Breast Lift with or without implants

Michael C. Edwards, MD, FACS

Article by
Las Vegas Plastic Surgeon

As part of the natural aging process, women lose skin elasticity in their breasts, gravity takes its toll, and breasts become less “perky”. Other factors have an influence as well including genetics, pregnancy, breast-feeding, and weight loss can produce similar results.

When position, shape and firmness of the breasts change, some women may become unhappy with their appearance and wish to return to their more youthful look. In these cases, a breast lift or mastopexy can reduce or eliminate sagging, and, for women seeking enhancement in size, can be performed in conjunction with implants to increase the breasts' volume. The goal of a breast lift is to elevate the nipple to a higher position and to tighten the breast skin and tissue from below. If a loss of breast volume has also occurred, often the only way to regain this fullness is with the addition of a breast implant.

General Description
In most instances, a breast lift is performed under general anesthesia as an outpatient procedure, and lasts between one and three and a half hours. If implants are used, a little more time is typically required. There are three basic techniques used for breast lift surgery with or without implants: concentric mastopexy, vertical mastopexy, and anchor-shaped mastopexy. Breast implants are usually placed partially under chest muscle and can be saline-filled or the newer silicone gel-filled implants. Your plastic surgeon will be able to review these options with you.

A. Concentric Mastopexy
During concentric mastopexy, a circular incision made around the areola as well as a second inner circle to allow the areola to be made smaller. The size of the out circle depends on how much lift is to be performed. The skin between the two incisions is removed and the nipple and areola is repositioned upward. The surrounding larger circle is closed like a drawstring around the smaller areola. This most often requires a permanent suture to be placed under the skin to hold the “purse-string” closed.

Because there is a relatively small amount of skin removal, this technique will only work for women with smaller breasts and minimal sagging. If an implant is used, it can be placed through the same incisions, leaving the only scar around the areola.

B. Vertical Mastopexy
For more breast sagginess, the incision will need to be extended vertically down the midline of the breast from below the areola to the breast crease. This approach allows an additional strip of skin to be removed, giving your plastic surgeon the option of greater correction. The resulting scar will be around the areola and down the middle, sometimes called the lollipop scar.

C. Anchor-Shaped Mastopexy
This procedure allows for the most correction with or without an implant. An incision is made above the nipple in the shape of an anchor, with a circle at the top. This incision forms the shape of the new breast with the nipple placed in the circle at the top of the anchor, and the elliptical line at the bottom forming the lower contour. You may or may not have drains used and these can be removed in your plastic surgeon’s office.

 

Recovery / Post Op Expectations
After your surgery, you will have dressings placed typically held in position with a surgical bra and/or an ace wrap. Bruising, swelling, pain, and discomfort will be experienced for the first few days depending on the type of surgery you had and medication will be prescribed to help lessen the effects. Your plastic surgeon will review with you what your activity restrictions and post-operative care will involve are but they typically involve no heavy lifting for up to six weeks and a slow return to physical activity depending upon the extent of your surgery.

Potential Complications or Adverse Outcomes
Although your plastic surgeon’s goals are to provide you with a safe and successful outcome, as with any major surgery, complications are a real possibility. Adverse reaction to anesthesia, infection, and blood clots are possible with any surgery. In addition, mastopexy carries with it some risks that patients should be aware of prior to surgery, including:

  • Asymmetry (left and right not being the same)
  • Change in sensation of the nipple and/or breast tissue
  • Potential poor healing of the nipple and areola due to decreased blood supply
  • Scarring
  • Irregularity in nipple position
  • Discoloration of skin and nipple

When implants are being used in conjunction with a lift, additional risks including implant leakage and interference with mammograms are possible. Your plastic surgeon will review the care of your breasts and implants to include the need for continued monthly self breast exam and mammography.

Who is a candidate?
Any patient with excess sagginess of their breasts with a desire to have some correction and/or increased fullness. Though surgery does not usually interfere with breast-feeding, it is best to not have surgery if you plan on becoming pregnant in the future as this could negate the results of surgery. Your weight should be relatively stable and if you smoke, your plastic surgeon will require that you are free from any exposure to tobacco products for two to four weeks before and after surgery to decrease the risks of complications.