BREAST LIFT (Masteopexy)

About Breast Lift / Mastopexy

Many women experience the natural changes in breast shape over their lifetime.  Gravity, hormonal changes, pregnancy, breast feeding, changes in breast size, significant weight loss or gain, and other environmental causes can all contribute to the natural process of changing breast shape.  Some women are bothered by sagging or “drooping” breasts (called breast ptosis), larger than normal areola, or a lower nipple position as they mature.  Many women will say, “My breasts just aren’t where they used to be before I had children.”  This can adversely affect their sense of beauty, youthfulness, and femininity.

Not only can overly sagging or ptotic breasts cause disturbing emotional and psychological symptoms making women self-conscious and uncomfortable with their body-image, but significant drooping may occasionally cause physical symptoms as well.  Large drooping breasts can cause back and neck pain or painful grooves on the shoulders from bra straps which are caused by excess breast weight on the chest.  Some women with large pendulous breasts have rashes, yeast infections, and non-healing skin wounds where their breasts rub on their chest or abdomen.  The constant moisture and rubbing of the bra against this area can be very troublesome, especially in the hotter summer months.

The goal of most breast lifting procedures is to move the nipple position up to the center of the breast and to adjust the shape of the breast to move it to a more youthful position.  Many times natural asymmetry exists where one breast has a different shape, size, or nipple position.  The secondary goal of breast lifting is to improve the natural asymmetries and to make the breasts look more alike knowing that perfect symmetry is probably not achievable.  “Breasts are sisters not twins.”

Mastopexy, or a breast lift, is always part of a breast reduction if a woman has very large breasts.  Patients interested in making larger breasts smaller can read the Breast Reduction section of our website. 

Women seeking mastopexy or breast lifting alone are usually women who are happy with the size of their breasts in a bra or would like to be SLIGHTLY bigger or smaller.  They are more unhappy with the appearance of their breasts than they are with the size of their breasts.

Women who would like more youthful uplifted breasts AND MORE breast volume are often candidates for a breast augmentation with or without mastopexy (breast lift).  In some cases, mild ptosis (or breast sagging) can be corrected effectively with a well planned breast augmentation to “fill out the deflated breast skin” as it was when the patient was younger.  However, many patients will still need a breast lift even after breast augmentation or enhancement.  The combination of the two procedures is more complicated and slightly more risky but can still be performed safely.  This decision requires careful discussion with your surgeon about your aesthetic goals.  Sometimes a staged approach with two separate surgeries to allow reshaping and healing of the breast followed by augmentation of the breasts in a second surgery several months later is the safest option.  Your surgeon will discuss this with you on an individual basis since every patient’s exam is different.  At Park Meadows Cosmetic Surgery, we are committed to providing an individualized approach to meet or surpass your aesthetic goals. 

INCISION TYPES

Is Mastopexy Or A Breast Lift Right For Me?

If you are a woman who is concerned about drooping or “deflated” breasts,low nipple position, or enlarged areola (the dark round skin around the nipple), then you are a good candidate to be evaluated for one of several options to improve your breast shape to a more uplifted, full, and youthful position.  Your surgeon at Park Meadows Cosmetic Surgery will examine your breasts and review your general medical history to help determine if you are a good candidate for surgery.  Usually surgery is an option once the breasts have fully matured (after puberty).  Also it is best to wait until the patient no longer expects any more pregnancies that would affect breast shape. The best surgical candidates are those women who are also mature enough to understand the procedure and have realistic expectations about the results.

In general, Mastopexy or breast lifting is a safe and successful procedurethat reshapes the breast fat, glandular tissue, and skin.   The surgeons at Park Meadows Cosmetic Surgery endeavor to restore a woman’s sense of femininity and youthful natural beauty by restoring the breasts to a more perky, youthful, and aesthetically pleasing shape that is balanced with the patient’s body.

Mastopexy (Breast Lift) Surgery

There are many techniques for lifting the breast depending on the severity of the ptosis or breast drooping and deflation.  All of them address the low nipple position.  Some of them are more aggressive in reshaping the breast and removing excess skin.  They can range from placement of a simple breast implant (breast augmentation or enhancement) for mild deformities, to “limited scar” techniques for moderate deformities, to longer scar techniques for those women needing the most correction.  With these techniques, scars can range from almost unnoticeable to an anchor shaped scar around the nipple, down from the nipple to the breast fold, and under the breast fold.  Your surgeon will discuss which technique is best for you.  Most women are happy to trade a well planned, well healed scar for a more youthful, full, and uplifted breast.

As stated, some women are good candidates for “limited scar” or “short scar” techniques that can eliminate one or more of the scars.

Stitches are usually buried and dissolve.  The patient will usually never see them or have the unpleasant experience of having multiple sutures removed in the office. 

All Surgery Carries Some Uncertainty & Risk.

Breast lifting or Mastopexy is not a simple operation because the surgeon has to reshape the gland, lift the nipple and remove the extra skin of the breast to recreate a lifted, aesthetically pleasing breast.  However, the operation is normally safe when performed by a qualified surgeon.  Nevertheless, as with any surgery, there is always a risk of complications.  These risks increase slightly when breast lifting is performed with a breast augmentation in the same operation.

Operative risks include, but are not limited to, excess bleeding, infection, poor skin healing, poor breast healing.  Because it is necessary to make incisions around the areola and nipple to move them to a higher location, the nipple can be at risk.  In very rare circumstances, the skin of the nipple can loose its blood supply.  If this happens, the nipple can die and cause permanent scarring.  This can be corrected to a large extent after healing by rebuilding the nipple (as is done for patients with breast cancer), but permanent scars of the nipple itself are still a rare risk of breast lifting.  Smokers are at higher risk for many of these complications.  It is important to stop smoking at least a month before surgery.

Aditional Surgeries: In the some cases, your body can be reshaped in 1 surgery.  However, some patients will be better advised to have more than 1 operation after a period of healing.  A planned staged approach can be safer in some patients.  Healing can be unpredictable resulting in asymmetry.  In some cases a second smaller “touch up” surgery is required to give you the best result possible.

Delayed Wound Healing and Dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.

Scars: A surgeon cannot lift and reshape the breast without making incisions.  Any incision will produce a permanent scar.  Your surgeon will discuss with you one of several options depending on your breast shape and size.  However, most scars heal well and almost all patients are happy to trade these incisions for an improved sense of femininity and self-confidence.  In the rare incidence, a scar will be thick and unattractive.  If this is the case with your scars, your surgeon will provide several options to fix or improve them.  Regardless, your scars should all be hidden behind a bathing suit top or a bra. 

Asymmetry: There is a saying, “Breasts are sisters not twins.”  That is to say that every woman has some natural asymmetry in her breasts.  Your surgeon will endeavor to correct any natural differences in your breasts and make your breasts match in size and shape. However, in any type of breast surgery, there can be slight differences in nipple position, breast shape, fullness, and healing that are impossible to predict.  If large differences occur after surgery, your surgeon is committed to provide you with the most pleasing result he thinks he can provide. 

Breast Sensation: Breast and nipple sensation can be changed by any breast surgery, including breast lifting, breast augmentation and breast reduction surgery. Some women experience REDUCED breast and nipple sensation because the nerves to the skin can be cut or damaged during surgery. These changes are usually temporary, but can be permanent and may affect your sexual response or your ability to nurse a baby. Most women will have no long-term change in their sensation.

Breast Feeding: A women’s ability to breast feed can be permanently affected with any breast surgery.  It is important to remember about 10% of normal women, without surgery, cannot breast feed.  Having a breast lift or augment will increase this risk.  Often women will be able to breast feed but will have to supplement with a bottle because their milk supply will not be adequate.  Mastopexy or breast lifting is generally NOT recommended until a woman has completed her childbearing because pregnancy after mastopexy can recreate the original breast sagging that was once corrected, thus requiring another surgery. 

Pain: If you experience severe pain not relieved by pain medicine, notify your surgeon immediately. Some discomfort is expected after surgery and you will receive a prescription for pain medication. The intensity and duration of pain after breast lifting will vary among women. Prolonged or intense pain can be due to scarring around a nerve and fortunately is very rare.

Infection: A small number of women develop an infection. This typically can occur several days to several weeks after the procedure. If an infection does not respond to antibiotic pills, a patient may need intravenous antibiotics in the hospital.  Fortunately, hospitalization is very rare.

Hematoma and Seroma: A hematoma is a collection of blood under the skin, and a seroma is a collection of the watery portion of the blood under the skin. Hematomas or seromas typically develop within the first few days after surgery; however, they may occur at any time after injury to the breast. The body can reabsorb small hematomas or seromas. Larger ones require the placement of a drain for proper healing. A small scar can develop at the surgical drain site.

Preparing For Your Mastopexy (Breast Lift) Surgery

The surgeons at Park Meadows Cosmetic Surgery will usually require you to have a current mammogram (breast x-ray) before your surgery, especially if you are older than 40.  Any breast surgery can alter your mammogram, so it is helpful to have a preoperative x-ray on record to compare if questions arise. You will also get a set of pre-operative instructions describing how you should prepare for surgery.  Certain medications and nutritional supplements can thin the blood and need to be stopped two weeks prior to surgery.

After Your Breast Lift

You will be given a comprehensive set of post-operative instructions prior to your surgery.  You will have steri-strips covering your incisions.  Some patients will have tape or bandages covering the breasts to help shape or support the breast after surgery.  You will be given a post-surgical bra to wear for approximately 6 weeks.  Many women find they can alternate this with a NON-underwire supportive exercise bra after two weeks.

Some patients will need drains in the breast for a very short time.  If you have drains, you and your family will be instructed on how to care for them. Most women are able to return to work 10 to 14 days after surgery if they do not have a very active job that requires heavy physical lifting or activity. It can take up to six months for the breasts to “settle” and achieve their final shape.

Patients can experience random, shooting, discomforts or pain after surgery.  This is normal and typically improves within several months. Some women will notice changes in their breast and nipple sensation after surgery.  Some women are more sensitive, while others are less sensitive.  These sensations tend to even out over time, but in a few cases can be permanent.

Preparing For Your Surgery

At least 1 month before surgery
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.

2 weeks prior to surgery
Stop all medications that can thin the blood 2 weeks prior to surgery. These include drugs such as aspirin, Coumadin, Lovenox, ibuprofen, vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. Please see the last page of this pamphlet for a list of drugs that must be stopped.

Report any signs of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.

1 week prior to surgery
Do not eat or drink anything after midnight before your surgery. This includes: no water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery.

The day before surgery
Plan to wear comfortable loose fitting clothes to the procedure.
Do not wear jewelry or bring valuables with you on the day of surgery.
You must arrange to have a responsible adult drive you home after your procedure.

What To Expect On The Day Of Surgery.

When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.

Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.

When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.

Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but they may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.

You must have a responsible adult drive you home from the surgery center. This individual should have your prescription filled at the pharmacy prior to taking you home. A responsible adult must stay with you the first night after your surgery because you have been sedated.

Post-operative Instructions

Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.

Driving: No driving for 48 hours after your procedure or while taking pain medicine.

Activity: You may walk and climb stairs immediately after surgery. After 4 weeks you may resume light activity such as brisk walking. During the first 4 weeks do not lift anything heavier than a gallon of milk. After 6 weeks you may resume more strenuous aerobic work and lifting activities as tolerated.

Work: Depending on your career and your rate of healing you should be able to return to work within 2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on your physical and professional profile.

Wound Care: Keep your dressings clean, dry, and intact for the first 48 hours. Then remove the top dressing, and leave the paper tapes in place; these will fall off in approximately 1 week. If you go home with a drain, empty and record its daily output. Keep a sterile dry dressing over the site where the drain enters the body. Change this dressing daily. Once the drain is removed, you need to keep a dressing over the drain site for 1 to 2 days or until the drain site heals.

Swelling: Moderate swelling and bruising should be expected during the first 2 to 3 weeks after surgery. During this period wear a bra without under-wires that provides support at all times (except when showering) to minimize swelling and discomfort. Mild swelling will continue for 2 to 3 months. Women may notice additional swel1ing and discomfort during menstruation.

Bathing: If you do not have a drain you may shower 48 hours after you remove your dressing. If you go home with a drain, you may shower once it is removed. Your surgeon will typically remove your drain 1 to 2 days after surgery. When you do shower do not direct the water spray over your incision site. Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks.

Medications: Ask your surgeon when you should resume your blood thinning medications. All other prescription medications may be resumed immediately.  While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Take the full course of antibiotics given by your surgeon to help prevent infection.

Smoking and Alcohol: Do not smoke for the first month after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption is dangerous while taking pain medicine because it has a tendency to worsen bleeding.

Post-operative Appointment: Your surgeon wi1l schedule follow-up visits at appropriate intervals. Please keep all these appointments so that your progress may be followed closely.

Special Considerations: Call your surgeon immediately if you experience any of the following: excessive pain, bleeding, redness at the incision site, or fever over 101° F.

Final Results: You will see dramatic improvements immediately after surgery with which you will be quite pleased.  However, it may take six months to a year before the breasts reach their final contour and shape.