Breast Lift (Mastopexy)

As skin loses its elasticity, breasts often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume (for example, after pregnancy or weight loss) breast implants inserted in conjunction with mastopexy can increase both their firmness and their size.

There are many different techniques of mastopexy and the position of the resulting scars may vary. There is always a circular scar around the nipple. A second vertical scar running from the lower most point of the nipple to the fold beneath the breast is also common. In some techniques, there is also a horizontal scar in the fold beneath the breasts. The horizontal scar can usually be kept quite short but its length does vary depending on the original shape of the breasts.

If you are planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually does not interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Planning your Surgery

At your initial consultation, it is important to discuss your wishes and expectations.

The procedure will be explained in detail, its risks and limitations, and the scarring that will result.

It is important to avoid taking Aspirin and non-steroidal anti-inflammatory drugs (such as Brufen and Nurofen) for 2 weeks before and after surgery as these drugs have an adverse effect on bruising and increase the chance of bleeding. If you are a smoker it is helpful to stop for two weeks before surgery and for a week afterwards so as not to restrict the circulation to the skin.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home.

The Risks

As with any surgery, there is always a possibility of complications or a reaction to the anaesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen.

Mastopexy does leave noticeable, permanent scars, although they will be covered by your bra (Poor healing and wider scars are more common in smokers.) Rarely, breasts may heal unevenly.

Temporary loss of sensation in the nipples or breast is common. Occasionally loss of sensation may be permanent.

The Surgery

Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. Mastopexy usually takes between 1 1/2 and 2 1/2 hours Before going to theatre your breasts will be measured and marked to ensure that a natural symmetrical uplift is achieved.

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the "doughnut (or concentric) mastopexy," in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.

If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

After your surgery

After surgery, you will have a surgical bra over gauze dressings. There may be some pain for the first couple of days especially when you move around or cough and some discomfort for a week or more.

Wounds are checked one week after surgery, but sutures are generally dissolvable and do not need to be removed.

You will need to wear a support bra for several weeks, until the swelling and bruising subside.

Some loss of feeling in around the nipples and in the breast skin is common. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Getting back to normal

Healing is a gradual process. Although you may be up and about in a day or two, do not plan on returning to work for a week or more, depending on how you feel. You must avoid lifting anything over your head for three to four weeks.

You will be given instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Every effort will be made to make your scars as inconspicuous as possible but it is important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

You should also keep in mind that a breast lift will not keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.

Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.