A breast lift, or mastopexy, is an option for women whose breasts are sagging, either from the results of aging, childbearing, breastfeeding or genetics. This condition is formally known as breast ptosis. Some women even describe their breasts as “deflated.” Mastopexy is also performed for younger women whose breasts are asymmetrical.
During most types of breast lift, the plastic surgeon takes away excess skin and tightens and reshapes the remaining tissue to support the new contours of the breast. In other surgeries, implants help lift and tighten the breasts. This results in a silhouette that is more youthful and firm. Here is what’s involved in a breast lift:
First: About Breast Ptosis
In order to perform a mastopexy that brings the best results for the patient, the plastic surgeon first needs to evaluate the degree of the patient’s breast ptosis. They do this by checking how far the breast and the nipple sag below the inframammary fold, or IMF. This is an imaginary line that just touches the lower curve of what’s considered a normal breast.
If the edge of the areola of the nipple just touches the line but the lower part of the breast hangs below it, the patient is said to have a pseudo ptosis. A grade 1 ptosis is when the line divides the nipple in half. A grade 2 is when the entire nipple is below the IMF. In a grade 3 ptosis not only the nipple but part of the curve of the upper breast is below the line.
Types of Breast Lifts
There are three basic types of breast lift. They are periareolar; vertical SPAIR, or short-scar periareolar inferior-pedicle reduction and the Wise pattern. Some surgeons use variations on these procedures, and different techniques work best on different types of breast ptosis.
Also called the crescent lift, this type of breast lift is best for a woman who has grade 1 or grade 2 breast ptosis. It is often performed on younger women who have just had a baby and want to restore their breasts to their pre-pregnancy firmness without too much scarring. These surgeries often involve adding a breast implant, either between the tissue of the breast and the chest wall muscle or in a pocket created in the chest wall muscles. Surgeons often consider saline implants the best type of implant for periareolar mastopexy because the implant can be inserted through an incision in the nipple, then filled.
Before the patient is given general anesthesia, the surgeon marks the areas of the breasts that will be operated on while she stands or sits up with her arms at her sides. The marks include the new position of the nipple, which is drawn with an X. In some patients, the level of breast ptosis is different for each breast. The doctor also uses a measuring tape to make sure that the breasts are ultimately symmetrical, and the patient doesn’t have to worry about exposing her areolas when she wears a bikini or low-cut dress.
When it is time to operate, the surgeon marks a circle around the edge of the areola then uses an electrocautery tool to make an incision. The incision is made here because the darker skin of the areola won’t show the scar as much. The incision is usually drawn between the 4 and 8 o’clock position on the bottom of the areola. The incision cuts through the tissue of the breast down toward the fascia that encloses the chest muscle. The flap that results should be at least 1 centimeter thick.
What the doctor does next depends on where the implant will be placed. The doctor uses electrocautery instruments and retractors, dilators and clamps to either place the implant right beneath the breast tissue or create a pocket in the chest wall. After the implant is placed, the incisions within the breast are closed with absorbable sutures. The incisions around the areola are closed with staples or sutures, and the patient is moved until they’re sitting upright. This allows the doctor to see where the nipples can be repositioned.
Usually, the areola is reduced in size by removing the top layers of the skin around it. The surgical wound is then closed with a purse string suture made with a straight needle to make sure the margin of the new areola is smooth and not scalloped. Some surgeons even use a 38 millimeter cookie cutter to help them shape the areola as it is sutured. Other sutures are placed around the areola to bury the purse string suture. Then, the incisions are covered with dressing, though holes are cut out for each nipple.
Vertical SPAIR Breast Lift
This technique was developed to result in a shorter and less noticeable scar. As with the periareolar breast lift, it saves the sensation in the nipple by making sure the it retains its blood supply even after it is repositioned.
During this procedure, the surgeon also marks the breast and the area around the nipple. They will then inject a local anesthetic and a vasoconstrictor, even though the patient is asleep. It makes the patient more comfortable when she wakes up after the operation and makes her less reliant on oral painkillers as she heals. The vasoconstrictor reduces the amount of blood loss, which cuts down on post-operative bruising.
The doctor then adds a tourniquet to stabilize the breast, or a surgical nurse will hold the breast. The surgeon places a guide over the areola to make sure the incision is perfectly round. Then, they make the incision around the edge of the areola and a larger incision around the areola that extends down the curve of the breast. The incisions form a keyhole shape. The doctor then removes excess skin and tissue from the breast while leaving the areola and nipple intact.
The surgeon then deepens the incisions until they reach the layer of fat beneath the skin of the breast. They remove some of the fat and excess glandular tissue while making sure that the nipple and areola are still attached to their blood supply. The surgeon then repositions the nipple and areola and sutures them in place.
Sutures are also added deep within the breast. The edges of the skin are pulled toward each other and also sutured and stapled. The surgeon then suture the entire circumference of the areola it to the surrounding skin. Sutures are added using curved needles and nylon thread until the incisions are completely closed up. Simply suturing the breasts actually moves them further up on the patient’s chest.
Wise Pattern Breast Lift
This type of breast lift is also called the anchor lift because it requires an incision around the areola, a vertical incision down the breast then a curved, horizontal incision at the inframammary fold, which gives the incisions the form of an anchor. The incisions are indeed called the ring, the shank and the stock.
Other than the extra incisions, the anchor breast lift is much like other breast lift surgeries. The surgeon can use a scalpel or electrocautery tool to make incisions and remove unwanted tissue. Some surgeons, after some breast tissue is removed, cover the nipple and areola with a mound of remaining breast tissue whose incisions are temporarily stapled together. They then incise a hole through the top of the new breast to allow the nipple and areola to emerge. When the breasts have been resculpted to the surgeon’s satisfaction, the temporary staples are removed, and the breasts are permanently sutured. The incisions are also covered with skin glue.
Patients can also opt for silicone implants when they have a breast lift. In that case, the surgeon creates a flap on the underside of the breast, and the implant is squeezed in and secured. After that, layers of sutures close up the breast incisions.
The length of the surgery depends on factors such as whether the patient is getting an implant and how much skin needs to be removed. Generally, a mastopexy lasts between two and a half to three hours.
Many people are surprised to learn that breast lift surgery is an outpatient procedure. That means that the patient can go home soon after the operation. First, however, she will be taken to a recovery area where she’ll be monitored as she emerges from general anesthesia. She also needs to arrange for someone to take her home and to stay with her at least overnight. Ideally, someone should say with her for a couple of days to help her with her daily tasks. It is important for the patient to rely on a strong support system.
Besides the dressings, the doctor will probably have inserted drains to take away excess fluid from the surgical wounds. The patient will also be fitted with a surgical bra that she’ll need to wear round the clock for one to two days after her surgery. After this, she’ll return to the surgeon, who will check to see that all is going well with her recovery. The old dressings will be replaced with new ones, and the drains will be removed.
The patient will no longer need to wear a surgical bra but will graduate to a post surgery bra. She must wear this garment at all the time for a few weeks, for it helps the breasts heal into their final shape. The improvement in the size and shape of the patient’s breasts can be seen over six months to a year. Scars from the surgery fade over time and are often barely noticeable after a year.
Bruising and swelling are to be expected, though discomfort can be eased with pain killers. The patient should not do anything strenuous for at least a month, and some doctors tell their patients to not do anything vigorous for at least six months. This can include not picking up anything that weighs more than 10 pounds. The patient should simply rest and allow her body to heal for several weeks after her surgery. She should remove the gauze and dressing regularly, and keep the area clean.
The patient should make sure to go to follow-up visits. Some surgeons may want to make small adjustments to the breasts to make them a bit more symmetrical. For example, some doctors tattoo more pigment around an areola to make it the same size as its partner. They’ll also make sure that the nipple is receiving a good blood supply.
Breast lift patients claim that arnica, an herbal supplement, reduces swelling. It’s also a good idea for a patient to invest in what is called a husband pillow and an airplane neck pillow. These offer support for the first few weeks after breast lift surgery, since the patient won’t be able to sleep comfortably on her back.
The patient must also drink lots of water, probably more water than she wants to, to flush the anesthetic and other medications from her body. She should eat a healthy diet that includes lots of fresh fruits and vegetables, soups and teas. The doctor or nurse will teach her how to massage her breasts to make sure that the implants settle securely into the pockets.
Call Us if You’re Interested in Breast Lift
If you no longer like the look of your breast because they sag or look like the air has been taken out of them, breast lift might be a solution for you. If that is the case, consider us here at DrYoungForever in San Antonio, TX. Contact us today to schedule your consultation with our professionals!