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 and all of them require some sort of surgery. There are no nonsurgical ways to permanently lift the breasts.
Breast droopiness is called ptosis. Ptosis of the breast is generally determined by the relationship of the nipple to the breast fold, and to the most projecting point of the breast.
Grade 1 ptosis
Grade 2 ptosis
Grade 3 ptosis
Although there is no clear cut algorithm that matches 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.
From least invasive to invasive, different techniques exist to lift the breast and 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 small amount, but don’t expect major corrections of ptosis from a breast augmentation alone. For a breast augmentation to successfully 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 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 the nipple still looks low after three months, I raise it in the office surgically under local anesthesia.
The crescent-shaped lift really refers to re-positioning the nipple higher on the breast mound. Calling it a mastopexy is somewhat 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.
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 positive alternative to the lollipop or anchor lift (see below), it has some major limitations. First, 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 and a flatter breast. For this reason, the Binelli or circumareolar lift, when performed to aggressively, will result in two 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 successfully.
On the other hand, the lollipop and anchor lifts, which do leave more scars, result in a more natural looking breast. Add an implant 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 lifts can provide superior results.
Revisions of scars after this type of lift are generally disappointing without the artistic use of medical tattooing, especially if there is a breast implant in place. Tension results in a widened scar and big implants can put excessive tension on scars.
The lollipop breast lift gets its name because the final incision resembles 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 to the Binelli or circumareolar without flattening the breast. In fact, the vertical lift not only lifts the breast but greatly improves breast shape.
There are limitations to 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 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, but many patients with this bunching will need revisions to include a horizontal incision.
The anchor lift, also called a Wise pattern breast lift, is generally the preferred approach for patients with significant breast ptosis. 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 generally heal remarkably well since they are not under much tension. The wise pattern or anchor lift horizontal scar runs along the breast fold and is well hidden under the breast.
Breast augmentation 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.
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 rates after breast lift are thankfully low and 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 you have after surgery, the greater your chance of having 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, while we are adding volume to enlarge the breast. This is the primary concern with single-stage mastopexy augmentations and the main argument to do mastopexy augmentations in two separate 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 of 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, bunching may need to be revised in the office by adding a horizontal incision in the breast crease and excising the bunching. 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. 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 over time.. Support bras are critical to keep tissues from stretching. But a great deal of tissue elasticity Is the effect of genetics.
I may not make any new friends with this answer, but other than surgery, there are none. Yes, noninvasive skin tightening procedures exist, but they are not recommended for the breast. A sagging 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 cannot 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 enemies to breast perkiness are 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.
Women frequently ask when it is appropriate to have a breast lift after pregnancy. Lactation will continue while breast feeding. Once breast feeding is stopped, it is generally a good idea to wait at least three months until performing a breast lift for two reasons. First, the breasts will take some time to contract after lactation is completed. Second, residual milk in the breast can pose an infection or healing risk.
There are several types of breast lift procedures, which differ in the size of the incisions required to achieve the desired results. A breast lift without a breast implant has a quicker recovery than breast lift with an implant. A pure mastopexy surgery is a surface operation, meaning all of the cutting is located 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 uncomfortable, although large incisions should be protected with dressings for a week. Exercise should be avoided for two to three weeks, depending on the size of your 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 soreness for the first three or four days. Upper body exercise should be avoided for four weeks. As a rule, I tell patients that they shouldn’t lift anything heavier than a gallon of milk for the first two weeks.
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 each saline or silicone implant, 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 and a price tag that ranges from $7,500 to up to $12,000 or more.
Trends for mastopexy have been to reduce the size of incisions. However, the best shapes for the breasts are often achieved with larger incisions, particularly 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 and nicotine products, as well as secondhand smoke will improve healing. Avoidance of sun exposure and religious application of sunscreen with SPF 30 or greater will reduce discoloration of the scar. Frequent massaging of the scar will flatten it.
If you are considering breast lift surgery, be sure you collect all the facts about the procedure necessary to make the right choice for you. To learn more, contact Artisan of Beauty Plastic Surgery at 310‑858‑8811.