Description of the Problem
Breast lifts (mastopexy) correct a breast that is ptotic or sagging. There are three main types which determine the best surgical approach
The breast tissue and nipple both move downwards. The distance from the nipple to the collarbone increases.
The nipple stays in position while the breast tissue slides downwards underneath it. Here the distance between the nipple and the fold below the breast increases.
This is a combination of the above types.
Figure 1: The three types of sagging breasts
Aims of Surgery
A breast lift aims to move the skin and breast tissue upwards while restoring the nipple to the correct position, where necessary.
In lifting the skin of the bottom half of the breast, scars must be made both horizontally and vertically. The amount of droop or sag will dictate the length of the scars required. The more skin excess there is, the longer the scars necessary. The nipple and areola can also be re-positioned. Before the operation, the surgeon will mark the breast to plan exactly how much skin to remove and whether to move the nipple.
During surgery, these markings help the exact amount of skin excess to be removed and the gland is then modeled. If necessary, the nipple is moved upwards, but rarely does it have to be detached from any of the underlying tissue so that the feeling and blood supply are safely preserved. Once everything is correctly positioned, the skin is re-draped back and sutured. The surgical result is checked using a special tilting surgical table and any necessary refinements performed.
Depending on the nature of the breast sag, there are several different types of operation available:
This only leaves a scar around the nipple and areola. It benefits from the minimal scarring. Main disadvantage of this technique is the flattening of the breast and nipple-areola complex and stretching over time of the areola into a wide, flat disk. It is only suitable for young patients with an elastic skin and with a very mild droop.
Figure 2: A peri-areolar mastopexy
Vertical scar mastopexy
Here the scar runs around the areola and vertically downwards a variable distance towards the crease underneath the breast. This technique is well suited to Type I problems, but can be less useful in other situations.
Figure 3: With a vertical scar mastopexy, excess skin is only removed in a horizontal direction.
Mastopexy with an ‘anchor’-shaped scar
This adds a horizontal scar along the crease underneath the breast to the vertical and periareloar scars, creating an anchor shape.
This provides the greatest flexibility in reducing skin excess and is well-suited to the Type II, Type III deformity and more severe cases.Even though the scars are more extensive, this is necessary for some patients to achieve the best improvement in breast shape. All the scars are well hidden by a bra or bikini.
Figure 4: Mastopexy with an anchor-shaped scar: the excess skin is removed both horizontally and vertically.
What to expect after Surgery
After surgery there will be dry dressings placed over the scars. If skin glue has been used to seal the wounds, the bandages can be removed to allow showering the following day. Otherwise, the wounds may need to be kept dry for longer. Depending on the extent of the surgery, you may need a drain through the skin, but this can usually be removed within 24 hours. There will be some supportive bands or tape over the breasts which can be replaced by a surgical or sports bra.
Normal things that can happen following surgery include:
- Bruising, especially around the scars
- A temporary loss of sensation
- Swelling, which increases over the first couple of days, then gradually subsides
- Mild pain will be experienced so analgesia is prescribed
Figure 5: case 1: Pre(above) and postoperative (below) pictures of a breast lift for Type III sagging breasts.
Figure 6: case 2: Pre(above) and postoperative (below) pictures of a breast lift for Type III sagging breasts.
Length of Stay
Even quite extensive breast-lifting can be performed as a day case. This means that you can arrive in the morning and leave later in the afternoon. Rarely is it necessary to stay overnight.
As mentioned above, if the skin has been glued, you can shower the next day. Elastic tapes and bands can be replaced with a supportive sports or surgical bra. This should be worn both day and night for 3 weeks. After this time, you will be advised on how long to wear the supportive during the day before changing to a normal bra, usually this is around 3 months.
You will need to take between 2 and 10 days off work depending on your job. You should avoid strenuous activity and sleeping on your stomach for 3 weeks. The wounds should be completely healed in 2-3 weeks but this will determine the rate of your return to normal activities.
- Wound healing problems
- Skin irritation
- Deep vein thrombosis
- Lung embolism
- Chest infection
- Sensory loss (rare)
- Ongoing pains
- Abnormal sensations
- Scar hypertrophy (thickening)
- Changes to the breast shape with aging
Breast ptosis or sagging is not a medical condition and does not cause any functional impairment. Therefore health services and insurers will not routinely fund this procedure. The entire operation including hospital stay, medical expenses and the fees must be covered by the patient. Since fees vary between surgeons and clinics, it is important to have a clear agreement in writing.