Due to factors such as pregnancy, weight fluctuation and the affect of gravity as we age, breasts can lose their youthful position and tone over time. The position of the nipple drops and the breast acquires a disproportionate amount of skin relative to the underlying tissue. Mastopexy is a procedure performed to counteract these issues, offering a more youthful appearance to the breasts. The nipple is raised and the amount of redundant skin reduced, offering an improved shape. It should be noted, however, this procedure does not typically offer a long-term increase in upper fullness unless an implant is used. Depending upon the patient's goals and concerns, an implant may or may not be used. Women with small chests see the best results from this procedure. Due to the effects of gravity on the heavier breasts, results for women with larger chests are not as long lasting.
The Consultation
As a plastic surgeon, I feel it's important to spend at least an hour discussing medical history and goals with potential patients, though consultation time may vary from surgeon to surgeon. Along with medical history, and examination to evaluate current shape, size, skin tone and degree of ptosis (droop) should also be performed. Incision options and the use of implants should be discussed, as well as implant styles and placement options. Every individual has her own goals and unique anatomical considerations. A detailed consultation is essential to address these important issues.
The Surgery
No matter who performs your surgery, it should always be performed in a fully accredited surgical facility, and anesthesia should be administered by board-certified anesthesiologists. Before surgery, the new nipple position should be planned as well as the incision type. While an incision is made around the nipple, the nipple remains attached to the underlying tissue, not "removed," then re-positioned to a higher location. Scarring caused by incisions will vary depending upon the degree of nipple droop. The simplest incision option follows the top of the areola. Others, such as the "lollipop" technique, uses a circular incision around the areola, and in the most extensive lifts, an incision in the inframmary fold is added to form an "anchor" type scar. If an implant is to be placed, the anchor incision is typically used. After surgery, light tapes are placed over the incisions and a sports bra is applied. The patient usually goes home or to Serenity should she choose. Serenity is a warm, comfortable facility geared for the post-operative care of the plastic surgery patient. A customized booklet which discusses further the procedure, risks, and pre- and post-operative instructions will be provided for you at your pre-operative visit.
The Recovery
At surgery, Dr. Orringer will do nerve blocks to help control early discomfort. Patients usually can shower in 2 days. Arm use and motion is not restricted although lifting associated with straining is not advised for at least 2 weeks. The post-operative pain is usually the most severe during the first three days. It is usually well-controlled with oral pain medications. By the end of the first week, much of the pain has subsided and many normal activities resumed. Generally, full exercise activity is not recommended for about 3-4 weeks post-operative. Driving should not be done until oral narcotics are no longer required for pain control. It is recommended that a support bra be worn, at all times, except when showering for the first post-operative month.
What are some of the Particular Concerns regarding Mastopexy surgery?
While most patients are very pleased with their results, there are certain important considerations that must be taken into account. Mastopexy surgery, even in its simplest form, involves permanent visible scars. While they fade with time, they do not "disappear." In addition, this surgery involves a risk of loss of sensation to the nipples and to other areas of breast skin. While most patients maintain the majority of their sensation, the possible loss of some sensation must be considered as well. Following mastopexy surgery, recurrent drooping will definitely occur. In fact, the process again immediately begins as the "new" breasts are exposed to gravity. The heavier they are, the quicker some recurrent deformity occurs. Further mastopexy procedures may be desired in the future. In this procedure, while the nipple position is elevated and the amount of excess skin hanging below the fold reduced, there is not typically a long term increase in upper volume, as is desired by almost every patient. This is usually only reliably accomplished by the addition of implants, which may or may not be an appropriate and acceptable addition to the mastopexy procedure.
Making the decision
Every surgical procedure has inherent benefits, risks and limitations. Before choosing to undergo breast lift surgery, patients should use their pre-operative visits to ask any questions they may have and take whatever time they may need to or determine whether undergoing mastopexy surgery is truly the right decision.