augmentation  implants  lift  reduction  reconstruction  rejuvenation  décolleté enhancement 

   

 Who Is This Procedure For?
This procedure is suitable for any woman who wishes to have their breast lifted or shaped into a more pleasing shape and is in good health, has no wound healing disorders, and has realistic expectations.  Although there is more to being a candidate than the above, the aforementioned is essential.  Only a qualified surgeon can determine if you are a good candidate after a physical examination and speaking with you at length regarding your expectations, medical history and determining your emotional state.

 What Is Breast Lift Surgery, Or "Mastopexy?"
Mastopexy is the surgery of the breast that incorporates excision of excess skin and re-suturing of the tissue to literally lift the breast and give it a more youthful, perky appearance.  The anchor incision used to be the only option and still may be your only option should you have excessive ptosis (or sag) to lift your breasts to their former appearance

 What Are My Options?
The options you have depend upon your needs as an individual.  These options are based on the amount of ptosis correction you need, your skin's elasticity and the amount of sag you are willing to accept versus the scarring you will receive.  Generally there are a few basic techniques, crescent, peri-areolar, Lejour, and the traditional full (anchor) mastopexy.  We have also added the Scarless Breast Lift procedure as well.

  • The Crescent MastopexyThis technique involves removing a crescent-shaped piece of tissue above the areola and re-suturing the tissue to a higher position.  This creates a minor lift for patients who have slight ptosis. Slight, egg-shaped areolae may result in heavier breasts or in patients who do not wear good, supportive bras post-operatively.  This is due to the skin stretching and the tension at the incision line. 

  • The 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 shape post-operatively.

  • The 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.

  • The Full 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. 

  • Scarless 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.

  • The Laser 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.

  • Pectoralis 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.

  • Suture 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.

  • Mesh 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. 

  • APTOS 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.

 What 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.

Numbness, or 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.

Aesthetic complications are asymmetry, hyperpigmented and keloid scarring, and scar stretching.

 Who 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. 

 What Should I Expect At My Pre-operative Consultation?
Pre-surgical 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.

Upon arrival 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.

You will 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 have already.  

Breast Ptosis Grades

After the 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.

 What 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.

 How 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.

Typical 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:

Consumption or Activity What Can Happen
aspirin disrupts coagulation; excessive bleeding and bruising
vitamin E disrupts coagulation; excessive bleeding and bruising
smoking vaso-constriction; can disrupt blood flow, poor healing, necrosis
alcohol disrupts coagulation; excessive bleeding and bruising
recreational drugs disrupts coagulation; excessive bleeding and bruising, increases effects of anesthesia 
diet pills and other stimulants disrupts coagulation; excessive bleeding and bruising
other supplements

   

disrupts coagulation; 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.

You should 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 post-operatively.  

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.

 How 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.

 What Should I Expect During My Recovery?
Although everyone's 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 emergency care.

Day 1
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 fluids.

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 warning sign.

Day 2
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 up.  

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.

Day 14
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 stage.

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 recovery stage.  

Day 21
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.

Month 2
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 incisions.

Month 3
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 

  • uncontrollable pain 

  • blisters or implant extrusion (if applicable) 

  • bottoming out of the implant (if applicable) 

  • displacement of the implant (if applicable) 

  • temperature over 100.5 F 

  • 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) 

  • uncontrollable vomiting 

  • loss of consciousness not related to sedatives 

  • temperature over 105 F 

  • convulsions 

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 

Scarring Concerns
This procedure will result in scars, placement of which depends upon the chosen technique.  For some these 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 information.

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.

 Anything 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 nonresorbable suture.

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.

 Where Can I Read More About This Procedure?
Breast Lift 4 You Patient Education & Support Network
Breast Lift Support & Discussion Forum
eMedicine Medical Information
Resource 

  

  


(Updated on 02/25/10)
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