What is a Breast Lift (Mastopexy)?

A mastopexy is an operation that removes the stretched-out skin to lift the breasts and the nipples restoring them to a more normal position on the chest. Many women find that with age the breasts sag. This is also frequently seen following breast-feeeding, or in women who have lost weight. As the skin surrounding the breasts stretches and the normal support is lost, the breast is allowed to sag and the position of the nipple on the chest lowers, often pointing downwards. Many women complain that with saggy breasts the cleavage disappears unless push-up bras are used to lift the breast. there may also be a loss of breast volume that many women would like restored.

Who can benefit from a mastopexy?

With time, all breasts will tend to sag due to the effects of gravity. Patients with minor degrees of breast sag may be suitable for an Augmentation Mammoplasty, using an implant to fill the breast and reduce the appearance of sagging. The advantage of having this procedure instead is that there is less visible scarring. However, with more significant sagging where the nipple is well below the level of the crease beneath the breast, a breast lift is the preferred treatment.

How is a mastopexy performed?

The operation is normally done under general anesthesia. There are variations in the technique depending upon the amount of loose skin present, but generally the goal is to reduce the excess skin, lift the breast, and re-position the nipple to a location higher on the chest.

For the most severe skin laxity, Dr. Horton uses keyhole pattern incisions which result in inverted "T" scars. The incisions are made around the nipple, then excess skin is removed around the nipple and the skin is re-draped around it to form a tight ski bra to provide support. For less skin laxity, incisions are made only around the nipple.

Drains at the operation site may be used for a few days, and wounds take several weeks to heal. There is bruising and swelling for several weeks. Pain is usually moderate after the first day, and arm activity is limited for the first week with a gradual return to normal and vigorous activity after four to six weeks.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is not possible without scars. However, Dr. Horton carefully plans his incisions such that scars are normally concealed by clothing. Breast scars tend to be noticeable when unclothed. The incisions are sutured with care to promote optimal scarring. Post-operative activity and wound care instructions must be followed carefully to promote healing. Your genetic healing characteristics are the main factors in determining scar appearance.

What are the more common complications?

The most common problem experienced with this operation is poor scar formation; the central chest area is notorious for this. Approximately 25% of patients who have a mastopexy will develop poor scars. At times these may be red, raised and itchy or tender (hypertrophic scars). The scars do tend to fade and soften over the course of one to two years, but they are never fine, hairline scars. They are, however, covered by clothing and most bathing suits, and are not present above the nipple. Generally, having been pre-warned about the scars, our patients have not found them to be a major concern.

Although complications are the exception rather than the rule, as in any surgical procedure there is always a possibility they could occur. General anesthesia always has risks in any surgery. Bleeding, infection, and delayed healing are possible. Nipple sensation may be altered, however this is usually temporary. Also, it is common to have a minor degree of asymmetry following this procedure. During the surgery, blood vessels are divided to allow for shifting of the tissues and in the post-operative period poor circulation may result causing loss of some breast skin or, rarely, a portion or the entire nipple.

How does the operation differ if I have an implant?

Many women desire an increase in breast volume as well as the breast lift. A breast augmentation can be combined with a mastopexy through the same incisions in one operation if desired. A larger implant will fill out the skin more and require less skin tightening through operation, thus will lead to shorter scars. However, one's breasts should be proportional to the rest of the body, so Dr. Horton will discuss your options in your private consultation to arrive at the best solution for your goals.

What are the risks associated with the implant?

The complications of the usual mastopexy as mentioned above apply. The addition of an implant is a relatively low risk procedure, but there are certain potential problems.

In 20-40% of patients, the fibrous layer surrounding the implant can tighten and apply pressure to the outside of the implant. This causes the breast to feel unnaturally firm and appear too rounded. This is the most common complication of a breast implant and can usually be fixed if addressed early. Some patients may benefit from a second operation to surgically release this fibrous layer. However some people are naturally prone to this problem and may continue to have firm breasts even after this secondary operation. Rarely, this can be severe enough to make removal of the implants advisable.

Infection, although uncommon, may occur and require removal of the implant for treatment. Occasionally, due to infection, the implant may erode through the skin and be rejected by the body. Asymmetrical positioning is possible though uncommon, and is usually due to some pre-existing breast asymmetry or the result of sever capsular contracture. Uncommonly, the implants can deflate requiring replacement. Any of these complications may result in temporary or permanent disability or deformity, may require further surgical treatment, and may possibly prolong the recovery period and time required off work.