Shape and position on the chest are as important as size in defining the attractive breast. Transforming a breast which droops into one which is well contoured and well placed challenges the surgeon's artistic skills.
-Andrew Barnett, MD
Sagging of the breasts, whether due to pregnancy, weight loss, or simply the constant pull of gravity, is a problem confronting many women. It may be due to loss of breast volume or stretching of the skin. Modern techniques of breast lifting, called Mastopexy, can correct many of these problems, producing a pleasing, youthful appearance.
How is breast lifting performed?
Mastopexy is designed to lift the breast, producing a more attractive shape. The droopiness of the breast is referred to as ptosis. In women with ptotic breasts there are three areas which can be affected:
- The skin envelope may be stretched.
- The gland may have shrunk, as after pregnancy and breast feeding.
- The nipple region may be too low.
To perform a breast lift, we must first decide where the problem lies. The skin, which acts like a natural "bra", must frequently be reduced to provide better support, much like purchasing a new bra when the old one is stretched out. The nipple may need to be repositioned to a slightly higher location, and the volume of the breast may need to be reduced or enlarged. Finally, the breast gland must be reshaped.
Is the nipple-areola region removed from the breast and re-attached?
No. The nipple areola region is left attached and moved by re-positioning the entire gland, with the nipple areola attached.
Where are the skin incisions located?
Incisions are customized to each patient. There are two main techniques that are used for breast lifting, the Vertical Technique, and the Inverted T Technique.
The older technique, the Inverted T Technique, which I still do on many occasions, has a number of steps. To reduce your skin "bra", I basically take a dart in the area between the nipple and the fold under your breast. This fold is referred to as the inframammary fold. The incisions are located around the areola, and extend downward, in an up-side down V, to the inframammary fold. When the incisions are closed, the remaining stitch line forms an up-side down T, with the top part of the T (now the bottom part) in the inframammary fold, and the vertical part of the T extending to the areola. There is also an incision which goes around the areola.
The newer technique, which is the more common technique in my practice is referred to as the Vertical Technique. This technique reduces the incision significantly by reducing or eliminating the horizontal portion of the inverted T so there is only an incision around the areola, and a vertical incision. At your examination, I will discuss both techniques with you.
The advantage of the Vertical Technique is that the scarring is much less, and the breast shape is better. It is my preferred technique, and I use it when possible. At your consultation, we will discuss the differences between the two techniques.
On rare occasions, the incision can be limited to the area around the areola, a procedure referred to as a circumareolar mastopexy.
Will there be much scarring?
During the first few months after surgery, the incisions tend to become red and occasionally raised. With time they tend to fade nicely. The final result, of course, depends on how you heal.
Is the procedure painful?
The surgery is performed while you are under anesthesia, either local or general. Afterwards, there is some discomfort, but it's quite minimal. You will certainly be offered pain medication after the procedure, but most patients require very little.
How long will I need to be off from work?
I recommend that you take a minimum of five days off from work. This allows you to recover from the early affects of surgery. At the end of one week, you may resume non-strenuous activities, but you should limit lifting and stretching for an additional two weeks.
Is a blood transfusion necessary for this procedure?
Generally not. On rare occasions, I will recommend that you donate blood before the surgery. Your own blood is stored especially for you and is given only to you at the time of your surgery. Since it is your blood and no one else's, there is essentially no risk of receiving "contaminated" blood. This is called autotransfusion. We will give you complete information at the time of your office visit.
Do I need any special tests prior to breast lifting surgery?
If you are thirty years or older, I recommend a mammogram prior to surgery. This allows us to see if there are any suspicious areas that should be biopsied at the time of the breast reduction. In addition, as for all surgery, routine laboratory tests are taken.
Can my breasts be made larger or smaller at the time of the lift?
Yes. The goal is to produce an attractive breast in balance with the rest of your body. To achieve this goal I may recommend that you consider enlargement or reduction. At the time of your consulta-tion, we can discuss this in detail.
Are there risks to breast lifting or reduction?
As with all surgery, there are risks. Bleeding, scarring and infection may occur. Differences in the size and shape of the breast, generally quite small, are occasionally seen. Loss of the nipple areola or loss of sensation to this area may happen, but this is very unusual. Continued drooping of your breasts as you get older may also change the shape of your breasts. Adverse reactions to medications and anesthetics can also sometimes occur. These risks are explained not to frighten, but to inform you. Breast lifting is in general a safe and predictable operation.
Will insurance cover the cost of surgery?
No. Breast lifting is considered a cosmetic procedure.
Should I have it done?
That's a question that only you can answer. At the time of your consultation, we can discuss your questions and concerns in detail. You don't have to decide on the first visit, and you may decided that you're not interested at all. What is important is that we work together to make the decision that's right for you.