Peri-areolar Mastopexy: This technique is also known as Benelli, doughnut,
donut, Circum-areolar or Concentric Mastopexy and was designed with the scars being around
the areolae itself. With the per-areolar mastopexy, a donut shaped piece of
tissue around the areola border is removed and the surrounding
tissue sutured to the areola. The incisions are sometimes closed
with "purse string" sutures to avoid scar stretching
however not all patients' bodies will successfully accept permanent
sutures. Sometimes a little more tissue is removed above the areola
(like the crescent) to compensate for a lifting effect when it is
sutured. It sometimes results in a flatter, rounder breast
Le Jour Mastopexy: Also
known as a Lollipop, Vertical, or Keyhole Mastopexy,
this technique is the same as the above but with straight incisions
from under the areolae to the mammary folds (crease). This is for
those who have medium ptosis, too much for the peri-areolar
lift only and too little for a full anchor incision.
Although some surgeons are capable of giving very
good results with the peri-areolar lift only for medium to
largely ptotic patients.
Anchor Mastopexy: Also
known as an Inverted T Mastopexy or Standard Mastopexy, this
technique is still the most commonly used technique. The incisions are made in the shape of
an anchor at the natural crease of the breast up to the areola and
nipple area. Nipple re-positioning is almost always necessary with
this technique. The nipple is left on a pedicle to maintain circulation
and nerve sensation and the areola is elevated and sutured into a
higher position. This is
considered one of the major scarring techniques but it sometimes
necessary with severely sagging breasts.
Mastopexy: Some surgeons consider the use of breast implants-only
to lift the breasts as a Scarless Mastopexy. The implants are
implanted via a trans-axillary (arm pit) or trans-umbilical (navel) incision and
endoscopic cameras are utilized to go
in and remove a pie-shaped section of breast tissue. The remaining
breast tissue is sutured together and a lifting effect is
created. Not many surgeons offer this technique so be sure to
ask for many before and after photos if you consult with a surgeon
who claims to perform this newer procedure.
Bra: This procedure was innovated and named by W. Grant Stevens,
M.D., F.A.C.S. of Marina Del Ray, California. This procedure
includes typical Full Mastopexy incisions but instead of discarding
the excised tissue, a laser (normally a CO2 Laser) is used to de-epithelialize
the skin and this tissue sewn to the chest wall to create an
internal bra, or sling, to support the weight of the breast.
This procedure can be incorporated into breast augmentation and
breast reduction surgeries.
Major Sling: Some surgeons are beginning to use the pectoralis
major muscle to support part of the glandular tissue of the
breast. IN this procedure, the pectorals major is dissected
from the wall of the chest and part of the glandular tissue is
folded under and sewn to the muscle.
Suspension: This procedure utilizes typical breast lift incisions
but also includes suture suspension of the glandular tissue to the
breast wall. The glandular tissue is anchored to the chest
wall using non-resorbable suture material, usually nylon or polypropylene,
to keep the breast tissue in its elevated position.
Bra: In this procedure a resorbable, and sometimes
non-resorbable polypropylene, mesh is used to support the breast
tissue. The mesh is implanted into the breast using a small or standard
incision, is placed around the breast tissue and fat and the sides
and bottom perimeter of the mesh is sewn to the chest wall.
Thread Breast Lift: This procedure is still in the experimental
stages and is for only very slightly ptotic patients.
Non-resorbable, blue, barbed polypropylene suture material is inserted
into the subcutaneous fat layer of the skin using trocars and
sleeves. Once the sleeves are removed and the suture material
is lightly tugged, the suture's barbs open up into the tissue and
anchor the skin into a tighter, lifted appearance. This procedure
does not support the breast tissue mound and only lifts the
skin. The results are not thought to to last as long as lifts
supporting the inner breast tissue. Another risk is the
possible visibility and palpability
of the blue threads under the skin, skin puckering and fluid
accumulation around the suture material.
Are The Risks & Complications Of This Procedure?
Inherent risks and
complications, such as an allergic or negative reaction to anesthesia
are possible. General risks such as infection, hematoma
(collection of blood within the tissue), seroma (collection of fluid in
the tissues), tissue necrosis (tissue death) if adequate vascularity is
not maintained either during the procedure or during the healing phase
are also possible. Suture breakage and wound separation are possible
as well. Inflammation and non-infected pus may appear around
permanent and resorbable sutures.
loss or change in sensation, is to be expected, at least
temporarily. However, numbness can become a permanent complication.
Odd sensations, including burning, prickling, coldness, crawling, etc.,
during the healing process are common but should prove to be
temporary. In rare instances, increased sensation is possible
resulting in a painful, overly-sensitive feeling when touched even by
clothing. Itching and redness may also occur.
complications are asymmetry, hyperpigmented and keloid scarring, and
Should Perform This Procedure?
Choosing a surgeon can be the most difficult and important part of the
process. While many advise only to choose a board certified
plastic surgeon, meaning only choosing a surgeon who is a member of the
American Board of Plastic Surgery, verifiable on the American Board of
Medical Specialties website, there is more to consider before choosing a
surgeon. Please see our special Choosing
A Surgeon section with tips on how to locate and decide upon a
surgeon to perform your procedure. This section will launch in a
new window for ease of reference and so you don't lose your place.
Should I Expect At My Pre-operative Consultation?
consultations are designed as meetings with surgeons so that you are
able to evaluate what they have to offer, their preferred technique,
before and after photos, anesthesia preferences and other
protocol. This is a very important step in the surgical process as
this is how you will ultimately choose who to book with.
You may wish
to ask if you may bring a friend for emotional support when you call or
email to book an appointment.
Some surgeons don't allow this practice, while others fully understand
and do not mind. This fact will vary from practice to practice so
be sure to inquire ahead of time. You should also determine ahead
of time if there is a consultation fee, more often than not you will
have to pay a fee which may range from $50. to $500. to meet with the
surgeon. This fee is usually designed to separate the serious
patients from those who are just interested but have no intention of
ever having surgery. Consultations may range from only ten minutes
to several hours, depending upon the surgeon and sometimes this duration
does not reflect upon consultation cost.
and check-in, you will be asked to fill out paperwork which will include
your name, address, contact information as well as the contact
information of an emergency contact. Health information will be
taken as well including known allergies, lifestyle (prescription and/or
recreational drug-use, alcohol consumption, smoking, etc.). Completely
disclosing any known or possible condition is vital to your
safety. If you are having general anesthesia, something such as
asthma or smoking can severely impact your health while you are
under. Also, be very truthful about medications you may be taking
or have taken recently.
then meet with the surgeon for a physical examination of the body part
you are consulting about, as well as discuss your options, the
techniques available, anesthesia questions, or anything else you wish to
inquire about. This is an important meeting so do not be afraid to
ask the surgeon anything, or give your input in any way.
You may also
wish to bring photos of breasts which you find appealing, however, with augmentation
only surgeons may only be able to give you a larger version of what you
consultation you may be directed to a patient coordinator's office to
discuss fees, financing, etc. You am either choose to book at this
meeting or wait until you are finished consulting with other
surgeons. Estimates are usually only valid for one to six months
so be sure to inquire about this before you leave.
Are The Average Costs Of This Procedure?
This procedure averages at
$3,500. to $8,000. and
does not include anesthesia, operating room costs, medications or laboratory
tests. Check with each surgeon regarding costs as all practices
have different fees and these fees may prove to be less if the surgeon
has his or her own operating suite. Having your procedure in a hospital
often increases the associated costs.
Do I Prepare My Body For This Procedure?
Once you book your surgery,
you are usually asked to come by for a separate meeting called a
pre-operative appointment. This procedure is designed to allow
discussion of more concerns, protocol specific to the preparation,
surgical and recovery process, pre-operative and post-operative
instructions. At this meeting you will receive instructions on what to
eat, what to take and how to prepare your body for your procedure as
well as how to care for yourself after the procedure.
instructions include cessation of all aspirin or vitamin E-containing
products and supplements, as well as cessation of diet pills, alcohol
consumption, recreational drug use, and smoking. You should
attempt to get your body in its best condition to decrease your chances
of complications. Complications can arise if you continue to
consume alcohol, recreational and some prescription drugs, some supplements,
and smoking. View our chart below to give you an idea of what can
happen if instructions are not followed:
excessive bleeding and bruising
coagulation; excessive bleeding and bruising
disrupt blood flow, poor healing, necrosis
coagulation; excessive bleeding and bruising
excessive bleeding and bruising, increases effects of
pills and other stimulants
coagulation; excessive bleeding and bruising
excessive bleeding and bruising, negative impact on liver,
increases or decreases effects of anesthesia, vaso-constriction;
can disrupt blood flow, poor healing, necrosis
Although many vitamins and
supplements can be harmful before and after surgery, there are also
helpful vitamins and supplements recommended to stimulate healing.
These may include Alpha Lipoic Acid, Arnica Montana, Vitamin A, Vitamin
B Complex, Bromelain, Copper, Vitamin C or Vitamin C Ester,
Chromium polynicotinate, VItamin D3, Folic Acid, L-Carnitine, L-glutathione,
MSM (Methyl Sulfonyl Methane), N-acetyl-L-cysteine, Niacin, Selenium,
taurine, Thiamine and Zinc. Please see our Helpful
Vitamins & Supplements section.
discuss the desired breast size during this meeting, as well.
Although breast tissue is measured in grams, breast implant size is
measured in cc/ml. There are several available options so please
discus them all with your surgeons. You may wish to ask about High
Profile (HP) implants for those who have a smaller ribcage. HP's
offer more projection and less lateral spread at the base. This is
a great option for women who are smaller framed but wish to have medium
to larger breasts for their body size. This is also the better
option for medium to larger framed women who wish to have large breasts
Mental preparation is also a
good idea as not being prepared for your experience can cause unnecessary
anxiety and fear. Also, not knowing what to expect and cause
anxiety when something as normal as bruising and discomfort
arises. Be sure that you know what to expect, what is normal, and
what is not so that you are better prepared during your recovery.
Support during this time is vital, so we invite you to join us on our Breast
Surgery Message Boards to speak with other patients who may be feeling
exactly the same as you currently are or others who have already been
through your current phase in the recovery process.
Is This Procedure Performed?
Please chose a procedure
name for a description, with diagrams, explaining that particular
technique. For your convenience, these pages will launch in a new window.
Should I Expect During My Recovery?
recovery will vary slightly, below is basically what to expect, barring
any complications. Levels of pain and bruising depend upon the
individual, however if any sudden swelling, intense pain or
discoloration should occur, alert your surgeon immediately and seek
Your surgeon should give you post-operative instructions that you should
follow carefully. These instructions will include activity levels,
icing instructions, wound care, personal hygiene instructions,
etc. If you should have any questions or concerns or feel pain
which is not manageable, call your surgeon or the on-call nurse
immediately. Should you begin bleeding or vomiting uncontrollably,
have your caretaker bring you to the hospitable and call your surgeon or
the on-call nurse immediately to have them meet you at the hospital.
You will usually sleep most
of the remainder of the day, waking only for medications or bathroom
breaks. You should try to eat something light such as soups,
Jell-O or protein shakes (although please check the labels carefully for
problematic additives such as high levels of vitamin E or other
anti-coagulants). Eating will help keep nausea at bay and keep
your strength up as well. You should also be drinking plenty of
You may feel more alert
later on that night and feel like watching TV or reading a book.
However, do not over-exert yourself any time during your recovery.
Even if you feel well, you mustn't cause your blood pressure or heart
rate to raise as this can cause a hematoma to occur. You
will more than likely have slight to moderate bruising, as well as swelling
and breast tenderness. Any discomfort should be alleviated by your
prescribed pain medications. Should any severe pain develop,
please contact your surgeon or the on-call nurse as soon as you can.
More than likely, you will
just sleep, waking only to eat, take medications or go to the
bathroom. Be sure to take your temperature regularly. A high
temperature could mean an infection.
You should not lift any
items over 3 lb., nor should you bend over nor reach above your
head. Do be careful when walking up or down stairs, or even so
much as down the hallway to the bathroom. Your medications can
make you dizzy and possibly cause you to fall. Wearing a shirt
which buttons or snaps in the front is recommended.
If your hair is long,
keeping your hair in a ponytail or braid is recommended as your hair can
become quite tangled. This will keep your hair tangle-free and out
of your face.
You may notice sensations
such as sharp pains, tingling, tickling, intermittent throbbing and
other sensations during the course of your recovery. Know your
body, although these are usually normal, anything intolerable could be a
By the next day you may feel more alert and but may not feel like
being very active. Remember
not to over-exert yourself in any way, as you are still at risk for a
hematoma. Your appetite may be increased and you may doze off
throughout the day. Continue to take your medications and
temperature regularly. Your surgeon's instructions should guide
you throughout the course of your recovery.
Day 3 - 5
You will notice your awareness and restlessness will increase during
these days, as well as your appetite. Should your medications make
you nauseated, you should take them with food if directed. Be sure
to continue drinking plenty of fluids. Your surgeon might have you
begin showering a few days after surgery. Sponge baths may
be taken before then if you feel as though you are in need of freshening
Day 7 - 10
Your first scheduled post-operative appointment is usually within 5 to
10 days, depending upon your surgeon's protocol. Your surgeon will
be able to evaluate your recovery and make any adjustments in your
care. Your surgeon may or may not change the bandages or have you
remove them completely.
Any remaining swelling,
bruising and tenderness will usually dissipate over the next few
weeks. Your resorbable sutures may begin to fall out by now, if
not your surgeon may have you return for removal or instruct you on
removing them yourself. If irritation develops around the sutures,
please let your surgeon know.
Your bruising should be faded or almost faded by now, however this will
depend upon your body's propensity towards bruising. You will notice
the incisions will begin to darken and begin to enter the unattractive
stage. This should last about 3 months. The scars will get worse
usually before they get better, so patience is a necessity during the recovery
You should no longer need
pain medications and should have well completed your course of
antibiotics by now, barring any problems which require additional
medications, of course. You are usually still under activity
restraints for another week and should still be wearing a supportive
bra. Support is vital during the scar maturation and general
Oftentimes, activity restraints are lifted at the 3 week mark, but
always listen to your own surgeon. Should you be allowed to return
to normal activity levels, please do so cautiously. You may find
that you tire easily during this stage as your body is still
recovering. You may feel as though you can sprint a mile, it is
often advised you should not. Go easy and always wear a supportive
bra or other garment which supports your breasts.
Sensations should begin returning, you may notice scars getting reader,
telangiectasia (visible capillaries) formation, breast flaking and
peeling, a more normal breast shape appearance and phantom pains as
feeling returns. You should still wear a supportive bra at all
times to lessen tension on incision lines and prevent scar stretching.
Although you may notice scar stretching and redness on the skin near the
Usually, the scars are at the worst at the 3rd month mark. After the
third month, scars begin to fade and blend in better with the
surrounding skin. You should
still wear a supportive bra at all times to lessen tension on incision
lines and prevent scar stretching. Scar maturation actually isn't competently
about 1 year post
You may still notice odd
sensations throughout the course of your recovery. This will occur
as sensation returns and your body heals.
What To Look Out For
Please contact your surgeon or the on-call physician immediately if you notice any of the following:
bleeding from your suture lines
pus or cloudy discharge from your incision areas, nipples or elsewhere
a foul odor from your incision areas, nipples or elsewhere
blisters or implant extrusion (if applicable)
bottoming out of the implant (if applicable)
displacement of the implant (if applicable)
inability to pass waste (both liquid and solid)
numbness of the legs (unless you had lipo as well)
uncontrollable dizziness not related to the pain relievers
deflation (if applicable)
Please contact your surgeon or the on-call physician AND go to the emergency room as soon as possible if you notice any of the following:
passing blood through urine, feces or spitting up blood
abrupt and severe swelling and discoloration (aside from normal swelling)
blackening of the skin (which is clearly NOT a bruise)
loss of consciousness not related to sedatives
What to do in case of a complication:
#1 STAY CALM
Have your emergency numbers handy and contact, or have your caretaker contact, your surgeon or the on-call physician to let them know of your problem as soon as you can.
If you are going to the emergency room don't forget to tell your surgeon WHICH hospital
Bring all of your medications with you to the hospital
It may be cautionary to pack an overnight bag ahead of time "just in case"
If you are able, keep a written journal (and if possible photos) of your symptoms and complaints
This procedure will
result in scars, placement of which depends upon the chosen technique. For some
may be faint, for others, very obvious. Depending
upon your body's healing capability, this scar may result in a thin,
light line or a darker red, or raised scar. Clearly, there are several
stages of scar tissue development, often the redness of the incision
line is most visible at three (3) months post-surgery. After this stage
the scar may continue to fade and the tissue flatten. Please discuss scar
treatments with your surgeon in advance so you know what to do while the
scar tissue is forming, instead of after when it can be too late. Please
see our Scar Treatment Section for more
Scars can also
result in a hypo-pigmented [: lacking pigment, or color] line in some patients, resulting in lightened areas of
skin where the melanin production has been compromised. Areola
tattooing, also know as micropigmentation, can counter these effects by
depositing pigments into the scar tissue thereby blending the lightened
parts into the surrounding tissue. Please know that scar tissue is
more difficult to tattoo than normal skin so be sure to choose a
micropigmentation technician who is well-experienced in tattooing scar
tissue. Please see our Areola
Repigmentation Section for more information.
Else I Should Know?
Temporary and permanent puckering may be an
issue for peri-areolar incisions. This results in an appearance
similar to the gathered section of a drawstring bag. Oftentimes,
puckering dissipates between the second and 6th week, others may take
longer. Steri-Strips, or other paper tape may assist in hastening
this process, however, fluid can also collect under paper tape so use
caution and only under your surgeon's advice.
Revision surgery is
possible, although usually uncommon. However, small in-office
revisions of incisions or scars are a possibility and nothing to be
alarmed about should the need arise.
Inflammation of the permanent
suture, if utilized, is also a possibility and should be watched during
the initial recovery stage. Although, always an infection
possibility, delayed infection is very rare. Inflammation, however
depends upon the individual. This may result in wound opening, pus
or weeping, and raised scar tissue under the areola wherever the
underlying permanent suture is. If this continues, do alert your
surgeon. Inflammation soon ceases after the removal of the
Irregular scarring may be an
issue for some patients. If this should occur, there are options
available. Again please see our Scar Treatment Section
if this turns into a permanent issue.
Can I Read More About This Procedure?
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eMedicine Medical Information
(Updated on 02/25/10)
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