Medical Terms: Breast lift=Mastopexy, Ptotic=sagging

Sagging breasts are common among women of all ages. Young women can develop sagging breasts right from puberty. This can be due to genetics, poor skin tone of the chest, anatomically low-lying breasts, asymmetric conditions, or large breasts, which quickly respond to gravitational effects. The majority of women do experience sagging of their breast tissues as they age from gravity, pregnancy, breast-feeding, and weight fluctuation. In addition, patients with stretchable tissues with poor tone and laxity will be predisposed to sagging. These skin types are characterized by loose, thin, relaxed and compliant tissues, and skin with stretch marks. Whatever the cause, Mastopexy surgery is an excellent way to re-contour, lift and tighten the breast. The goal is perkier, shapely, natural looking breasts with increased superior pole fullness.

There are various mastopexy techniques available. Dr. Brown individualizes the surgical approach based on the degree of breast elevation required, also taking into account a patient’s overall breast size and inherent tissue tone. Patients with looser, lax tissues require more skin and tissue tightening in all dimensions. Be prepared for the trade-off of permanent scarring on the breast from this surgery. There is no other way to effectively lift and tighten breast tissues without external scarring. The scars are acceptable for the majority of women, as they hide along natural breast contours, and fade to normal skin color over time. The benefits of fitting into various clothing styles and bikini styles that look great and fit comfortably typically outweigh the presence of hidden and inconspicuous scars. Women feel confident, youthful, healthy, and sexy with perkier, firmer breasts.

There is a common misconception that breast lift surgery decreases overall breast cup size. Dr. Brown realizes that this is not desirable, and therefore specializes in breast lift surgery preserving all tissue, inclusive of skin, that is used for maintenance of current size. Certainly, all bras fit differently, and an uplift of breast tissue changes shape so that bra size could change. Dr. Brown will evaluate the amount of natural tissue available while honoring your desires for final cup size. Surgery is performed to keep your breast size the same, decrease size if desired, or increase breast size if indicated with implants.

Who is a Candidate?

• Women of all ages with sagging (ptotic) breasts
• Women with loose skin, stretch marks, and volume loss after pregnancy and breast feeding
• Individuals after significant weight loss or weight fluctuations
• Individuals with large breasts who have experienced gravitational descent from gravity
• Women with breast or nipple asymmetry, enlarged areola, or degrees of tubular shaped or pointy shaped breasts
• Women with nipples that are on the lower aspect of the breast mound or point toward the ground
• Women who desire more upper pole fullness
• Women with breast implants who desire removal or downsize of their implants
• Healthy individuals who are non-smokers

Goal of Surgery:

• To raise the breast and nipple, tighten the skin, and achieve a youthful, well-contoured breast
• Improved symmetry in appearance, volume, and nipple position. Perfect symmetry of breasts is not realistic, breasts are naturally slightly different
• Maximum yet natural increase in upper pole fullness
• Improved nipple size and appearance with centralization of the nipple and areola on the breast mound
• Superior and medial breast fullness, better cleavage
• Ability to wear swimwear, dresses, and attractive clothing styles that look good, fit well, and feel comfortable
• To be able to find bras that fit and are attractive
• To satisfy a woman’s cup size desires, whether it be a smaller or larger breast size (by the addition of an implant), or to maintain current volume
• A long-lasting result

Procedure Description:

• The procedure is done on an outpatient basis under general anesthesia
• An incision is made partial thickness around the nipple areola complex, allowing size reduction if needed for ideal proportion on the breast mound. The nipple remains attached to underlying nerves, blood vessels, and ducts. Redundant skin is removed and tightened. Breast tissue and skin can be removed if the patient desires a smaller cup size. For patients who want to preserve all tissue and maintain their current size, techniques which involve skin invagination (tucking-in) rather than resection are utilized. For patients desiring an increase in cup size, an implant may be added (see procedural section on Augmentation-Mastopexy)
• There are several types of Mastopexy procedures that Dr. Brown uses. Each surgery is tailored for the individual to provide maximal lift while minimizing scar lengths when possible. Periareolar breast lifting involves skin tightening around the nipple only. These candidates have low nipple positions with very minimal sagging. It works well for patients with tubular breast deformity or patients with enlarged areola. It affords very minimal lift, and the final scar around the areola tends to be quite visible. Vertical Mastopexy works well for small to moderately sized breasts with good overlying skin tone, and moderate sagging. The final scar pattern is similar to the configuration of a lollipop. A full mastopexy works well for moderate to severe sagging, when maximal skin and tissue tightening is needed in all dimensions. It is also required in patients with poor skin tone. The final scar pattern is similar to an anchor shape on the breast.
• Both skin and gland are elevated and tightened
• Breast lift surgery involves the trade off of permanent scars on the breast. Skin take out and tightening requires incisions, and subsequent scars. They are well concealed along natural breast contours, typically around the nipple and down the lower half of the breast. Patients with more severe sagging may also warrant the addition of a scar underneath the breast or along the inframammary fold. Patients are most concerned about the central vertical limb scar which courses directly down from the nipple to the inframammary crease. However, this concern is generally unwarranted, as this scar limb almost always heals and fades the best over time, while the maneuver provides a powerful lift effect
• Small volume reductions may be recommended in larger breasts to decrease the chance of recurrent sagging over time
• Drains are used in approximately 50% of cases depending on the extent of the procedure

Postoperative Course:

• The patient goes home in a sports bra with gauze
• If drainage tubes are used, they are removed in 4-7 days in the office
• Bra support with a comfortable sports bra and/or underwire bra is required to optimally shape the breasts as they are healing. The underwire bra recommended almost never affects the healing incisions.
• Long term normal bra wear is encouraged, to decrease risks for recurrent sagging which is more likely in larger breasted women with poor inherent tissue tone
• Expect unusual appearance of the breasts initially, which resolves in several months. Minor appearance changes occur under your clothing for up to 6 months
• Bra cup size cannot be guaranteed, as all bras fit differently
• Sutures are mostly absorbable. External suture knots are clipped in the office between 1-2 weeks.
• It takes 2-4 weeks for complete incisional healing
• Most patients take 1-2 weeks off work, and then return to non-physical work. No heavy lifting, fitness activities, or strenuous upper body exertion for 4 weeks
• No tanning of scars for the first year
• It takes at least one year for the scars to mature and fade
• Breast-feeding after any type of breast surgery cannot be guaranteed. About 30% of women may have difficulty breast feeding after surgical intervention
• Temporary sensation changes are common, either numbness or hypersensitivity. Nerves can take a full year to recover, it would be rare to experience a permanent change after one year

Other Options:

• Addition of a breast implant at the same time for small breasted women, known as an Augmentation-Mastopexy
• Body contouring procedures such as liposuction or abdominoplasty
• “Mommy-makeover”-breast surgery in conjunction with waistline contouring after childbearing is completed, to restore pre-pregnancy contours

Dr. Brown realizes that permanent scarring on the breast can be a problem for some women, especially those with a history of poor scarring ability, such as those with a history of keloid or hypertrophic scars. In these individuals, a non-surgical approach may be recommended. The decision to undergo mastopexy surgery has so many positive ramifications for women, that the scars do not end up being an issue for them or their significant others. Under-correction of sagging is more of an issue, and therefore Dr. Brown will advise you on the best procedure to elevate and tighten your breasts. If there were a reliable and effective method or technique to perform breast lift surgery without external scars, we would be doing it that way.

Dr. Brown is a specialist in Mastopexy surgery. She focuses on the creation of upper medial pole breast fullness and a beautifully attractive cleavage, using your natural tissue and avoiding the need for an implant. Women of all breast sizes are able to achieve attractive, perky and youthful breasts, which contributes to a healthy and fit–looking silhouette.