Breasts lose their perkiness over time due to weight changes, gravity, aging, pregnancy and nursing. As the skin loses its elasticity, it loses the ability to support the breast. Over time, volumetric changes in the breast occur causing the breasts to lose their shape and firmness. A mastopexy (or breast lift) is a procedure that will remove some of the excess skin of the breast to raise the position of the nipple and areola. This also allows the shape of the breasts to be improved, reduce the sagging of the breasts, help restore volume to the upper poles of the breasts, and correct asymmetries between the breasts. In addition, a mastopexy will reduce an enlarged areola (the dark skin around the nipple) to a more normal size.
A mastopexy is a very similar procedure as a breast reduction. Both procedures reduce the size of the areolas and raise them back to a more aesthetic position on the breast. They also reduce the sagging of the breast by removing some of the excess skin of the breast. The difference is that a breast reduction also removes some volume from the breast and makes it smaller. A mastopexy doesn’t change the size of the breast. Patients that have large, pendulous breasts may benefit more from a breast reduction, whereas those patients with small, sagging breasts would do better with a mastopexy. Breasts of all sizes can be lifted; however the lifting effect will not last as long in heavier breasts.
The most common reason that women proceed with a mastopexy is that pregnancy and nursing have stretched out the skin of their breasts. Another complication of pregnancy is “post-partum involution,” in which patients frequently have less volume in the breasts after they are done breast feeding than they had prior to their pregnancy. This exacerbates the sagging appearance of the breast. If a patient is planning on having additional children, then it is usually best to delay the breast lift until after they are done having children, as additional pregnancies will stretch the breast skin again. If a patient becomes pregnant after a mastopexy, they are usually able to breast feed as the milk ducts and nipples remain attached.
The most noticeable disadvantage of a breast lift is that it will leave permanent scars (any incision made on the body will leave a scar). The scars improve with time and are placed so that they are covered by a bra or swimming suit. Patients who smoke tend to have more unfavorable scars than non-smokers. A short-scar mastopexy (lolli-pop shaped incision) has smaller incisions than a traditional, wise-pattern mastopexy (boat anchor shaped incision) and the short-scar mastopexy is the preferred procedure for small and medium size breasts. For patients with large pendulous breasts, the wise-pattern procedure is the better option. During the consultation, measurements of the breasts are taken and the amount of excess skin is evaluated. This allows us to determine which procedure is better for the patient.
Some women would like to correct sagging of the breasts and would also like to add more volume to their breasts. These patients will typically get their best results if they have their breasts lifted and augmented. For most patients, they will have a better result if the mastopexy and breast augmentation are performed as two separate procedures, particularly if they have any significant asymmetry between the breasts. If there is a significant amount of loose skin or sagging, the mastopexy is the initial procedure. If there is a minimal amount of loose skin or sagging, then breast augmentation is the initial procedure followed by the mastopexy three to six months later. Dr. Boswell will discuss this with you at the time of your consultation so that you can make an informed decision.
The Surgery
Performing a mastopexy usually takes about 1.5 to 2.5 hours depending on what type of mastopexy is performed and how much excess skin that a patient has to remove. The incision for the “short-scar mastopexy” is right around the areola and then extends straight down to the inframammary crease (the fold underneath the breast). This allows the nipple and areola to be elevated to a more raised position. The resulting incision looks like a “lollipop”. In addition, the size of the areola can be reduced if it has stretched out due to pregnancy, gravity, or weight changes. The incision for the “traditional” or “wise-pattern mastopexy” is around the areola, straight down to the inframammary crease, and then extends horizontally in the inframammary crease from the sternum (breast bone) to the axilla. This incision is about 70% longer than the short-scar mastopexy and it does allow the removal of excess skin extending out to the axilla (armpit). The wise-pattern mastopexy is for the larger breasted patient with more excess skin. The areola can also be made smaller with this procedure if necessary. Once the excess skin is removed, the remaining skin then re-draped over the breast mound to create a natural breast contour.
Some patients would like to have additional tissue removed at the same time as their breast lift and this is called a “mastopexy with volume reduction.” This is particularly helpful if the patient has one breast that is slightly larger than the other breast. Also some patients would like to have a small amount of breast tissue removed at the same time as their breast lift and this can help to address the excess volume.
A “concentric circle” or “doughnut” mastopexy is performed by making a circular incision around the areola and removing the excess skin. This procedure is only for patients that have a minimal amount of sagging and relatively small breasts. This procedure frequently causes the areolas to stretch out over time and they can become wider than they were before the surgery. Most women that are interested in a mastopexy have too much excess skin to be removed by this circular incision.
What to Expect After a Breast Lift
Typically the surgery is an outpatient procedure, which means that you will be able to go home on the same day as the procedure. You will be in a surgical bra that you can wear for as long as it is comfortable. Some patients like to wear the bra because it gives them compression and some patients like to go without a bra. Your incisions will be sealed with Dermabond, so that you will be able to shower the next day. The sutures are all absorbable and hidden underneath the skin, so they will not need to be removed.
Following surgery you may have some bruising of the breasts and areolas. The bruising is usually gone within 7-10 days. The swelling will increase each day after surgery for about four to five days, then swelling will start to decrease. About 80-90% of the swelling will be gone one month after surgery, although it will take about 6 months for all of the swelling to go away. In general, this is usually not that painful of a procedure. Most patients rate their pain as a 3-4 out of 10 and the pain is well controlled with oral pain medication. Patients typically don’t need any pain medication after a couple of days.
You will probably have some altered sensation of the nipples and breast skin following the surgery. Some patients have increased sensation of the nipples (hypersensitivity) which will go away with time. Some patients can have numbness of the breast skin and/or nipples and this usually fades over about 6-12 weeks as the swelling decreases. In some patients, this numbness can last more than a year and in some patients it can be permanent (this is fairly rare).
After surgery you will have a 10 pound weight restriction on things that you can lift for the first two weeks after surgery and then a 20 pound weight restriction for the following two weeks. Most patients feel ready to return work after a week’s recovery and frequently patients want to return to work sooner. You can perform all types of exercise 6 weeks after surgery and you will not have any restrictions at this point.
We will always make every effort to minimize the scars as much as possible. However, any time a plastic surgeon makes an incision, it will make a scar. It takes about 18 months for scars to fully mature and fade. Scars tend to be red and raised for about 6 months, they then lose their color between 6 and 12 months, and then scars flatten out between 12 and 18 months. The scars are located on the lower part of the breast and typically are not visible even when you are wearing a swim suit or low-cut top.
The results of a mastopexy are not permanent. As time goes on, the effects of gravity, aging, and weight changes can cause the skin to stretch out again. Typically, the recurrence of sin laxity is not to the same degree of skin laxity as was seen before the surgery. Patients typically do not need to have a second mastopexy even if they become pregnant after their mastopexy.
Length of Surgery
Typically 1.5 to 2.5 hours
Anesthesia
General anesthetic (you are asleep)
In/Outpatient
Both short-scar and wise-pattern mastopexy procedures are usually outpatient
Side Effects
Patients will have temporary pain, swelling and bruising. Numbness is unlikely and can be either temporary or permanent. Frequently patients will have dry breast skin. The scars are permanent although they do fade with time.
Risks
Unfavorable scars that can raised, wide, and/or thick. Loss of the skin including the nipples and areolas. Altered sensation of the breast skin or nipples that can be permanent. Bleeding after surgery that requires going back to surgery. Infection. Asymmetry of the breasts or nipple/areolar position.
Recovery
Most patients are back to work within a week. Patients can start light exercise in two weeks and are back to unrestricted exercise in 6 weeks.
Maximal scar improvement usually takes about 18 months. Scars tend to be red and raised for about 6 months, they lose the redness over the next 6 months, and flatten out between 12 and 18 months.
Duration of Results
Most patients only need to have one breast lift during their life and this is not a procedure that patients have more than once. Weight changes (gain and loss), pregnancy, aging, and gravity all can increase additional sagging after surgery.
