The Breast Enhancement InstituteTM
The Breast Lift, or Mastopexy Procedure:
Explaining why the breast may change in shape:
As the female body ages the breast skin may lose some of its firmness and cause the breasts to sag under the pull of gravity.
Large changes in breast size as with pregnancy, or large weight loss, can also cause the breasts to sag prematurely. In cases when there is a significant degree of tissue relaxation, or laxity, the breasts can appear flattened. Women often describe them as if the “air was taken out”, or they have deflated.
In severe cases of tissue relaxation a significant downward descent of the breast will occur. As more of the breast descends downward, the once centrally located nipple area (Areola) will descend as well. This phenomenon is referred to as breast ptosis, or in common terms- breast sag.
To obtain the ideal balance between breast shape to breast volume either a tailoring of the breast shape (mastopexy), or an increase in the volume (augmentation) of the breast may be needed. Sometimes both procedures are performed in combination to attain the best result. This combination is referred to as an augmentation mastopexy. – it can be done either as one combined, or as two separate (staged) procedures.
Who May Need a Mastopexy?
The Breast Lift, or Mastopexy, is a technique used to safely lift the sagging breast tissue- specifically to cone the breast, and raise the areola. The medical term for tissue sag, or increased laxity in its shape is called ptosis.
In the breast lift procedure a portion of excess skin, and sometimes the underlying breast tissue, is removed and the nipple position is raised to a higher more youthful position.
Breast Ptosis is graded from Class 1 to Class 3. This classification is based on the position of the nipple tissue with respect to the lower breast fold (Inframammary fold, or IMF). As the degree of laxity increases the nipple tissue sits lower on the breast. For example, in Class 3 ptosis the nipple tissue rests at the lowest point on the breast.
Sometimes one may hear, or read, a reference to pseudo-ptosis. This is not true ptosis. It instead relates to the manifestation of breast tissue that extends below the lower breast fold, with the nipple tissue resting above the fold. Whether a breast lift is necessary is evaluated by Dr. Maggi on a case by case basis.
Depending on the amount of ptosis (or breast tissue laxity) that is present will determine which type of procedure is best.
The mastopexy procedure on average takes between one to two hours, and the patient you can expect to go home after the surgery is completed. In many cases patients are able to return to work after 4 to 5 days.
The Incision Choices Used for the Mastopexy:
There are 3 common incision patterns used:
- Around the nipple area (Crescent, or Peri-areolar lift).
- Around the nipple area and extending vertically downward along lower third of the breast (Vertical lift).
- Around the nipple area, extending vertically downwards, and then with a horizontal component located within the breast’s lower fold.
(Inverted T, or Anchor pattern lift)
How the right mastopexy incision is chosen?
In cases of pseudo ptosis (pre-ptosis), or mild degree of true ptosis:
-The placement of a breast implant alone (augmentation procedure) may improve the breast’s overall appearance.
The need for a lift may remain, but now that the upper breast fullness is enhanced the patient may decide to wait to get a breast lift. This allows for the patient to consider her options in a staged manner before facing additional scars, and cost.
In selected cases of very mild Ptosis:
- Dr. Maggi may suggest that a breast augmentation alone can be performed. That is, with the consideration, or understanding, that a breast lift may still be needed afterwards as a second stage procedure. If this is the case he usually recommends waiting 2 to 3 months before the patient is certain that the lift procedure is necessary.
- In some cases of mild ptosis many times just a rim of skin around the areola may be all that is needed to be excised. If an excision of tissue superior to the areola is only needed- this is referred to as a Crescent-Lift. In a Crescent-Lift the scar will then only be located around the upper half of the areola.
In cases of more moderate Ptosis:
- Tissue may be removed around the complete circumference of the areola, referred to as a Peri-areolar lift, (sometimes called a Benelli Lift).
- In this case the incision will go around the entire diameter of the areola only.
In the more significant cases of Ptosis:
- Many times both skin and some underlying breast tissue may need to be removed in order to obtain a greater amount of reshaping, or coning of the breast.
- This may require a Vertical, or Inverted T (Anchor) lift. In these cases the incisions will go around the entire areola and extend below onto the inferior pole of the breast, as in a vertical (or short-scar) lift.
- In some cases of Ptosis an extension of the vertical incision that runs along the breast fold may be added to achieve the proper breast contour.
Additional Considerations with the Mastopexy:
- In cases of significant overall breast volume loss along with breast ptosis, a breast implant is combined with the mastopexy procedure. This can be performed at the same time, or Dr. Maggi may recommend to staging the two procedures as two separate operations for safety reasons.
- To best determine what options are available an evaluation by Dr. Maggi of the current breast shape and size is required.
- Please click here for link to schedule a complimentary consultation at BEI.
- These techniques are also often used to adjust one breast areola to improve symmetry between the two breasts.
Diagrams to show the Breast lift Proceedures
(ABOVE) When the nipple-areola is low and needs a small degree of elevation of 1 to 2 cm, an upper periareola crescentric ellipse can be excised to elevate it. An augmentation mammaplasty can also be done through this inscision.
(ABOVE) A circumareolar (doughnut mastoplexy) skin excision tightens the skin minimally without elevating the areola. It is effective for patients with tubular breast and for patients with very large areolae and psudeoptosis who are to have augmentation mammaplasty. Breast skin is removed by leaving only a central circular scar. The scar, however, tends to widen and the nipple is not elevated. It can also result in unnatural central breast flatness and loss of attractive central projection. This strategy is helpful in avoiding a tight point beneath the areolar closure of a vertical mastoplexy. A circular suture in the skin periphery can rduce final skin tension and produce a finer scar.
(ABOVE) In patients with glandular and minor ptosis the circumareolar excision with a short vertical ellipse tightens the skin and elevates the nipple-areola. Care must be taken to avoid too much tightness below the areola.
(ABOVE) For patients with major ptosis who need maximum breast elevation a vertical and horizontal excision provides effective breast elevation. This approach produces a longer unframammary scar compared to procedures for patients with less advanced ptosis, but provides the best results. For these patients it is often necessary to have longer inverted T pattern scar.
(ABOVE) This pocket is expanded medially to accommodate the breast implant. Some prefer to use a rouch-surface implant so it will maintain its position. The implant is selected to give the desirable general fullness in the central breast, as well as the upper breast region. Wound closure is accomplished in layers, and the lower breast parenchyma is sutured to the inframammary crease to give good nipple-areolar coverage. An incision is made around the periphery of the V to permit mobilization of the nipple-areola to its new position. The wound is then closed laterally and medially toward the center of the T. Any excess skin along the vertical limb is excised. The incision is closed from the point of the T up to about 6 to 6 cm. The nipple-areola is cut out as a circle with a few millimeters less diameter to avoid a tight areolar closure and a widened scar. The incision is then closed with layers of absorbable intracuticular sutures.
Breast Lift - Fast Facts
Description: A surgical procedure to raise and reshape sagging breasts.
Average Cost: $4500-$5500
Length of Surgery: Two to four hours
Recovery time: Return to work in seven to 10 days. Resume vigorous activity in three to four weeks.
Treatment Frequency: Once, and generally long lasting, however gravity, pregnancy, weight fluctuations and aging can effect results.
Risks: Asymmetry of breast and/or nipples, loss of sensation, irregular scar formation, complications related to anesthesia