Mastopexy: The Breast Lift
The breast lifting operation includes several different procedures. The purpose of each of the operations is to lift the breast up and re-position the nipple to where it was prior to sagging. Sagging occurs due to three circumstances that affect the body either alone or in conjunction with each other. First, after pregnancy and breast feeding, the breast has become stretched and the skin loosened. Frequently there is actual loss of some breast tissue, and this creates sag. Second, weight gain and loss can stretch the skin and also increase sag. Third, the process of aging and the effects of sun and gravity tend to decrease the elasticity of the skin, and this can be a significant factor in creating sag of the breast. The goal in all these instances is to move the nipple back to a higher position and to reshape the breast to create a more beautiful appearance.
The amount of sag and elasticity of the skin determines the best procedure to be performed. It is important to decide whether augmentation or reduction should accompany the uplifting procedure. The procedure that one elects to undergo is determined by several factors. First and foremost is the amount of sag or ptosis (pronounced: tosis) present. When a slight amount of ptosis is present, a "Crescent Mastopexy" can be performed. This is frequently performed in conjunction with breast augmentation. The nipple can be uplifted two to five centimeters (about one to two and a half inches). The incision, and therefore the subsequent scar, is around the edge of the areola (pigmented skin). Should a greater amount of lifting be required, an incision will be needed that completely surrounds the areola with a vertical line dropping down the center of the breast to the bottom of the breast, and sometimes a horizontal incision is required which is placed at the bottom of the breast in the crease between the breast and the chest. This is called a Formal Mastopexy, and this procedure, too, can be performed with breast augmentation.
It is important for the patient to realize that the factors that created the ptosis have permanently altered the skin's elasticity. Because of this, a small to moderate amount of re-sagging will occur after the surgery. In rare instances, significant re-sagging will occur. Over many years, re-sagging can occur in a large percentage of patients; however, it does not sag to the extent that existed prior to the surgical repair. The extent of re-sag is determined by skin elasticity, smoking, sun exposure, and weight increases and decreases.
All mastopexy procedures are performed using Light Sleep Anesthesia, and all procedures are performed as outpatient procedures at The Cosmetic and Reconstructive Surgery Center. The crescent mastopexy calls for the removal of a crescent of skin above the areola, moving the nipple upward, and suturing the nipple into the new location. The formal mastopexy requires incisions fashioned in such a way as to actually create a new breast envelope. This allows for the repositioning of the nipple and the reshaping of the breast. As mentioned, either of these operations can be performed in conjunction with a breast augmentation.
The First Two Weeks After Surgery
Sutures will have been placed underneath the skin. These will dissolve over several months. Special tissue glue is placed over the incision line to help protect the wound. A bra will be worn continuously for 21 days, 24 hours per day. Instructions on bra removal for washing will be given after the surgery. There is generally very little pain after this operation and only a moderate amount of swelling. The patient may return to work in three to five days unless the work involves bending or lifting. Walking may be resumed the day after surgery.
The scar from the crescent mastopexy is placed directly at the junction of the areola (pigmented skin) and non-pigmented skin. It heals leaving a scar that is barely visible in most people.
The formal mastopexy involves more incisions. Patients generally tolerate the scars, as the scars are far less unsightly than the sagging breast. Over the course of 12 to 24 months, the scars fade dramatically and in many individuals are not very noticeable. In some individuals, the scars will always be somewhat visible, generally seen as a lighter area on the breast.
All patients undergoing mastopexy should be certain that they understand the incisions and resulting scars. When the patient knows ahead of time what to expect, it is our experience that the scars are not particularly objectionable, as the breast is far improved in both shape and position.
Nipple sensation is generally preserved with this operation. The incidence of loss is usually less than five percent. In many individuals where there is significant ptosis, the sensation has diminished prior to the operation. In these individuals, nipple sensation will sometimes increase after the procedure.
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