Q & A

What is a breast lift? A breast lift is an operation designed to reposition the breast tissue to a higher level on the chest while tightening the skin envelope and raising the nipple position. In some cases, placing a breast implant will accomplish all of the goals of a mastopexy simply by adding volume to the breast that has been lost due to aging or childbirth.

What happens to the breast that makes a mastopexy necessary? In some cases, patients are born with an abnormally shaped breast, or a nipple position that is unusually low. The majority of patients have changes in the breast that have evolved over time. These changes include a loss of soft-tissue volume, stretched-out skin, and a nipple position that points down. Most commonly, the changes occur as a consequence of pregnancy. During pregnancy, hormonal stimulation causes the breast tissue to swell and increase in volume. Women can commonly experience an increase of up to a cup size during their pregnancy. While the increased breast size can be welcome, it disappears after delivery – with or without breast-feeding. As hormonal stimulation is removed and volume decreases, an unwelcome side-effect of breast enlargement becomes evident – stretched skin. The combination of stretched skin and loss of breast volume leads to an “empty” or “floppy” appearance to the breast which is most evident in its upper half. In addition, the nipple assumes a lower position on the breast that points downward instead of outward. These changes are termed “post-partum atrophy of the breast”.

How is the operation done? There a many types of operations designed to re-shape the breast. The choice of operation depends on what changes need to be corrected, and their severity. Each operation must be customized to the needs of the individual patient. Choices include:

Breast Augmentation: For less significant changes in the breast, restoring lost volume can effectively raise the nipple position and “re-fill” the stretched skin envelope.

Peri-areolar mastopexy: This operation makes an incision around the edge of the areola to detach it from the skin and allow its position to be moved. A circle of skin around the areola is then removed to help tighten the skin envelope. Suture material is then passed around the skin edge as a “purse string” and tightened. After healing, the operation will leave a scar around the entire areola.

Vertical Reduction patterns: Vertical patterns are similar to the peri-areolar mastopexy, but include removal of skin between the areola and the infra-mammary fold (the natural crease between the bottom of the breast and the chest). In addition to leaving a scar around the areola, there is a scar in the midline of the breast below the nipple.

Modified Wise pattern: Mastopexy performed using this technique is essentially a breast reduction without removing volume. Scars left by the operation are the same as those created by the vertical reduction pattern, but also include a scar in the infra-mammary fold. This pattern is also known as an “anchor” or “inverted T” pattern due to the overall shape of the scar.

Regardless of the technique used to lift and tighten the breast, breast implants can be placed through the incisions if needed to restore lost volume. The combined procedures are commonly done and termed “mastopexy-augments”. Similarly, every patient who needs their nipple raised to a higher position on the breast will have to accept a scar around the areola. In most cases, the decision to have a Mastopexy is a conscious choice to trade scars on the breast for an improved shape. The major issue is the amount and location of the scarring.

Will Mastopexy change my mammogram? Yes, however this does not represent a problem. This issue has undergone extensive study and the changes in the mammogram do not create confusion in the detection of cancer. In patients old enough to need annual mammograms, they should be done prior to surgery to insure that no “surprises” occur during or after the operation. Abnormalities on a mammogram should be thoroughly evaluated prior to undergoing any type of breast surgery. A new baseline mammogram should be done approximately six months after the surgery.

Can I breast feed after a mastopexy? In most cases, Mastopexy does not disturb the milk glands or ducts of the breast, and should allow breast feeding post-operatively.

Will a mastopexy get rid of all of the stretch marks on my breast? Unfortunately, stretch marks above and on either side of the areola are not removed by a mastopexy. Excess skin below the nipple is removed and usually takes some of the stretch marks with it. In some patients, the existing stretch marks can become red after a Mastopexy - as they were when they first appeared. This is due to tension being placed on them from the “repackaged” breast tissue. The good news is that they fade to a silvery-white as they did following pregnancy.

What are the risks of surgery? Most risks are the same as any operation and include bleeding, infection, wound separation, and fluid collections. Potential problems specific to mastopexy are: Loss of nipple sensation; necrosis and loss of part, or all, of the nipple; asymmetry of the breasts; scar hypertrophy; and stretching or widening of the areolar diameter. Serious complications are most common in patients who smoke due to poor wound healing and impaired blood supply to the tissues. As with most cosmetic surgery, the overall rate of significant complications is low.

Can the breasts drop again and require another operation? In patients who gain significant weight after surgery, the breast can increase in size due to increased fatty tissue volume. Similarly, if pregnancy occurs after Mastopexy, the breasts can increase in volume as do breasts that have never been surgically altered. For this reason, Mastopexy is ideally done on patients who have completed child-bearing, and have a stable base-line weight. Waiting for surgery until after pregnancies are completed assures a more long-lasting result.

Can I have a Breast Lift at the same time as a Gynecologic operation such as a hysterectomy, tubal ligation, or laparoscopy? The answer is yes for many types of gynecological surgery. Ask you GYN doctor if combined procedures are right for you.

Why would I want to combine these types of operations? Cost savings are realized by reducing the total operating time. If you are having gynecologic surgery for medically indicated reasons, there is usually a recovery time involved that includes time off of work. By having your breast operation at the same time as your gynecologic procedure, you can recover from both at the same time!

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469