A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin’s natural elasticity or simply the effects of gravity. The procedure can also reduce areolar size (the dark skin surrounding the nipple), and it can be combined with breast augmentation for added breast volume and firmness. Breasts of any size can be lifted, but results last longest when they are originally small and sagging.
Women planning to have children are advised to postpone surgery, since pregnancy and nursing can counteract its effects by stretching the skin. However, mastopexy should not affect your ability to breast-feed.
Mastopexy may be performed in a hospital, an outpatient surgery center or a surgeon’s office-based facility. It is usually done on an outpatient basis under general anesthesia, and lasts from 1-½ to 3-½ hours.
A number of pre-operative steps are typically taken such as a mammogram, measurement of the bustline, and discussion with the surgeon about the desired size and shape of the breast and placement of the nipple. During the procedure an anchor-shaped incision is made from the location of the new nipple down to and around the crease beneath the breast. The surgeon removes excess skin, relocates the nipple and areola, and reshapes the breast using skin from around the areola before closing the incisions with stitches.
Patients with small breasts and minimal sagging may be recommended for smaller-incision mastopexy. One such modified procedure is concentric (“doughnut”) mastopexy, in which two concentric circular incisions are made around the areola and a doughnut-shaped swathe of skin is removed.
After surgery the breasts are wrapped with gauze dressings, over which an elastic bandage or a surgical bra is placed. After a few days this is replaced with a soft support bra which is worn 24 hours a day for about a month. Breasts will probably be bruised, swollen, and uncomfortable for a few days but this will pass. Numbness in the breasts and nipples should lessen as swelling subsides, although occasionally it lasts for months or even permanently. Stitches are removed after one to two weeks, and many patients return to work then.
Complications are uncommon but may include bleeding, infection, numbness, uneven positioning of nipples and widening of scars. Scars can be covered even beneath bathing suits and low-cut tops.
Modern surgical technology makes it possible to construct a natural-looking breast after mastectomy (breast removal) for cancer or other diseases. The procedure is commonly begun and sometimes completed immediately following mastectomy, so that the patient wakes with a new breast mound instead of no breast at all. Alternatively, reconstruction may begin years after mastectomy. Many insurance companies cover reconstruction following breast cancer surgery, and legislation is currently before Congress to make coverage mandatory.
Women whose cancer seems to have been eradicated with mastectomy are the best candidates for breast reconstruction. Those with health problems such as obesity and high blood pressure and those who smoke are advised to wait. Others prefer to postpone surgery as they come to terms with having cancer, consider the extent of the procedure, or explore alternatives.
The reconstruction itself consists of multiple operations, the first of which involves creation of the breast mound and is performed during or after mastectomy in a hospital under general anesthesia. Later surgeries, if necessary, may be done in the hospital or an outpatient facility, with either general or local anesthesia.
There are several ways to reconstruct the breast, both with and without implants; your breast surgeon and plastic surgeon should work together with you in deciding which is the best for you.
Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from any surgical procedure (bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia), there are some risks inherent in breast reconstruction, including infection around the implant, if an implant is used, and capsular contracture, when the scar (capsule) around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from “scoring” the scar tissue to removing or replacing the implant. Some patients may need time to come to terms emotionally with their new breasts.