Mids 30s Female with Breast Sag and Underwent Breast Lift (Mastopexy) - Foster City, CA

As I progressed through my early 30's, my once very nice, round, full 36C cup breasts started to sag and even get larger. The areolas enlarged as well. I started to feel very unattractive because of this. My bra straps were getting stretched out quickly. Bathing suit tops that fit and that were flattering were impossible to find. I couldn't fit into my nicer tops and sweaters because I had to buy larger sizes to accommodate my distorted breasts....however, the tops were too big for my waist and made me look more overweight than I already sort of was and also made me look pregnant. I was embarrassed to be topless with intimacy, especially when on top, because I could only imagine how ugly it was to look at these saddle bags from their perspective.

I had been considering a breast lift procedure for a few years but hesitated because I was concerned I would need implants to contour the normal breast shape. I didn't want implants because I didn't want to be bigger and I also didn't want the risk they carry (infection, rupture, poor shape). I also wanted to get the procedure done when I was younger because the integrity of my tissue is better, my skin would heal better and I would avoid further sagging and loss of dense breast tissue that would have to be replaced by an implant. (**Side note: I work in surgery including cosmetic and reconstructive surgery so I have assisted in these procedures and see the intra-operative benefits of a lift/reduction on healthy and young tissue. I also know in detail how these procedures are performed). When I wrote this today, I am now 5 weeks out of a bilateral mastopexy without implants.

I decided to consult with Dr. Beck who performed some facial cosmetic surgery on me a few years ago and I was very happy with the outcome and his process. A bit about Dr. Beck: He is a board certified surgeon (this is important) and has had training as a resident at reputable residency programs. He has a reputation at location hospitals for being meticulous. He remains current with approaches to cosmetic procedures. How do I know this? I worked a local hospitals where he operates and I asked the OR staff about his intra-operative skills, etc. The staff at these hospitals had very nice things to say about him. He also does not market fad interventions or procedures that have been reported as dangerous by studies and research (i.e. American Board of Plastic Surgery, FDA). This is important. You don’t want a medical cowboy testing procedures on you that aren’t accepted by their peers as a standard of care.

He makes every encounter feel personal. I don’t feel like he is giving me a rehearsed speech when explaining his approach to procedures, the work up, the recovery, and realistic expectations. I work around surgeons everyday and I appreciate when they describe a realistic experience and outcome. This is important so that patients don't let their imagination carry them to a place that no surgeon can go...It's called the perfect outcome. There's no such thing. Every patient’s experience and progress is different in some way. What's important is that the projected appearance of the physical change is attempted to be described by the surgeon and the patient desires what the surgeon intends to create. REMEMBER THIS. For example, if you weigh 250 lbs and have 40DD breasts and desire an outcome of perky perfectly round breasts based on internet pics of patients that weigh 150lbs with 34C breasts, the patient will be disappointed with any outcome because the expectations are unrealistic. STAY REALISTIC. If you want to limit breast sag and distortion, then a lift is great.

To prepare, I did lose a little weight over the past year, about 20 lbs. I also did that because I wanted to get in shape before surgery, develop strong upper body and core muscles, and limit post-op sag that would occur if I lost weight after surgery. This would distort my post-op results. I also wanted my lungs and cardiovascular system to be in good health for such a big procedure. THIS IS A BIG PROCEDURE! This is not finger surgery. The operation is performed over your chest which houses critical organs (heart, lungs, aorta, diaphragm...you get it.) If these aren't in good health, intra-operative issues can arise and recovery can be jeopardized.

The surgery was about 4 hours long (mastopexy without implants) and I woke up with a post-op bra on and a drain coming out from each breast. I had diffuse chest discomfort but it was tolerable. I decided to stay in the hospital, overnight, to be monitored closely by nursing staff and the hospital MD. Here’s why…..prolonged surgery like this one requires fluid replacement, lots of intravenous anesthetic and some blood loss. Your body can handle this, usually, but sometimes there are complications in the immediate post-operative period that can be scary if you are at home (i.e. difficulty breathing, persisting bleeding, extreme pain, vomiting, drain emptying and recording of the values.) Being in the hospital to get skilled help getting to the bathroom every hour, yes every hour after all the fluid they dump into you, getting around the clock medications that are dosed properly to prevent overdose, monitoring of drain output, having a physician available immediately in case of a need for a medication dose adjustment, and having my vitals signs monitored ….all this is was very helpful. It cost about $800 cash but its worth it. My family are not equipped to deal with these issues. Also, Tylenol IV is amazing. Believe it….Oxycodone can help but there’s annoying side effects. Tylenol IV is fast acting without sedation and nausea.

I was able to stand the first day and walk but I was dizzy. Like I said, I peed a lot. I felt weak. My drains put out about 30-50cc of fluid per day, yuk. I did have some nipple sensation but not areola sensation. I was also totally numb over the lateral and under sides of my breasts. I was told this was normal. Over the next few days I tapered my used of oxycodone and relied mostly on oral Tylenol and Celebrex. My breasts felt very swollen, throbbed and were tight. On around day 3, they started to feel like rocks, truly. They were so hard, tight and heavy on my chest. I couldn’t lie back completely in my recliner because it felt like someone was pushing on my chest wall. I could breathe fine but I was so uncomfortable. No amount of oxycodone can fix this. Only sitting up helped.

I drank water like it was going out of style. I drank my 27oz water bottle infuser with fruit infused, about 5 times a day. This is fat and skin surgery so staying well hydrated is crucial to keeping the tissues hydrated. Remember, only a small portion of water we drink will be delivered to the skin and fat. If you don’t hydrate well, then you’re seriously depriving traumatized tissues.

Showering was uncomfortable as well the first time. Since you’re restricted on arm motion due to pain and as to not stress the sutures and incisions, you’re limited to a really good scalp shampoo. I didn’t use any soap on my breasts, just let the warm water run over them. I also let them air dry. No towels…nasty stuff lives in those. On post-op day 5, my drain output had decreased to 1cc per 24 hours for the past two days. I had a friend who is a breast reconstructive PA who came over and took out the drains and put some bandages on the drain sites. I wouldn’t do this yourself unless instructed to do so or unless you know what you’re doing. It didn’t hurt at all.

At night I slept sitting propped up about 30 degrees. I found it helpful to have good supportive pillows and a thicker blanket rolled up and wrapped around my back and through my arm pits kind of like a horseshoe. I supported the sides of my breasts, my shoulders and arms. It also prevented me from trying to roll and shift in my sleep. My sleep was complete garbage the first few weeks. Ive read this is common. Sitting upright feels fine but the minute I tried to lie back, misery. I feel like the breasts all of a sudden weighed a ton and started swelling. Stupid gravity.

On about post-op day 3, I started taking short walks, about 3 blocks twice a day. It helped my lungs, my circulation and guts stay normal (it improves constipation from pain meds). It’s important that you incrementally start to resume some normal activities such as dish washing (light), folding clothes so that your muscles don’t atrophy and you don’t get too weak. There are some common sense things like not lifting anything heavy like a chair, a laundry basket and not to do any overhead activity because it can strain the incisions, tear sutures and cause tissue to separate and cause bleeding and pain. Everyday I increased my activity slightly. I also actively weaned down the oxycodone use over two weeks to the point where I was using half only at night.

I had strange sensations over the next three weeks…..I would suddenly get shooting pains in my nipple and breast. They would last a few seconds but stop me in my tracks (probably nerves waking up?) My nipples started to feel like they were on fire all the time. My post-op bra (which I wore everyday 23.5 hours of the day) was so irritating to my nipples and areolas. The bra elastic started to irritate my skin, especially underneath the breast. So, I started taking it off for 30 minutes a day while sitting up and sitting topless. Yes, topless. My skin needed a break, a breather. Also, wash your post-op bra every two days. Some nasty bacteria and skin yuk can build up on that thing. I also used some 4x4 medical gauze to be the middle man between my nipple and bra which seemed to reduce some of that direct bra contact irritation. I would also get back spasms around my scapular region. So, I started light cross chest stretching and side and forward bending to get those back and shoulder muscles moving. My right breast, one day, would be my problem child with more hardness/tightness than my left. Then the next day my left breast would sting and ache. Consistently, my arm pits and axilla region was sore and tender. I’ve heard this is common as well. By week 5 this significantly has improved.

The non-nipple/non-areola skin became dry and flaked because I was not putting ANY lotion on them initially. This is common, according to other people to have had this procedure. About two weeks in, I start using a very light moisturizer on my chest and breast skin but staying clear of the incisions. This helped with that flaking and itching. At my second post-op visit, Dr. Beck recommended I start using Biocorneum which is a silicone based topical gel that is applied daily. It also has SPF. From my understanding, it encourages the incision to heal evenly, minimizes hyperpigmentation and creates a mechanical barrier. Its expensive but worth it. Remember, your skin is an ever evolving body organ. The way your incisions look post-op week 1, vs month 1 vs month 6 vs year 1 will be dramatically different. Puckering, unevenness, slight redness, all these little asymmetries will likely even out over time. Not only does the top layer of skin turn over constantly but the under layers of connective tissue including fat turn over. Your skin wants to be smooth and even so give it time to work out these things. Of course there are things to be worried about such as puss, abscess, wound tearing apart…yes, these are bad. I even had a small scab that wouldn’t go away 3.5 weeks post-op. Dr. Beck pick it off and found a small suture that was preventing the skin from bridging with the deeper skin tissue layers. It was not infected, it is common and I didn’t daily wound care at home which was easy and its still healing nicely. Remember, there’s a lot of tension on these incisions as the breast tissue swells and adjusts to the new orientation.

At about week 3, I was able to reach over head with some chest and skin tightness. Reaching behind my back was a bit uncomfortable. Between week 2 and week 5 my quality of sleep suffered and I was miserable. I think I was sleeping around 4 hours a night at best. Around week 5, which is where I am now, I am able to sleep on my side with my normal two pillows and no pain medications. I am able to do all my normal activities except jog and lift weights. I’m waiting another month to start that because I don’t want to re-instigate unnecessary swelling and discomfort. Its not worth it. The numbness around my areolas is slowly resolving as well as the numbness under and around the sides of the my breasts. The breast tissue is becoming more supple and less taught as the swelling subsides. I am able to bend over and reach for things without sudden discomfort.

I continue to follow up with Dr. Beck almost weekly and he is very pleased with the results too. He answers all my questions and reassures me that my strange sensations, areas of numbness, swelling, asymmetry, are all common experiences and will slowly resolve over the next year. His staff is very approachable and always respond to my emails and voicemails. I don’t feel like I’m not on the ignore list now that my surgery is over. Sometimes patients feel ignored after the surgery takes place. I never have.

My incisions at week 5 are doing well minus the healing wound under my left areola. The right breast vertical incision is very hard to see. The areolas are looking more natural….not perfect, but natural. I have fullness in the upper area of the my breasts which was lost over the years. I have fullness and roundness to my breasts which was also lost. They have settled slightly when compared to the first week post-op but this is expected. I still wear my post-op bra most days. However, I can now tolerate wearing a bra that has thick straps and wide support. STAY AWAY FROM UNDERWIRE for the first 6 months as well as thin and lacy and padded bras. Lacy and thin material bras give no support while overly padded bras shouldn’t be necessary after surgery. Plus they’re uncomfortable at first. Get bras with good coverage and support. This will help prolong the life of your lift. Of course at some point you can still occasionally wear a cute or novelty bra for an evening but these should be used on special occasions. They don’t provide support long term. I went through a lot for this procedure. I don’t want to ruin it by wearing crummy bras. Try the soma.com website for good examples of supportive bras with thicker straps, material with good integrity and wider bands with multiple clasps. You don’t have to wear ugly bras that don’t reveal a little cleavage. But there’s a happy medium between full coverage bras and skimpy ones that should be used rarely.

To say that I am satisfied with my results is an understatement. I’m thrilled! This procedure has not defined me or made me want to have more cosmetic procedures like some people worry about. I had this procedure done because I liked who I was and who I was going to become as I age, but I felt like my breasts were not on par with how the rest of my body was aging. I wanted them to retain some essence of youth and attractiveness. I wasn’t expecting to be a bathing suit model. I’m not expecting men to oogle over my chest or women to be envious. I’m expecting to be more comfortable in tight clothing, fit into my old tops and dresses without accommodating my terrible boobs, wear bathing suit tops without having to pull them up and adjust them every 5 minutes. I’m looking forward to continued recovery and re-entering the exercise phase.