All breast lifts are not created equal.
Age, hormones, significant weight loss and multiple pregnancies can all contribute to sagging breasts. Though breast size may be ample, they may droop (ptosis) and lack firmness or substance. Breasts may appear pendulous and nipples may point downward below the breast crease. A breast lift restores sagging breasts to a more naturally rounded shape and repositions the breast and nipple to a more youthful height and projection.
If a patient is satisfied with their breast size and just wants more “perky” breasts, a lift is all that is necessary. A mastopexy (breast lift) lifts the breast but is NOT intended to add volume or fullness to the upper portion of the breast. If flatness or loss of volume in the breast is of major concern, implants need to be considered either at the time of the lift or at a later time for a more proportioned result.
There is a common misconception that a lift without an implant will not work. In fact, in most instances where size is sufficient, the lift will significantly lift the breast and improve the shape even without implants. Exercise, diet and creams will not change the position of your breasts. A breast cannot contract to its original size and shape without surgical intervention.
They are two apprehensions I hear in consultation—scars and an unnatural result. Therefore, I am diligent about addressing those two concerns. You cannot have a breast lift without incisions, but there are techniques available to minimize scarring. Incision location is determined during consultation. It depends upon breast size, shape, degree of ptosis and elasticity of your skin. Symmetry is not always attainable. Not even Mother Nature provides perfect symmetry. However, both the nipples and the breasts should be close to mirror images of each other.
Newer techniques also allow for significant shortening of the scar from the traditional anchor to a lollipop type scar. In some instances a scar around the nipple/areola is sufficient for the lift.
My priorities during a breast lift consultation are:
- To decide whether an implant alone, a breast lift alone, or if both are necessary to obtain the best and most natural result.
- To properly evaluate skin elasticity and quality and determine the extend and location of scars. There must be agreement on the tradeoff between scars and the improvement in shape.
- To determine whether an internal “auto-augmentation” mastopexy is beneficial (see below),
Breast feeding in the future is of concern to some and it is usually not precluded with any of the lifting techniques. With internal mastopexy technique, there may be some impact on the amount of milk production.
I favor the newer shape enhancing auto-augmentation” technique when possible. This type mastopexy is done not by just lifting and removing the extra skin alone, but in addition it involves internal breast tissue re-modeling as part of the lift. It reshapes the breasts, narrowing of the base, giving more projection and central fullness , while lifting the breasts.
If you have a significant degree of sagging tissue in the lower part of the breast, an “auto-augmentation” mastopexy is most effective. By moving the hanging lower breast tissue to the central and upper portions of the breast, the hanging breast tissue essentially serves as a source of augmentation for the areas that are deflated, by being moved and sutured in place in these areas. The excess skin is removed independently, the skin pocket is tightened and the nipple and areola are placed at a higher location. The scars are shorter with this type technique and will resemble a lollipop.
Skin alone mastopexy is still quite adequate in many instances, and will give excellent results without internal breast rearrangement. In very mild cases of ptosis, a scar limited to around the areola can be utilized to lift the nipple and tighten the pocket moderately. An implant can add volume where needed and enhance the results of the lift and especially useful if there is significant loss of volume and the desired goal is a fuller breast.
Breast lift is a highly effective procedure to reshape sagging breasts.
Anesthesia: general or MAC
Length of surgery: Varies- from one to 5 hours
Outpatient/inpatient- out patient
Adjunct procedures: augmentation
Recovery: One week