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Breast Lift
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• Breast Lift (Mastopexy) is performed for improving the shape and position of the breast. Most commonly, the procedure is requested to correct drooping that occurs after pregnancy and with aging. • The procedure can be helpful in correcting breast shape differences (asymmetry). • The procedure can be combined with use of a breast implant: o if more fullness is desired in the upper chest than can be achieved with breast lift alone; o if increase in size is also desired. • If the breast is deflated or has lost volume, but the nipple position is okay, breast augmentation without a lift can be a good solution. • Breast implants do not lift the breast; they only fill out the breast. o Breast augmentation will not elevate the nipple position or the bottom of the breast. o If the nipple or the bottom of the breast is too low, a breast lift procedure is necessary to achieve elevation. • Drooping of the breast is a consequence of stretching or loss of elasticity of the skin and of the internal breast tissues. o Internal to the breast are many suspensory ligaments, very fine fibrous strands that help to support the breast and its shape. o When the suspensory ligaments stretch out, the breast droops. o We do not have any techniques to tighten loose suspensory ligaments. • Breast lift techniques can be used to surgically o reposition the nipple-areola complex o reposition the droopy breast o reshape the breast • Drooping (“ptosis”) is determined by the degree to which the nipple has descended below the height of the breast crease or by excessive drooping of breast gland below the breast crease (“glandular ptosis”). • At the time of the breast lift, I will tighten and raise the breast as much as can be done safely. o Right after surgery, you will see that the top of the breast is full and round, and the bottom of the breast appears tight. It is normal to see some dimpling from some of the suturing; this will disappear over the first few weeks. During the first several weeks after surgery, the breast will “settle” into a more natural appearing tear drop shape. o The elasticity of the skin and breast ultimately determines how much the breast will settle after the breast lift. Tissue elasticity is very individual and is influenced by genetics, aging, hormones, pregnancy, medications, general health, and nutrition. o For most women, most of the settling after breast lift occurs by 6 months post-op o After that time, recurrence of drooping is a function of the factors that influence tissue elasticity • I employ different breast lift techniques to best suit the individual o This can best be determined at consultation with physical examination. o Newer techniques of breast lift include internal reshaping of the breast gland This produces a more powerful lift that is longer lasting Older techniques just used the skin to reshape the breast. • Longevity depended on skin elasticity alone. • Periareolar Mastopexy: a crescent of skin is removed from just above the nipple areola complex. [insert diagrams] o If the nipple-areola complex is slightly low (~1/2-inch or less), and there is no glandular ptosis (drooping or flattening of the breast). This procedure only adjusts the position of the nipple-areola This is a skin-only procedure that does not change the shape of the breast or lift the breast. o This procedure leaves a scar aligned with the edge of the upper half of the areola. o Periareolar Mastopexy can be combined with breast augmentation to improve breast size and shape. • Circumareolar Mastopexy: skin is removed around the nipple-areola complex and a purse-string suture is used to pull the skin tight around the nipple-areola. [insert diagram]. o Because of the tension created by pulling the skin around the nipple-areola complex: this technique causes reduces the projection of the nipple-areola complex and flattens the breast; • The shape of the breast often looks “boxy;” the scar around the nipple-areola complex often widens over time; the nipple-areola is widened and the nipple flattens over time; o Although many techniques and types of sutures have been tried to avoid these undesirable effects, few are consistent or successful. o The tradeoffs of limiting the scar to the edge of the areola in this technique are rarely worth it. • Short Scar Mastopexy: the incisions place the scars around the edge of the areola with a vertical scar on the bottom of the breast, extending part or all the distance to the breast crease. The shape of the scar is sometimes compared to a “lollipop.” [insert diagram] o This technique works best for: women wanting reduction of an enlarged areola for elevating the nipple-areola more than ~1/2 an inch for correction of mild –to-moderate glandular ptosis. o The breast can be reshaped to restore projection. • Anchor-Scar Mastopexy produces the circular scar around the areola, the vertical scar from the lower edge of the areola to the breast crease, and a horizontal scar in the breast crease [insert diagram] o This technique is used for moderate-to-severe drooping. o The breast crease incision allows removal of the skin to reduce the lower pole/hemisphere of the breast. This is usually necessary when the distance from the nipple to the breast crease measures more than ~3 inches. o In most cases, the horizontal scar is much shorter than the length of the breast crease, so the scar will be well concealed in the crease. The length of the horizontal/breast crease scar is proportional to the amount of skin to be removed. The incision is designed to place the scar about ¼” above the crease to minimize irritation from bra seams and underwires. • Augmentation Mastopexy combines breast augmentation with breast lift o Breast implants (silicone or saline) will add volume to the breast Restore or increase breast size Implants can help to fill out the upper chest • Sometimes the breast lift alone may not fill out the upper chest as much as desired o Breast implants will help to shape the breast Implants can help to shape a rounder or fuller upper breast o Avoid “over-augmentation” Even for the benefit of shaping, it is a poor compromise to go bigger than you want to be. o The implants can be placed behind the muscle (subpectoral) at the time of breast lift. • Recovery from breast lift is usually easier than women expect o Return to non-strenuous work/physical activity is typically 5 days Avoid high impact activities for 6 weeks • e.g., jumping, jogging, and large arm swinging motions, like tennis or golf. • Repetitive arm motions like vacuuming should also be avoided for 6 weeks. Limited driving is okay at about 3-5 days post-op You will fatigue easily because your body uses a lot of energy to heal. • Plan on a midday nap/timeout during the first week or two weeks post-op. • Remember: you will not have a complication from taking it easy, but you most likely will have a complication if you do too much too soon! o Pain is usually minimal Most women will take few, if any pain pills o Augmentation Mastopexy recovery is more like that of breast augmentation Return to non-strenuous work/physical activity is typically 10-12 days Use of the Anesthetic/Pain pump is a great benefit for post-op comfort • Studies show dramatic reduction in pain with the Pain Pump o Subjective pain scale scores are halved o Narcotics pain pill use is reduced by at least 50% Less narcotic use means • Less nausea/vomiting • Less narcotic side effects • Better sleep • More pleasant recovery • A tiny catheter (tubing) is placed into each breast at the time of surgery • The catheters are attached to a small pump filled with local anesthetic (lidocaine) which slowly and continuously drips into the breast surgery site • There is a bulb you can press to add increase the amount of anesthetic, if you require more. o The flow rate is regulated so you can’t “overdose.” • The pump is about the size of a baby’s bottle and is worn with a belt around the waist. • The pump reservoir holds enough anesthetic to last about three days; we’ll refill it for you during your post-op visits. • Most people will have us remove the catheters, around the 5th day post-op. o The removal is simple, requires no anesthetic, and is done in the exam room o Most people describe the removal as not painful, but a “weird pulling sensation.” o I rarely use drains. o I use dissolvable sutures, so suture removal is not necessary o I place Steri-Strips, protective paper tapes over the stitch lines Tapes are left in place for 6 weeks • The tapes protect the incision lines • Tapes act like a splint on the fresh stitch lines, helping to reduce spreading of the scar. • It’s best to leave the tapes intact to protect the incision lines, rather than change them if they get a spotted with some blood seepage. o Showering after surgery is okay, but don’t soak the tapes and be careful to use only tepid water to avoid thermal injury to the healing tissues. Post-op Visits Anesthesia/Sedation Hospital vs Office Surgical Suite Complications Important Considerations: • It is important to remember that all plastic surgery involves trade-offs and compromises. I will do my best to let you know what these may be. • Although we strive for perfection, no plastic surgery is perfect (Neither is Mother Nature!) • If you will tend to focus on imperfections after surgery rather than on the improvements you have achieved, do not undergo cosmetic surgery: you will be frustrated and no happier for your efforts. • Each operation will have flaws: be sure you understand what they may be and that you can live with them. • It is impossible to guarantee the results of any surgery; but I can guarantee that I will do my best for you! • There are many areas in plastic surgery where experts may disagree. These comments reflect my understanding of best practices of plastic surgery.
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