Breast Lifts Can Help Regain Your Youth
Mastopexy is the medical term for a breast lift. It is also less commonly referred to as a “boob lift.”
As women age the breast tissue loses elasticity. These changes result in weakened support of the breast. In turn, the breasts begin sagging. The medical word for breast sagging is “ptosis” (pronounced ‘toe-sis’). One other major factor responsible for these breast changes is pregnancy. Specifically, lactation. During pregnancy the breasts engorge with milk. The skin envelope subsequently stretches. Unfortunately, the skin often does not retract after the lactation ends. The combination of sagging breasts with breast size reduction leads to a deflated looking breast.
Once breasts begin to sag there is no stop. That is, the changes that cause breast droopiness are irreversible. Unfortunately, no diet or exercise can raise the breast or nipple. In addition, outside of surgery, there are no safe methods to enlarge the deflated breasts created from lactation. No pills, lotions, or potions. It’s an inconvenient reality.
When we discuss sagging breasts, or ptosis, plastic surgeons employ a grading system to better define the degree of droopiness. There are 4 categories of ptosis and they are characterized by the relationship of the breast to the nipple and the orientation of the nipple. The purpose of the classification system allows plastic surgeons to communicate more efficiently. It also helps them guide surgery strategies.
The normal breast: The nipple sits above the breast fold.
- Grade 1 ptosis: The nipple sits at the level of the breast fold.
- Grade 2 ptosis: The nipple sits below the level of the breast fold.
- Grade 3 ptosis: The nipple sits below the level of the breast fold and the nipple is pointing down.
Now, there is one more type of breast ptosis. It’s called pseudoptosis. Pseudoptosis refers to a breast where the nipple is at or above the fold but the breast is sagging. This type of breast often appears deflated. It also looks similar to the complication of “bottoming out” from breast augmentation. Bottoming out refers to a condition where the breast implant falls lower than the its position behind the nipple. The result is descent of the breast fold and a breast that sits too low on the chest wall. However, the nipple position remains unchanged. More on bottoming out can be found on the breast augmentation procedure page. The chart below illustrates the classifications:
The Purpose of a Breast Lift and What it can Offer
The purpose of the surgery is to raise either the nipple, the breasts, or both nipples and breasts to a higher position on the chest wall. That is, to make the breasts perky. Breast lifts can also be combined with implants to increase volume. This is commonly performed and termed augmentation mastopexy.
Conversely, a breast reduction will not only make the chest smaller, but will also lift the breasts into a perkier position. Breast reductions and mastopexys share very similar goals and incisions. The difference of course, is that one reduces the size of the breast and the other doesn’t. Additionally, both procedures almost always involves reducing the areola.
The Trade Off
The main trade-off with all breast lift procedures is improved shape for scars. As a rule, the more tissue that needs to be tightened, the more incisions. More incisions means larger scars. The addition of breast implants may either increase or decrease the size and location of necessary scars. Like every procedure in plastic surgery, you’re best off discussing your desires with a board-certified plastic surgeon.
Types of Breast Lifts
Breast lifts come in various forms. They range in the amount and location of incisions. Meaning, the amount of post-operative scarring will depend on how much of a lift is required. That is, the more droopy the breast the more incisions will be necessary to properly reshape the breast. While there are many techniques to do this they all share on thing in common: skin removal.
Ptotic breasts by necessity have redundant skin. Meaning, sagging breasts have an excess of skin in relation to volume. This is an important point because in certain cases, the addition of volume alone can effectively lift the breast. One other point is this: the resultant lift can make the the appearance of the breast appear smaller. It is true that the plastic surgeon is only removing skin. However, the effects of reshaping the breast into one that is perky generally condenses the tissue. Thus, in cases where a woman wants also want a bigger bust, a mastopexy and augmentation should be performed. This combination can be performed in either one or two stages. Single or double staging remains a raging debate among plastic surgeons. There is more on staging below.
Based on the amount of ptosis, the type of lift is determined. There are four major approaches:
A crescent lift moves the areola upward by the removal of skin above the areola. As a general rule, any more than 1 cm of this type of lift can distort the shape of the areola by elongating it. It should be noted this technique nipple lift only and is not a true breast lift. In addition, the crescent lift does not reduced the areola. To the contrary, it often enlarges it since the surgery places added tension of the areola. The areola tends to stretch over time.
Periareolar (Benelli, Circumareolar, Donut)
- A periareolar lift is also commonly referred to as Benelli lift or circumareolar lift. This technique removes skin circumferentially around the areola with preferentially more removed from the top. It also lifts the breast mound. The result is:
- 1) A smaller, more elevated nipple
- 2) A smaller areola
- 3) A mound lift (sometimes)
- The periareolar lift is one of the most overused techniques in plastic surgery. That is because of the temptation to camouflage scars as best as possible. Indeed, the incision for this type of surgery places the incision inconspicuously along the border of the areola. However, this is not without consequence. Because skin is being removed, the tissue tends to stretch over time. The more tissue removed, the more tension and expansion of the areola. And, the wider the scar. The other consequence of a Benelli lift is that the breasts flatten. Because tissue is removed around what should be the most projected part of the breast, the result is loss of projection.
- This is not to say that plastic surgeons should abandon the donut lift. However, it must be the performed on the right patient. Who is the right patient? For one, the proper candidate is one who only requires up to approximately 1.5 cm of nipple elevation. Meaning, Grade 1 ptosis. A lift of more than 2 cm often leads to the undesired consequences mentioned above. Below is the incision placement for the periareolar lift:
- A vertical lift refers to the inclusion of a periareolar lift incision plus an incision that runs from the areola down to the fold. The tissue is reshaped under the skin by one of a number of methods. One common way is the use of tissue pillars. Under the skin, pillars of tissue are created and sutured together. The sutured pillars are then tucked up and often secured to the muscle above.
- This is the preferred type for mild to moderate sagginess since it spares the incision from the fold. Grade 1 and mild Grade 2 ptosis breasts may be candidates for this technique. Mentioning a vertical mastopexy without mentioning the possible need for scar revision would be irresponsible. Because there is not horizontal incision, tissue by the fold bunches up. This bunching up generally results in a scar that may need to be revised. The percent of patients that require such a revision are about in up to 20 percent. However, the scar revision can be performed quite easily under local anesthesia in the office. The incisions for a vertical breast lift are below:
Inverted T, Anchor Mastopexy, Wise Pattern Mastopexy
- The incisions include the periareolar incision, vertical, and horizontal scars in the fold. This type of breast lift is reserved for breasts that are the most ptotic. Similar the the vertical lift, the tissue is reshaped under the skin in a number of different ways which is beyond the scope of this page. Suffice to say, each tissue reshaping technique offers its advantages and disadvantages but is more often driven simply by surgeon preference.
- The one unique disadvantage this approach has compared to the others (other than a third incision) is a high tension point at a trifurcation. Where the vertical incision meets the horizontal incision, the forces acting at this location can cause this portion of the incision to heal poorly. However, like in the vertical lift, scars can be improved after one heals. But it’s a good idea to understand that poor healing (in the form of a small wound separation) may occur. The good news is that often a band aid is enough for a couple of weeks. Below are the incisions for an anchor mastopexy:
Mastopexy Augmentation: One or Two Stages?
Mastopexy combined with an augmentation is sometimes done in one operation or two. Staging these two procedures have become a more common trend over the last 5 years. While the disadvantage of staging is added cost and the need for two surgeries, the advantage is often a superior cosmetic result and overall increased safety with respect to blood supply to the nipple.
While one could make the argument that single-stage operation may give the desired appearance and that a revision of any imperfection is no different than a two-stage surgery, that isn’t entirely true. First, a combined augmentation mastopexy in the first stage requires longer operating room time. However, infection rates correlate positively with operating room time.
In addition, the risk for capsular contracture risk may increase. Second, the issue of debate isn’t purely cosmetic – it is safety. Mastopexy augmentation generates two opposing forces simultaneously. One force is making the skin envelope tighter by skin removal to restore perkiness. The other force is enlarging this tighter envelope. These opposing forces can lead to overzealous resection of tissues and more demand on blood supply to the nipple and areola. The unfortunate consequence of this may be skin loss, poor healing, or nipple necrosis.
Moreover, even if proper tissue resection is performed, one can never predict how the patient may heal (or not heal). The addition of an implant exponentially makes the unpredictable nature of healing an important factor in the decision process. The larger the implant, the greater the potential for healing problems.
However, there is a role for single stage mastopexy augmentation. When the nipple needs to be raised just a few centimeters, a single stage mastopexy augmentation is appropriate as it doesn’t add the risks mentioned above. The other role for a one stage approach is an informed decision to have one. The real trouble occurs when patients are told about the advantages and disadvantages of the one versus two stage approach. One accepting the possibility for a second surgery is the foremost single important piece of information necessary to be a viable candidate for the single stage approach.
Lastly, small implants (less than 350 cc) are far safer than very large implants for the single stage approach. If very big is the goal and this can only be accomplished with implants, the two stage approach is strongly preferable. Safety first. Always.
Breast Lift Surgery Description
Most breast lifts are performed under general anesthesia. The exception to this may be crescent or some periareolar mastopexys where nipple elevation is the only goal. The surgery may last up to 4 hours in cases where the inverted T method is chosen. Unless an augmentation is performed, the procedure is surface operation. Meaning, the dissection and tissue resection remain above the muscle. There are no major nerves or vessels in the vicinity of this surgery field.
Breast Lift Candidates
Droopy breasts alone do not make one a good candidate. Paramount to the procedure is ensuring good health and the avoidance of any and all nicotine products. Smoking (and any form of nicotine) will constrict small vessels in the tissues and impair healing. The outcome of proceeding with a mastopexy with nicotine on board can be nothing short of disastrous. For that reason, it is imperative that patients be one hundred percent up front with their plastic surgeon when it comes to this topic.
Likewise, specific health issues like diabetes may impair healing, particularly if it is poorly controlled. A list of medications that must be avoided is also a topic of consideration and will be provided before surgery.
Assuming that the above boxes are checked, the best candidates are those women who wish to have the same size but just perkier. The addition or subtraction of volume with an implant or reduction can be combined with the lift. Augmentation mastopexy can be performed either together or staged; then the augmentation is performed months later.
Perhaps the second biggest factor in good patient selection is the acceptance of the big trade-off: improved shape at the expense of scars. The scar location and visibility vary from the type of lift to the inherent healing capacity of the patient. Other factors will include whether implants are used and the surgical technique chosen by the physician. A great deal on this topic will be discussed during the consultation.
During your consultation, Dr. Neavin will ask questions about a patient’s general health and whether or not smoking or nicotine products are a concern. All nicotine consumption must be avoided for at least four weeks before surgery. A medication list will be reviewed as well as any family history of breast cancer.
While a lift does not increase one’s risk of developing breast cancer, the idea of obtaining this history is to determine whether or not a screening mammogram to develop a baseline makes sense. After a breast lift, reduction, or augmentation, the internal architecture of the breast will be changed. Thus, a pre-surgery mammogram is sometimes helpful to have for down the road. If indeed there is a family history of breast cancer, the age for a screening mammogram will be determined by Dr. Neavin and your treating medical doctor.
Measurements of the breasts will be obtained as well as the degree of sasginess. Desires for increasing or reducing the size of the breast and the areola will be assessed. The plan for lifting can be discussed with diagrams or even markings on the chest with an erasable marker.
Recovery will be proportionate to the extent of surgery and whether or not a concomitant breast augmentation is performed. Some stitches may need to be removed seven or eight days after the procedure. It is safe to assume that at least one week would be required before resuming any strenuous activity. As a good rule, one shouldn’t lift anything heavier than a gallon of milk for two weeks. Returning to work will depend on the type of job you have. Desk jobs can be resumed within a week. Returning to exercise such as weight lifting or the treadmill may take up to a month depending on the extent of surgery. These details will be ironed out when you meet with Dr. Neavin.
Final results after your surgery are not seen for several weeks. Some swelling will occur and and the results might even appear a little funny looking for some time. As the tissues relax, the breasts will form into a more round, beautiful shape. If implants are incorporated, it may take weeks for the implants to settle. It is important to maintain contact with your plastic surgeon during the post-operative period to ensure that incisions are healing, and the tissues are recovering appropriately.
Breast Lift Surgery Scars
Scars from mastopexy are related to many factors including:
- the incision size and placement of incisions
- tension on the closure
- and individual healing capacity
All efforts are made to reduce scar visibility. Incisions around the areola are well camouflaged. Incisions in the fold are well hidden. The vertical scar is not very visible since it rests on the under-surface. Again, the trade off is shape for scars.
Close follow-up with Dr. Neavin will ensure the best possible scar outcome. This may include creams, massaging protocols, or injections in the office. Scar revisions are rarely required for most breast lifts. With vertical lifts up to 20% of patients will benefit from a scar revision. Patients must wait up to 6 months before any such touch-up to ensure the best outcome.
For more information on breast lift surgery please visit the FAQ page here.
When you choose Dr. Neavin for your procedure, you can rest assured you will receive the highest standard of care. His goal is always to deliver the best possible outcome. There are no short cuts to this goal. Schedule your consultation today with Dr. Neavin at his Los Angeles practice. Make your appointment by calling 310‑858‑8811 or text 323‑975‑1287.