Mastopexy is the medical term for breast lift procedures. 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 and the breasts will begin to droop. The medical word for breast sagging is “ptosis” (pronounced ‘toe-sis’). Once breasts begin to sag there is no stopping the breasts to continue to do so. 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 breast lift surgery, there are no safe methods to enlarge the deflated breasts. No pills, lotions, or potions can restore breast perkiness. It’s an inconvenient reality.
When we discuss sagging breasts, or ptosis, plastic surgeons employ a grading system to better define the degree of breast droopiness. There are 4 categories of breast 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 and determine which mastopexy approach will be best.
Depending on your grade of ptosis, this will determine the effectiveness of breast lift surgery.
- 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.
What can a Breast Lift accomplish?
The purpose of a breast lift is to raise either the nipple, the breasts, or both nipples and breasts to a higher position on the chest wall 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 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 are required. 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.
Surgical Techniques of Breast Lift Procedures
Based on the amount of ptosis, the type of lift and the amount of lift is determined. There are four major approaches:
The Crescent Lift Approach
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 breast surgery places added tension of the areola. The areola tends to stretch over time.
Periareolar Lift (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:
Vertical Incision Approach
A vertical breast lift refers to the inclusion of a periareolar lift incision plus an incision that runs from the areola down to the fold 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.
Combining Breast Augmentation with a Mastopexy
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.
Breast Lift Surgery Details
Most breast lifts are performed under general anesthesia. The exception to this may be crescent breast lift 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.
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.
During your breast lift 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 After Surgery
Recovery from a breast lift 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 breast lift 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.
When you choose Dr. Neavin as your plastic surgeon 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.