Breast

1. Overview

A breast lift (or “mastopexy”) is a cosmetic surgical procedure used to lift and reshape sagging (ptotic) breasts resulting from pregnancy, breastfeeding, fluctuations in weight, and/or aging. By rearranging the breast tissue and raising the nipple position, while removing excess skin to tighten the surrounding skin envelope, a mastopexy can help restore a firm, more youthful breast profile.

2. IDEAL CANDIDATES

The best candidates for a breast lift procedure are healthy women who:

• Are non-smokers
• Have a stable and relatively normal body weight
• Are satisfied with their current breast size
• Have realistic expectations regarding the results of the procedure
• Are bothered by one or more of the following breast-related issues:
• Sagging (ptotic) breasts
• Breasts that have lost their youthful shape and firmness
• Breasts that appear flatter (“deflated”), have an elongated shape, or are pendulous
• Nipples that fall below the breast crease when the breasts are not supported
• Nipples/areolas point downwards
• Stretched breast skin and enlarged areolas
• Breast and/or nipple asymmetry

3. THE PROCEDURE

3.1. ANESTHESIA

A breast lift procedure is usually performed under general anesthesia. Though less common, the procedure can also be performed under local anesthesia with intravenous sedation.

3.2. TECHNIQUES

A breast lift can be performed through a variety techniques. Regardless of the breast lift technique used, an incision is required to remove excess skin in order to lift and reshape the breast.

3.2.1. INCISIONS/SCAR PATTERN AND LOCATION

• Excess skin within the incision pattern is removed and wounds are closed in multiple layers with absorbable sutures.
  This technique is most often used in cases of severe ptosis (sagging), where there is a larger amount of excess skin.

B. VERTICAL MASTOPEXY

• The incisions used to perform a vertical mastopexy will result in a “keyhole” (or “racquet-shaped”) scar that circles the areola and extends vertically down to the breast fold.
• Excess skin within the incision pattern is removed and wounds are closed in multiple layers with absorbable sutures.
• This technique avoids the horizontal scar component required by the Wise pattern technique.

C. PERIAREOLAR MASTOPEXY (“DOUGHNUT MASTOPEXY”)

• The incisions used to perform a periareolar mastopexy will result in a scar that circles the areola.
• The size of the areola is reduced by removing a “doughnut” of areolar and breast skin. The outer margin of the reduced areola is then reattached to the surrounding skin with absorbable sutures to lift the breast.
• This technique results in the least amount of visible scarring of all the available breast lift techniques.

Although scars are permanent and visible on the breast, they are well concealed when wearing a swimsuit or brassiere.

4. COMBINED PROCEDURES

4.1. BREAST PROCEDURES

A breast lift will not significantly change the volume of your breasts. One of the following combined procedures could be more suitable treatment option for women with ptotic breasts, who are also looking to either increase or decrease the volume of their breasts:

4.1.1. MASTOPEXY-AUGMENTATION (BREAST LIFT WITH IMPLANTS)

• Women who are suitable candidates for a breast lift procedure, but who are also interested in enhancing volume of their breasts, should consider the option of having combined mastopexy-augmentation procedure.
• A mastopexy-augmentation offers patients the benefits of both a breast lift and BREAST AUGMENTATION procedure, in a single operative setting.

4.1.2. BREAST REDUCTION (REDUCTION MAMMAPLASTY)

• Women who are suitable candidates for a breast lift procedure, but who would also like to have smaller breasts, should consider the option of having a breast reduction procedure.
• A breast reduction procedure uses incision patterns which are very similar to those used to before a breast lift procedure; however, in addition to removing skin, a breast reduction procedure removes excess fat and breast tissue before lifting the breast.
• Please refer to the section on BREAST REDUCTION (REDUCTION MAMMAPLASTY) for a more detailed description of this procedure.

4.2. OTHER

4.2.1. BODY CONTOURING PROCEDURES

• Patients who are also bothered by excess sagging skin in other areas of their body could consider combining their breast lift with another body contouring procedure (i.e. “tummy tuck” and/or liposuction). Combined procedures offer patients the advantage of treating multiple areas of their body in one operative setting with a shorter overall recovery period.
• See also MOMMY MAKEOVERS
• A “mommy makeover” is a combination of cosmetic surgical procedures to address changes in a woman’s body following childbirth. The most common procedures that are combined include:
• Breast lift (mastopexy) or breast lift with implants (mastopexy-augmentation)
• Abdominoplasty
• Liposuction (usually of the abdomen and lower body)

5. PREOPERATIVE CONSULTATION

Dr. Lee will perform a thorough medical evaluation during your consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.

After carefully evaluating your breast anatomy and assessing your aesthetic goals, Dr. Lee will review your available surgical options and help you choose the breast lift technique that will allow you to achieve your desired results. The following factors will be taken into consideration by Dr. Lee throughout the decision-making process: your body weight and height; your breast size and shape, the size and position of your areolas; the degree of breast sagging (ptosis); as well as the quality, elasticity, and amount of excess breast skin.

Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively.

Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram 1-2 weeks before surgery. Dr. Lee may also recommend that you undergo a pre-operative baseline mammogram, as this helps detect future changes in your breast tissue. If necessary, further recommendations will be made once the results of these tests have been reviewed.

7. RISKS AND COMPLICATIONS

As with any surgery, there are risks associated with breast lift procedure. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.

Risks and complications include:

• Risks associated with anesthesia
• Bleeding (hematoma)
• Infection
• Changes in nipple or breast sensation, which may be temporary or permanent
• Scarring
• Fluid accumulation (seroma)
• Poor wound healing
• Persistent postoperative pain
• Breast contour and shape irregularities
• Excessive firmness of the breast
• Potential inability to breastfeed
• Potential loss of skin/breast tissue where incisions meet each other
• Potential partial or total loss of nipple and areola
• Skin discoloration and/or prolonged swelling
• Potential of fat tissue deep to the skin dying (fat necrosis)
• Deep vein thrombosis
• Possible need for revision surgery

Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery.