Mastopexy is a procedure to elevate the nipple-areolar complex and tighten the breast skin envelope. The procedure is used when the nipple height is approximately at or a bit below the breast crease, which often happens following childbirth or after breast-feeding. A very mild relaxation of the breast may be corrected with implants, by removing a crescent of skin from the upper half of the areola, or with the dual-plane breast augmentation procedure. When the nipple is well below the crease the breast laxity is more severe and will probably require additional incisions and skin removal. Breast implants inserted during a mastopexy can increase ﬁrmness and size.
Extremely large, heavy breasts—D cups or larger—tend to sag soon after a mastopexy, so women with larger breasts may not be good candidates for this surgery. The problem is that the skin envelope simply can’t withstand the eﬀects of gravity, although in some cases internal sutures, absorbable mesh, a muscle sling, or other techniques may be used to suspend the breast tissue. Pregnancy also may undo the positive eﬀects of the surgery. Ideal candidates are women with moderate-sized breasts who are ﬁnished having children.
If there ever was a procedure that has to be tailored to the individual, it’s mastopexy. Every patient’s anatomy varies, so it is extremely important not only to be aware of all your options but also to discuss your procedure extensively with your surgeon.
Your surgeon will do a breast examination and take careful measurements of your nipples in relation to other parts of your breasts and your torso. Perhaps you’ll only need a lift on one side. The size and shape you expect may not match what a surgeon has in mind, so bring in pictures to show your doctor what you envision. Your doctor should also give you a general idea of where your areola and nipple will be positioned.
Here are some things to consider when deciding whether to have a mastopexy:
• If your breasts differ markedly, do you want an enlargement or a reduction?
• How much scarring can you tolerate as a trade-oﬀ for a breast lift? Determine with your surgeon which lift procedure will give you the most improvement with the least scarring.
• Do you want a smaller areola? If so, how much smaller?
• Are you planning to have children or breast-feed children in the future? If so, your results may not last, and your surgery should be deferred until your family is complete.
Listen carefully to your surgeon’s recommendations. Take notes if necessary. You’re the one who has to live with the results.
When it comes to breast lifts, the most important element in patient satisfaction is realistic expectations. Remember that the results aren’t permanent. Gravity, aging, and weight ﬂuctuations can take their toll on your breasts again. Scarring will be considerable, even in “minimal incision” breast surgery. Be prepared for these outcomes before going ahead with a mastopexy.
Mastopexy is very much a three-dimensional operation. If you combine it with breast augmentation, which is also highly three-dimensional, be prepared to experience some differences from one side to the other. This may not happen, but the odds increase as you add two procedures together. Another possible complication when combining mastopexy with implants can occur if the muscle attachments are not properly released or the skin envelope isn’t tightened. In this case the nipple can be forced downward, creating a “double- bubble” look as the breast hangs oﬀ the high-riding implant.
This is a same-day procedure usually done under general anesthesia but occasionally under intravenous sedation if limited incisions are to be used. The procedure takes about one and a half to three and a half hours. Depending on the nipple level and amount of excess skin, incisions can range from a small crescent above the areola to the classic incision pattern that looks like an anchor. I have created a procedure that uses a wavy incision around the areola, which can better camouﬂage the scar (published in Plastic and Reconstructive Surgery, 2002, p. 1778, “ ‘Zigzag’ Wavy-line Periareolar Incision”). Any of the mastopexy procedures may be done in combination with breast implants.
Crescent Mastopexy: The most limited procedure involves removing a crescent or half-moon pattern of skin horizontally along the top of the areola. This leaves a curved scar along the top half of the areola. Crescent mastopexy can be used when the nipple needs to be raised about half an inch. It works well in combination with breast augmentation because the implant’s volume also supports the nipple in an upward direction. Some surgeons prefer to place the implant on top of the muscle in a mastopexy procedure.
Note: This incision may “bottom out” a larger breast as the tightened upper breast pushes the still-relaxed lower breast down and out.
Doughnut Mastopexy: Doughnut or concentric mastopexy involves a circular incision around the nipple. A doughnut or ring of skin anywhere from one-half to two inches is removed. Upon closure the breast skin is tightened around the open doughnut as the nipple is elevated. This procedure is appropriate in a limited number of patients with smaller breasts and minimal sagging. It may ﬂatten the breast slightly and can cause radiating folds of skin but avoids more extensive scars. Doughnut mastopexy may be extended with additional skin removal from below the breast. This helps support the breast upward.
Classic Mastopexy: This procedure has various forms. The most common follows the natural contour of the breast, with skin removed around the nipple, down the breast front, and horizontally along the crease. Internal tacking often is placed to support breast tissue higher on the rib cage. The nipple and areola are moved higher. Surrounding skin is pulled tight to shape and support the breast. This leaves an anchor-shaped incision.
A variation, known as minimal incision surgery, eliminates the incision across the breast crease. The smaller the breasts, the more minor the incisions.
Your breasts will be bruised and swollen after surgery. Swelling will be minimal to moderate and last several weeks. Avoid salty foods to diminish excess swelling. Pain is moderate. Your surgeon will order pain pills and possibly an antibiotic. Stitches are buried and can be dissolvable, so no removal should be necessary. Some surgeons use permanent sutures which must be removed. Drains are rarely necessary. A drain is a small plastic tube connected to a light bulb shaped reservoir. The compressible reservoir creates gentle suction to remove excess ﬂuid from the surgical area. The recovery room nurse will teach you how to care for the drain prior to your discharge from the surgery center.
Immediately after surgery, you may wear an elastic wrap or surgical support bra with gauze bandages. When you switch to a good support bra, wear it around the clock for three to four weeks. Avoid vigorous exercise or direct contact and avoid sleeping on your stomach for the same amount of time. Sexual activity that causes pain in the surgical area should be avoided.
Mild depression following surgery is normal, and is the result of the anesthesia. The best thing to do is ride it out—it will pass quickly.
Massive swelling on one side compared to the other, fever, redness, or unusual drainage are causes for alarm. Call your surgeon immediately.
Road to Recovery
It is important to avoid lifting anything over your head for at least four weeks after a breast lift. The same holds true for engaging in strenuous exercise or sports. In rare cases, mastopexy could aﬀect your ability to breast-feed. Subsequent pregnancies also may stretch your breasts to their pre-procedure sagging state, so many surgeons avoid performing a mastopexy until a woman has ﬁnished with child bearing. If you would like to learn more about a breast lift procedure in Minneapolis or St. Paul, please contact my office to schedule a consultation.
Risks and Limitations
There is a chance of numbness in the nipple or scattered areas of the breast skin. Bleeding can occur, even to the degree that a secondary drainage procedure can become necessary. As in any surgery, infection is possible. Incisions also could separate in high-tension areas. This usually requires cleansing and antibiotic ointment for several weeks as these areas heal.
Mastopexy leaves noticeable scars, which will be covered by your bra or bathing suit. If you smoke or don’t follow recovery instructions completely, you’re at risk for tissue death and scars that widen or become infected. The procedure also can leave unevenly positioned nipples and other breast asymmetries.
The major problem with breast lifts is that gravity keeps working, especially with women who have larger, heavier breasts. With newer techniques of suturing the internal breast tissue to the chest wall, longer-lasting results are available.