Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag.Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts-at least, for a time.
(No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume-for example, after pregnancy- breast implants inserted in conjunction with mastopexy can increase both their firmness and their size. If you're considering a breast lift, this web page will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask Dr. Jensen if there is anything about the procedure you don't understand.
The best candidates for breast lift
A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match you ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Jensen.
The best candidates for mastopexy are healthy, emotionally stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.
Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.
Illustration 1: Over time, a woman's breasts begin to sag and the areolas become larger.
All surgery carries some uncertainty and risk
A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon like Dr. Jensen. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following Dr. Jensen's advice both before and after surgery.
Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in you nipples or breasts.
Planning your surgery
In you initial consultation, it's important to discuss your expectations frankly with Dr. Jensen, and to listen to his opinion. Every patient-and every physician, as well has a different view of what is a desirable size and shape for breasts.
The surgeon will examine your breast and measure them while you're sitting or standing. He will discuss the variables that may affect the procedure-such as your age, the size and the shape of your breasts, and the condition of your skin-and whether an implant is advisable. (For more information on implants, ask Dr. Jensen for the ASPRS brochure on breast augmentation.) You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.
Dr. Jensen should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He should also explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.
Don't hesitate to ask Dr. Jensen any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for your surgery
Depending on your age and family history, Dr. Jensen may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications.
While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
Where your surgery will be performed
The surgery may be performed in the Hospital (Rogue Valley Medical Center or Providence Hospital) or in our own outpatient surgery center. It's usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an inpatient, you can expect to stay one or two days.
Types of anesthesia
Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation.
In selected patients-particularly when a smaller incision is being made-the surgeon may use local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and will feel minimal discomfort.
Mastopexy usually takes one-and-a-half to three-and-a-half hours. Techniques vary, but the most common procedure involves and lollipop shaped incision following the natural contour of the breast.
What are my options?
Here is a description of three different incision patterns and techniques that Dr. Jensen will discuss with you:
- The "anchor" incision, made around the perimeter of the areola, vertically down from the areola to the breast crease and horizontally along the breast crease, produces the longest incision.
- It is for women with a severe degree of sagging who will not be helped sufficiently by shorter incisions. This incision, which is the oldest technique, is often used for a breast lift in conjunction with a breast reduction.
- The "lollipop" lift, also known as a "keyhole" incision, made around the perimeter of the areola and vertically down from the areola to the breast crease, is suitable for women with a minimal to moderate degree of sagging who will not be helped sufficiently by the periareolar technique. This is often combined with silicone implants to give more fullness in the upper pole of the breast.
- The "donut" lift, also known as the "periareolar incision," made around the perimeter of the areola only, is suitable for women with a mild degree of sagging. When used by a skilled surgeon in conjunction with the placement of implants, it can produce a satisfactory result for patients with very minimal sagging. This is my least favorite technique as it tends to flatten the breast and really doesn’t produce much of a lift.
- The "crescent" lift, which is less commonly used, is an incision that lies just along the upper half of the areola. A crescent-shaped piece of skin is removed above that line, and the surrounding skin is reattached to the areola. This type of lift is usually done in conjunction with breast augmentation in women with no sagging. It cannot accomplish the same degree of lifting as the other incision techniques.
Illustration 2: Incisions outline the area of skin to be removed and the new position for the nipple.
Illustration 3: Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions giving the breast its new contour.
The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
Incisions follow your breasts’ natural contour defining the area of excision and the new location for the nipple.
If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
After your surgery
After surgery, you’ll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by Dr. Jensen.
Within a few days, a soft support bra will replace the bandages or surgical bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.
If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.
Illustration 4: If your expectations are realistic, chances are you’ll be satisfied with your breast lift.
You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.
Getting back to normal
Healing is gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don’t hesitate to call Dr. Jensen.
Dr. Jensen will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be intact.
Your new look
Dr. Jensen will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
You should also keep in mind that a breast lift won’t keep you firm forever-the effects of gravity, pregnancy, aging and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.
Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.