Breast Lift (Mastopexy)

Mastopexy

Breast  Lift (Mastopexy )

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Women’s breasts often change over time, losing their youthful shape and firmness.
These changes and loss of skin elasticity can result from:

• Pregnancy
• Breastfeeding 
• Weight fluctuations 
• Aging 
• Gravity 
• Heredity

Breast lift, surgical term mastopexy, raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour.
Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well. A breast lift can rejuvenate your figure with a breast profile that is youthful and uplifted.

Why have a mastopexy?

Breast lift surgery is a highly individualized procedure and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image. If your breasts are sagging and not the shape they used to be this can cause under confidence and depression plus lead to problems such as back, neck & shoulder pain, excessive sweat rashes and difficulty in participating in sport or find clothes to fit well.

A breast lift is a good option for you if:

• You are physically healthy and maintain a stable weight
• You do not smoke
• You have realistic expectations
• You are bothered by the feeling that your breasts sag, have lost shape and volume
• Your breasts have a flatter, elongated shape or are pendulous
• When unsupported, your nipples fall below the breast crease 
• Your nipples and areolas point downward 
• You have stretched skin and enlarged areolas 
• One breast is lower than the other    

Ask advice

If you are considering having a mastopexy, it is advisable to contact your GP. Your GP wil have an overview of your general health, and may know about any past illnesses or conditions that increase the risks of complications during surgery.

A breast lift is usually a cosmetic procedure and not essential to your health. You will only qualify for a breast reduction on the NHS if you meet specific, often strict, criteria set out by your local health authority. Many women are unlikely to qualify.

To decide if you meet these criteria, you'll usually be referred to a surgeon and a psychologist or psychiatrist. They will report on whether there are good enough psychological, social or physical reasons to justify surgery on the NHS.

What you should consider prior to surgery

Prior to going ahead with mastopexy, you should consider the result you hope to achieve.
Many women find that the benefits of breast lift far outweigh the side-effects. However, because a breast reduction is done, at least in part, for cosmetic reasons, it is especially important to carefully consider the risks.

Because breast size alters with body weight, you will be more suitable for surgery if your weight is stable. Your breasts won't grow again after surgery, but they may still fluctuate in size if you gain or lose weight.

If you are a younger woman, the surgeon will advise you to wait until your breasts have stopped growing before performing the operation.
As with breasts that have not been surgically reduced, some drooping will still occur as you get older.

A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anaesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.

Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

The success and safety of your breast lift procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs 
• Previous surgeries
• Family history of breast cancer and results of any mammograms or previous biopsies

Consultation Prior to Surgery

Each surgery is unique to the individual and the surgeon’s individual approach towards the patient corresponds accordingly. A state of good health is an obvious pre-requisite. This is your chance to ask questions about the operation. It is a good idea to bring a list of your questions to the consultation

The surgeon will also give you advice on how best to prepare for the operation. If you are overweight, you may be advised to lose weight beforehand. Smokers will be advised to give up because smoking increases the risks of surgery, including delayed healing.

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors 
• Examine your breasts, and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas 
• Take photographs for your medical record 
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast lift surgery and any risks or potential complications
• Discuss the use of anaesthesia during your breast lift
• Get lab testing or a medical evaluation (i.e. blood tests)
• Take certain medications or adjust your current medications 
• Get a baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
• Stop smoking well in advance of surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Pre-operative Instructions

• After a consultation with your plastic surgeon and arranging for the operation date, you shall undergo an internal pre-operation examination. If, after the first consultation, there are any concerns about the surgery, another consultation can be arranged.
• One month before the operation, do not use any medications containing acetylsalicylic acid (Aspirin etc.). It can increase bleeding during and after the surgery.
• It is assumed that no acute illnesses occurred in the period of at least three weeks before the planned operation (viral illness, cold, etc.). Report any and all illnesses to the clinic.
• Drink two to three liters of mineral water daily three days before the operation, however, 6 hours before the operation do not drink, eat, or smoke.
• Have a good night’s sleep the night before the operation; you should be well rested before the operation. No alcohol may be consumed the night before the operation.
• Wash your hair the day before the operation and do not put any facial cream, milk or make-up on the day of the operation. Any jewelry, including earrings, should not be worn.
• We recommend for you to be accompanied by a close person in the time of your stay at the clinic and in your hotel/suite. Immediately after the operation, you must not drive any vehicle by yourself. 

The Mastopexy operation

Your breast lift surgery can be achieved through a variety of incision patterns and techniques. The appropriate technique for you will be determined based on:

• Breast size and shape
• The size and position of your areolas
• The degree of breast sagging
• Skin quality and elasticity as well as the amount of extra skin

1 - Anaesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Your doctor will recommend the best choice for you.

2 - The incision

There are three common incision patterns:

1) Around the areola

                    
2) Around the areola and vertically down from the areola to the breast crease

                    
3) Around the areola, vertically down from the breast crease and horizontally along the breast crease

                     
3 - Reshaping your breasts

After your doctor makes the incisions:

• The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
• The nipple and areola are repositioned to a natural, more youthful height.
• If necessary, enlarged areolas are reduced by excising skin at the perimeter
• Excess breast skin is removed to compensate for a loss of elasticity.

4 - Closing the incisions

After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed.

Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.

Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.

5 - The results

The results of your breast lift surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade.

Satisfaction with your new image should continue to grow as you recover and realize the fulfilment of your goal for breasts which have been restored to a more youthful and uplifted position.

Post-operative Period

Patients stay at the clinic/hospital overnight and are usually released the following morning. Before the patient leaves, the jelly bandages are changed and the drains are removed. It is recommended to rest well for several days and for the patient to avoid any physical strain.

The bandages will be changed again on the third or fourth day after the surgery. The suture is of self-absorbent material. In three to four weeks, supposed the wound has healed as expected, the patient may begin applying the scar pressure massage.

The patient will be instructed on how to massage the breasts. The patient is advised to wear an elastic bra of a sport type. However, full physical load and activity are permitted only after one to two months. After a six-month period, regular check-ups at a mammary clinic are recommended.

Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon.

Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Side-effects

The decision to have breast lift surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

The risks include:

•   Unfavourable scarring
•   Bleeding (hematoma)
•   Infection
•   Poor healing of incisions
•   Changes in nipple or breast sensation, which may be temporary or permanent
•   Anaesthesia risks
•   Breast contour and shape irregularities
•   Skin discoloration, permanent pigmentation changes, swelling and bruising
•   Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
•   Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
•   Breast asymmetry
•   Fatty tissue deep in the skin could die (fat necrosis)
•   Fluid accumulation
•   Excessive firmness of the breast
•   Potential partial or total loss of nipple and areola
•   Deep vein thrombosis, cardiac and pulmonary complications
•    Blood clots
•   Pain, which may persist
•   Possibility of revisional surgery

Specific complications of breast reduction include:

• occasionally, scars may stay thick, red and irritable for a long time 
  rarely, abnormalities of the blood supply may result in loss of part, or even all, of a nipple
• breasts will always change shape slightly after the procedure, but occasionally the breasts may be more uneven than normal, or the nipples may not be level

Follow-up

You will always have a post-operative consultation with your surgeon to review the results and to check on your progress. Once you've returned home, you'll need two to six weeks of rest depending on your age and health. A week or two after surgery, your stitches will either dissolve, or you'll need to have them removed. If stitches are not dissolvable they will be removed at your post operative check up with your surgeon prior to returning home.

Your new breasts!

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.
You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.
Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic