Common Breast Lift (mastopexy) Questions
What is a mastopexy or breast lift?
A breast lift is referred to as mastopexy. The idea of a mastopexy is to restore the breast position to a higher place on the chest wall. There are many different ways this can be accomplished. All of them require some sort of surgery. There are no non surgical ways to permanently lift the breasts. There are no pills or potions.
Breast droopiness is called “ptosis”. Ptosis of the breast is generally described with the relationship of the nopple to the breast fold, and, its relationship to the most projecting point of the breast.
Grade 1 ptosis
Grade 2 ptosis
Grade 3 ptosis
Although there is no clear cut algorithm matching grade of ptosis to type of mastopexy, the general rule is that the higher the grade, the more incisions need to be placed on the breast to restore perkiness.
What are the types of mastopexy procedures?
From least invasive to invasive, techniques exist that either lift the breast to correct droopiness.
Breast augmentation surgery can correct very mild forms of breast ptosis. Saline implants placed under the muscle, or silicone implants placed over the muscle or in a dual plane accomplish this the best. The nipple can be lifted a little, but don’t expect major corrections of ptosis from a breast augmentation alone. For a breast augmentation to improve ptosis, the nipple should already be resting at the same level of the breast fold. With the addition of volume, the nipple will reside on a fuller, more projected and premier breast. If the implant is placed in a breast where the nipple is starting off lower than the fold, it will generally end up looking unattractive.
In some cases of mild ptosis it makes sense to perform a breast augmentation without a lift and wait several months to see if the implants settle into a position that lifts the nipple. Patients may not like the shape of their breast for a few months, but it may save additional incisions and scars on the breast. If in 3 months the nipple still looks low, I raise it in the office surgically under local anesthesia.
What is a crescent shaped lift, or crescent shaped mastopexy?
The crescent shaped lift really refers to repositioning the nipple higher on the breast mound. Calling it a mastopexy is abut of a misnomer because the breast isn’t lifted. The nipple is lifted. This is generally performed when the breast has mild ptosis, and the aesthetics of the breast could be improved moving the nipple higher to sit at the most projecting part of the breast. As a rule, one can only lift the nipple 1 to 1.5 cm this way before really distorting the shape of the areola. All areola will stretch from this procedure, but it’s a fair trade off for a premier looking breast.
What is a Binelli or circumareolar lift?
The Binelli or circumareolar breast lift describes an incision that removes skin mainly outside and around the areola with a repositioning or suspension of the breast to a higher position on the chest wall. The scar rests around the areaola. While this sounds like a magnificent alternative to the lollipop or anchor lift (see below) it has some major limitations. For one, the more the nipple and breast needs to be lifted, the more skin must be excised. Excision of skin will place tension on the closure and result in a widened scar. This is inevitable. It also flattens the breast. Thus, the Binelli lift orcircumareolar lift when performed to aggressively willresult intwo unfavorable cosmetic outcomes.
In addition to widened scars, the areola will also widen with time. It always does. Plastic surgeons have tried all sorts of tricks to keep the areola small and youthful looking using fancy permanent stitches and stitching patterns. None combat the forces of nature.
This is opposed to the lollipop and anchor lifts which do leave more scars, but a premier, more natural looking breast. Add an implant into the mix with a Benelli or circumareolar lift and the problems are compounded. However, with a conservative approach in the right patient (ie. small implant, lift no more than 2 cm) the Benelli and circumareolar lofts can be terrific.
Revisions of scars from this type of lift generally are disappointing without the artistic use of medical tattooing, especially if there is a breast implant in place. Tension equals widened Scar. Big implants can put a lot of tension on scars.
The lollipop breast life is called this because the final incision ends up looking like a lollipop. It is also referred to as a vertical lift because there is no horizontal scar running along the breast fold as in the anchor lift. The lollipop will generally reduce tension around the areaola and result in a superior scar than the Binelli or circumareolar without flattening the breast. In fact, the vertical lift not only lifts the breast but greatly improves breast shape. Like anything else, there are limitations the the vertical or lollipop breast lift. There is a point where a horizontal incision must be incorporated. Unlike the circumareolar or Benelli lift, there are no good hard numbers regarding nipple or breast lift to implement when we decide if we need to add a horizontal incision to the vertical incision to restore perkiness. A large part of this decision is surgeon preference or experience. There are a few plastic surgeons that believe almost every breast can be lifted simply with a vertical incision. Most, however, would disagree. When one pushes the limits with a vertical lift, bunching of the skin inevitably occurs on the bottom of the breast. Bunching of skin may get better with time, and many patients with this bunching will need revisions to include a horizontal incision.
The anchor lift is also called aWise pattern breast lift is generally the preferred approach for patients with significant breast posits. This incorporates principles of the Benelli or circumareolar lift as well as the vertical lift and adds a horizontal component to result in the most powerful lift possible. The length of the horizontal incision is determined by the amount of lifting necessary.
With the vertical and Wise pattern lifts, the scars will rest around the areola, and one from the center of the areola to the breast crease. In fair skinned women, these scars because they are not under a great deal of tension generally heal remarkably well. The wise pattern or anchor lift horizontal scar runs along the breast fold and is well hidden under the breast.
Breast augmentations can be combined with any breast lift approach either at the time of surgery or in a later stage. For more on breast lift or mastopexy augmentation, please visit this section.
What are the risks of a breast lift or mastopexy?
Like any other surgery risks include bleeding and infection. However bleeding and infection are generally less common than healing problems.
Bleeding is never life threatening, but can put pressure on the tissues resulting in poor healing or nipple necrosis. There is more on nipple necrosis below.
Infection rate of the breast after breast lift is thankfully low. Just about all of them will resolve with oral antibiotics. The signs and symptoms of a breast infection include redness, warmth, and tenderness.
The more tension and the more incisions, the greater chance of a healing issue. With a mastopexy augmentation, wound healing is a feared complication because there are two counteractive forces acting against the incision – the skin envelope is reduced to lift the breast, yet we are adding volume to enlarge the breast. This is the primary concern for single stage mastopexy augmentations and the main argument to do mastopexy augmentations in 2 stages.
For the Benelli or circumareolar breast lift, tension is placed along the incision around the areola. When one lifts the nipple more than a couple centimeters, the tension on this closure increases and can result in widened scars. In addition, the areola will also expand over time. A feared complication from this type of lift is wound separation. If wound separation occurs, wound care in the form of gauze or antibacterial ointment is applied until the wound heals. Months later, the scar can be revised.
A vertical or lollipop lift has what is called an incision trifurcation. This is an area where the vertical incision meets the areola incision. not only is this a point of tension, it is also a point of potentially less blood flow. Small skin separations in this area are not uncommon. They too are treated with dressings and ointments and can be revised down the road.
A complication unique to the vertical lift is skin bunching along the bottom of the breast. While this is expected to some degree, in more significant cases where the horizontal incision was spared, bunching may need to be revised in the office by excising the bunching by adding a horizontal incision in the breast crease. However, your surgeon may tell you to be patient to allow the tissues to settle. Sometimes, not always, the bunching relaxes over the course of months saving one from an additional horizontal scar.
Asymmetry is common after a breast lift or mastopexy. One of Dr. Neavin’s mentors, Dr. Guy Stofman in Pittsburgh, used to have a saying, “God didn’t make you perfect so neither can I.”. This wasn’t an excuse, it was a reality. Mild asymmetries in breast and areolas size and shape is normal. Large ones should be corrected if they can be corrected. One shouldn’t worry about asymmetry in the incisions, however, if your breasts are symmetrical. It isn’t uncommon for incisions to be asymmetrical when one is operating on asymmetrical breasts.
Another complication which might be better called an expectation, is recurrence of ptosis. Generally, the drop won’t be enough to revise the breast. But tissues stretch. The cant beat gravity. Support bras are critical to keep tissues from stretching. But a great deal of tissue elasticity Is the effect of genetics.
What are the alternatives to breast lift?
I may not make any new friends with this answer, but other than surgery there are none. Yes, non invasive skin tightening procedures exist, but they are not recommended for the breast. A saggy breast doesn’t just sag because the skin is loose. The entire breast composite is droopy.
Rather than considering what can be done to reverse breast ptosis, one should focus on preventative measures if breast are still in a perky shape and position. Chances are if you are reading this, you are beyond support bras. Smoking is very detrimental to the elastic properties of skin. And while you technically may be able to disown your mother and father, you can replace the genes they passed on to you. There is no pill, no injection, no gene therapy, and no laser that can prevent breasts from dropping.
Perhaps the greatest enemy to breast perkiness is pregnancy and rapid weight loss and gain. Lactation and weight gain stretch the tissues of the breast. In many people, the breast will not return to its prior firm shape after pregnancy or after rapid weight loss.
A common question women ask is when it is ok to have a breast lift after pregnancy. Lactation willcontinue while breast feeding. Once breast feeding is stopped, it is generally a good idea to wait at least 3 months until performing a breast lift for two reasons: one, The breasts will take a couple of months to contract. Two, residual milk in the breast can pose an infection or healing risk.
What is the downtime to breast lift?
There are several types of. Breast lift procedures as discussed above. They mainly differ in the incisions which are proportional in size to the droopiness of the breast. Breast lift without breast implant has a quicker recovery than breast lift without implant. A pure mastopexy surgery is really a surface operation, meaning, the cutting of fished is above muscle. For this reason, the downtime is mainly related to any post operative pain and healing of the incisions. Mastopexy without breast augmentation is not terribly painful. However, large incisions should be protected with dressings for a week. Exercise should be avoided until 2 weeks – 3 weeks depending on the size of incisions.
The addition of breast implant will change the post operative regimen. If the breast implant is placed under the muscle as most are, then one could expect more pain and soreness for the first 3 or 4 days. Upper body exercise should be avoided for 4 weeks. As a rule, I tell patients that they shouldn’t lift anything heavier than a gallon of milk for the first 2 weeks.
What is the cost of breast lift (mastopexy)?
The cost of a breast lift is related to complexity and duration of surgery. The addition of breast implants may add extra time in addition to the cost of the implants ($400 to $700 for saline or silicone, each, respectively). Simple one sided (unilateral) lifts that can be performed under local anesthesia in the office may cost less than $1,500. However, most women desiring a breast lift will be faced with several hours of surgery with a price tag that ranges $7,500 to up to $12,000 or more.
What is the future of breast lift surgery?
Trends for mastopexy have been to reduce the size of incisions. However, the best shapes of breasts are often breathed with larger incisions in women with very saggy breasts. Trading improved shape for scar is the rule for breast lift surgery. The future of this procedure will parallel the ability to reduce scar visibility. Unfortunately, there is no magical instrument, cream, or pill available to make scars disappear or prevent them altogether. Prevention of infection, avoidance of all tobacco products, nicotine products, and second hand smoke will improve healing. Avoidance of sun exposure and religious application of sunscreen with SPF of 30 or greater will reduce discoloration of the scar. Frequent massaging of the scar will flatten it.