breast reduction together with a breast lift.
Mammary Ptosis (Drooping) – What Is It?
Mammary (breast) ptosis is drooping of the breast. It is actually subdivided into two categories. The first category is true ptosis which is described as drooping of the nipple/areolar complex. For the purposes of discussion, the areola is the pigmented skin around the centrally raised nipple. In a youthful breast, the nipple-areola complex is above the inframammary fold (lower crease of the breast) which is termed 1st degree ptosis. As one ages and due to the effects of genetics, gravity and pregnancy, the nipple-areola complex may descend to the level of the inframammary fold which is termed 2nd degree ptosis. When the nipple-areola complex is below the inframammary crease, it is now considered to be 3rd degree ptosis. Pseudoptosis, or false ptosis, refers to the distribution of glandular tissue within the breast. Although the nipple-areola complex may actually be at or above the inframammary fold, the breast may “bottom out” due to the effects of pregnancy, lactation, gravity and genetics. In this situation, the breast has lost its superior fullness, and the glandular tissue of the breast sits low on the breast with the bottom edge of the breast below the inframammary crease.
Am I a good candidate for a breast lift?
The best candidates for breast lift are women whose breasts meet some or all of the following conditions:
- Breasts sag
- Breasts have lost shape or volume
- Breasts are flat, elongated, or pendulous (hanging)
- Breast skin and/or areola is stretched
- Nipples or areolas point downward
- Nipples or areolas are located in the breast crease when breasts are unsupported
- One breast is lower than the other
In summary, anyone who has grade II or III ptosis of the nipple (nipple-areola complex at or below the level of the inframammary fold) may be a candidate for a breast lift procedure. Pseudoptosis (glandular ptosis) may also be corrected at the time of breast lift surgery. It is also very important that breast lift candidates are healthy, do not smoke, maintain a stable weight and have realistic goals and discuss them with their plastic surgeon prior to surgery.
Women planning to have children are advised to postpone surgery, since pregnancy and nursing can counteract a breast lift’s effects by stretching the skin. Mastopexy does not affect breast size. There may or may not be improvement in upper breast fullness depending on your anatomy and tissue quality. Women who desire larger, smaller or more rounded breasts may want to consider a breast augmentation together with a breast lift or breast reduction (the design of which always includes a breast lift) instead of a breast lift alone.
Mastopexy may be performed in a hospital, an outpatient surgery center or a surgeon’s office-based facility. It is usually done on an outpatient basis under general anesthesia, and lasts from one and a half to two and a half hours. There are several types of incision methods that can be used when performing a breast lift. The technique a surgeon chooses depends on the patient’s breast size, shape, degree of sagging, size and position of the nipples, amount of excess skin, and skin quality.
All breast lift procedures involve an incision encircling the areola. The three most common incision types are two rings around the areola in a doughnut shape (small-incision mastopexy, generally only recommended for patients with small breasts and minimal sagging); around the areola and from the 6 o’clock position on the areola to the lower breast crease (lollipop shaped scar) and in the more extreme cases of drooping, a lollipop incision with an additional half-moon incision along the breast crease (anchor shaped scar) is required. However, using current short scar techniques, this is becoming less common.
In all cases, breast lift surgery begins with administration of anesthesia or IV sedation. The surgeon makes the necessary incisions, and then he or she lifts and reshapes the breast tissue into its new, rejuvenated contour. He or she moves the nipple and areola higher on the breast and removes extra skin around the perimeter if the areola is enlarged. Finally, the surgeon trims the excess breast skin that resulted from poor elasticity. Stitches layered deep throughout the breast tissue support the lifted breasts. When the mastopexy is complete, the skin is closed with stitches, tissue adhesive and/or surgical tape. Some of the incisions are hidden in the breast crease. Others will be visible. All scars will mature with time.
The best way to think about breast lift surgery is to think of the breast as consisting of two components. The first is the skin “brassiere,” and the second is the glandular/fat content. With pregnancy and lactation, the glandular/fat contents enlarge, thereby stretching the skin. After lactation ceases, the glandular and fat contents revert back towards their previous size or smaller, however the skin has been stretched and does not have the same degree of elasticity. In this regard, the skin envelope remains larger than it was previously. Therefore, the skin envelope, if stretched to its natural degree of tension, would have volume that far exceeds that of the glandular/fat tissue inside it. Furthermore, as the glandular/fat tissue stretches, the very ligaments that support and sustain the shape of the breasts (Cooper’s ligaments) are stretched and do not go back to their previous size, thereby causing the glandular/fat content to descend downward. Therefore, there are actually two issues causing breast drooping. The first is the disparity in skin brassiere size versus the actual volume of the glandular/fat contents of the breast. This is seen, for example, in a woman who starts with a B cup breast, and then enlarges to a D cup with lactation, then the glandular/fat tissue of the breasts shrinks back down to a B cup in size, but the skin brassiere may be a C or even a D cup. The second issue is the fact that there is loss of firmness and shape of the glandular/fat contents within the breast.
The ideal breast lift procedure is one that 1) corrects the disparity in the skin brassiere envelope size versus the volume of glandular/fat contents; 2) elevates the nipple-areola complex and lastly; 3) reshapes the gland/fat contents. The last component is not always possible, depending on the technique being used. When selecting a technique, you and your surgeon need to have a thorough discussion about what your desires are as well as your concerns regarding scarring. Some women are less concerned about the scars than others, and this may have a significant impact on which procedure the surgeon feels is best in your case. Whether the breast lift surgery consists of a periareolar incision only (around the areola), an areolar plus vertical incision from the 6 o’clock position on the areola to the inferior breast crease (lollipop incision) or an incision around the areola, a vertical incision below the areola and a lower breast crease incision (anchor incision), the goals of the procedure are the same. When possible, the glandular tissue itself is elevated off the underlying muscle and repositioned higher on the chest muscle and the glandular/fat tissue is reshaped with internal sutures to help give the breast a more natural and longer-lasting shape.
Yes, in many cases. Not every woman with ptosis (drooping) of her breasts is a candidate for a breast augmentation simultaneous with a mastopexy. If your breasts are drooping and you wish to be fuller and larger, than a breast augmentation procedure performed at the same time as a breast lift may be the right procedure for you. Your surgeon will assess your breasts in terms of breast volume, skin envelope size, skin elasticity, and your overall aesthetic balance. Only then can a proper decision be made as to whether or not a breast augmentation can be performed concurrently with a breast lift procedure.
Dr. Epstein will thoroughly examine your breasts, obtain measurements and note the overall shape, size and elasticity of your breasts, as well as the position of the nipple-areola complex. After careful assessment and incorporating your own personal concerns, he will be able to make recommendations as to which is the best procedure for you. It is very important if you are a smoker to refrain from smoking for at least six weeks prior to the surgery and six weeks afterwards to minimize the risk of problems with wound healing.
After surgery, the breasts are wrapped with steri-strip dressings, and you may need to wear a surgical bra. You should be back to most activities of daily living (except strenuous exercise) in 24 – 48 hours. The breasts may be bruised and swollen after surgery, but this will pass in a few days. Any numbness in the breasts and nipples should lessen as swelling subsides. Discomfort is usually mild to modest and easily controlled with pain medication, if necessary. You may return to work in a few days in most cases, unless your work is strenuous. Stitches are removed in about two weeks.
If you agreed on realistic goals with Dr. Epstein, you should be very satisfied with the look of your lifted breasts. You will be able to see the results of your mastopexy immediately after surgery, and you may become even more satisfied as swelling goes down and incision lines fade. The breasts should remodel and look even more natural as time progresses.
Most likely the scars will always be visible, however they will fade. Your body’s own biology of wound healing will determine how visible the scars will be.
Complications are rare after mastopexy. Smoking dramatically increases the risk of complications, which is why Dr. Epstein will not perform mastopexy in patients who are actively smoking. Possible complications of a breast lift include:
- Temporary or permanent numbness in the nipple or areola
- Uneven positioning or shape of breasts or nipples
- Widening of scars
- Poor incision healing
- Fluid buildup
- Breast hardening
- Damage or necrosis of breast tissues
- Need for revision surgery
Dr. Epstein will be happy to discuss all the risks and benefits of a breast lift with you.