Women who come to our Honolulu, Hawaii practice for breast lift surgery each have their own reasons for wanting to enhance their breasts.Mastopexy or breast lift surgery is a procedure to manipulate the breast tissues as well as the overlying skin to create a “perkier” breast mound and reposition the nipple/areola in a better position on the breast mound. This web page also addresses mastopexy procedures which do not manipulate or sculpt the breast mound but simply reposition the nipple/areola on the existing breast mound.
Breast lift surgery can be performed by a variety of methods and there is no one method which is best for all patients. In most practices, the patient will make the decisions regarding mastopexy based upon their goals and expectations as well as their anatomy and willingness to take risks. Like everything in life, there are advantages and disadvantages for each option and every patient has different opinions and desires so you are encouraged to discuss the various options with your plastic surgeon at length to find out which option is best for you. Your plastic surgeon will review a few common options and some of the advantages and disadvantages of each option.
A crescent mastopexy involves excision of a small ellipse of skin from the superior aspect of the areola. This is truly not a mastopexy procedure as it does not shape or sculpt the breast mound at all. It can move the position of the areola up to 1 cm higher on the breast mound and may effectively reposition the areola in patients who have implants.
The peri-areolar mastopexy procedure has the shortest length of scar. Despite the small length of the scar, it is quite common for the scar to be rather thick, ropy and most noticeable. The peri-areolar mastopexy does not manipulate or sculpt the breast gland but can reposition the nipple/areola 1-2 cm higher on the existing breast mound. The advantage to this procedure is the scar is limited to the skin around the areola and there are no other scars on the breast mound. The disadvantage is that this scar is often times under considerable tension and tends to heal with a thick, ropy consistency. Another disadvantage is that it is difficult to sculpt or shape the underlying breast gland through this incision.
The vertical mastopexy is a very popular alternative and involves a scar around the areola and in a vertical direction beneath the areola down to the crease under the breast. This “lollipop” shaped scar allows exposure to the underlying breast gland to adequately shape and sculpt the breast mound. Additionally, closure of this vertical incision allows the breast “pillars” to be sutured together in the midline which creates additional projection and support to the breast mound independent of the overlying skin. The advantages to the vertical mastopexy include excellent breast shape, projection and long-term results. The disadvantages of the vertical mastopexy include significant breast projection (some people do not desire this) and the fact that the surgical result on the operating table does not look like the final result which will be seen in 3-4 months. Another potential disadvantage to the vertical mastopexy is the fact that skin is not removed in the horizontal plane and tightening of these tissues may take 4-6 months. The other advantage to the vertical mastopexy is that it avoids the transverse or “anchor” shaped scar.
The Wise pattern mastopexy is the traditional mastopexy performed most commonly 20 years ago and it is still popular in certain circumstances today. The “inverted T” or “anchor” shaped scar is utilized to cone the breast up into a conical shape and allows removal of excess skin in both a vertical and horizontal direction. This type of mastopexy is very advantageous in patients who had massive weight loss and have significant excess skin. A potential disadvantage of this procedure is that the skin will lose its elasticity over time and the breast mound tends to “bottom out”. This type of mastopexy has a very pleasing shape on the operating table and allows plastic surgeons to sculpt the breast mound and achieve a very nice shape. Both the vertical and Wise pattern mastopexy procedures involve separating the skin envelope from the underlying breast gland and then sculpting and repositioning the underlying breast gland separate from the skin envelope. Once the breast gland is shaped, the skin is closed over the newly sculpted breast mound to create the final shape. Because of the extensive undermining of tissues with both of these procedures, the blood supply of the skin flaps as well as the nipple/areola can be compromised. For this reason, these procedures are not performed on smokers.
Occasionally, breast lift procedures are performed in conjunction with a breast augmentation and this involves manipulating the breast gland as well as placing an implant to give more projection and a larger base diameter. When a breast lift procedure is performed in conjunction with a breast augmentation surgery, it is called an augmentation mastopexy surgery. Augmentation mastopexy surgery is one of the most complicated procedures performed by plastic surgeons and always involves some type of compromise from either the mastopexy portion or augmentation portion of the procedure. In general, mastopexy procedures constrict or tighten the soft tissue envelope of the breast. Breast augmentation procedures stretch out or expand the soft tissue envelope of the breast. When these 2 procedures are performed together, there will always be a compromise of either the tightening component or stretching component of the procedure. If you are considering an augmentation mastopexy procedure, you will need to have a lengthy discussion with your plastic surgeon regarding this.
The plastic surgeon will perform specific measurements using the notch at the apex of the patient’s sternum as a fixed reference point to determine the amount of breast tissue, amount of breast skin, laxity of skin and sagginess (or ptosis) of the breasts. The ideal candidate for mastopexy surgery is a patient who has ptosis or droopiness of their breasts and desires a “perkier” breast mound with an improved shape. Some patients experience deflation of their breasts following breast feeding and these patients may require augmentation in addition to mastopexy. It is recommended that patients wait at least 6 months following breast feeding cessation before undergoing any type of breast surgery. Often times, patients may come into the office requesting breast augmentation surgery when in reality a major component of their breast appearance is droopiness or ptosis. It usually takes considerable time to explain to a patient with sagging tissues how an implant may not improve the sagging and in some cases make it appear worse. The scars for a breast lift (mastopexy) surgery can be a considerable deterrent for patients who want to improve the appearance of their breasts. Discussing how a misshapen breast is not aesthetically pleasing even if there are minimal scars and the trade off of an aesthetically pleasing shape to the breast with scars is still a difficult decision for some patients.
The immediate recovery will depend upon what type of anesthesia that your plastic surgeon will employ for the surgery. A total intravenous anesthesia (TIVA) technique which wears off relatively quickly has minimal side effects such as nausea. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. The other main determinant of recovery from mastopexy surgery is a surgical drain that most likely will be placed at the time of surgery. Most plastic surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in 3-4 hours and most patients will experience mild to moderate discomfort at this stage. Surprisingly, most patients state that the pain from breast lift or mastopexy surgery is not as much as the anticipated. Most patients will have discomfort with raising her arms overhead for 3-4 weeks. There are no specific restrictions following mastopexy surgery aside from no soaking for a week. Patients may shower the following day; but no Jacuzzi, swimming or soaking in the tub for a week. Most plastic surgeons want to see their patients back in the office 5-7 days after their surgery to remove the drains which are placed at the time of surgery. For most plastic surgeons, there are no sutures to remove. It is most common to use absorbable sutures which melt on their own within a few months and the outer skin is often times sealed with skin glue which flakes off in a few weeks. One of the potential risks of surgery is infection and this usually manifests itself around 5-7 days after surgery and is usually effectively treated with oral antibiotics. Other risks of breast augmentation include anesthesia problems or adverse reactions, scars, bleeding, hematoma (blood collection), delayed wound healing, contour irregularities and recurrent ptosis (drooping). Your plastic surgeon will go over all of the potential risks and complications with you prior to surgery so that you can make an informed decision regarding the risk to benefit ratio for their proposed surgery.
The actual “full” recovery period from a breast lift is at least a year and this involves a gradual softening and settling of the tissues its natural position. A significant amount of the recovery occurs within 2-3 months, but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. Immediately following mastopexy especially vertical type mastopexy, the breast will have a very protuberant appearance with a very rounded upper pole. Over the course of a year, this appearance will soften and the upper pole of the breast will develop a more natural slope with the breast mound assuming a more natural appearance as well. Other long term potential complications are related to each patient’s own tissues and the loss of elasticity in those tissues. The amount of sagging which can occur in these tissues is mostly dependent on that particular patient’s genetic makeup.