Also known as a Mastopexy, Breast Lift surgery is designed for women who have saggy breasts. It is considered the most difficult of all cosmetic breast enhancement procedures. Dr Eddy Dona has refined his techniques over the years and utilizes his own pioneering modifications to maximise the likelihood of achieving an excellent result for his patients.
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A breast lift (or mastopexy) is performed to correct droopy or saggy appearing breasts, creating fuller and perkier breasts. It involves lifting the position of the nipple and often increasing the breast volume, especially in the upper part of the breasts.
Breasts may be saggy because they initially developed that way or more often they become that way with the passage of time. The skin and ligaments which maintain the youthful shape of the breasts stretch and elongate, and lead to sagging and drooping breasts. This sagging is made worse by the loss of natural breast tissue volume over time. This is a condition that affects women of all ages. The factors which influence the degree of droopiness that develops over time include:
During your consultation with Dr Dona in Sydney, Dr Dona will evaluate the degree of ptosis or sagging of your breasts as minor, moderate or severe. You will be able to tell Dr Dona how you would like your breasts to look post surgery, and express your concerns. Photographs are taken before surgery for your records.
A breast lift procedure simply means lifting the breast tissue and nipple area to create a better breast shape. This can be done with or without the use of an implant.
There are numerous natural anatomical variables that I must assess and work with when planning your breast lift surgery. Of course, due to the persons pre-existing breast state, it’s often not possible to achieve the results that person desires. This is when painting a clear picture of realistic expectations is required.
Breast issues:
Furthermore, the greater the amount of natural breast tissue the greater the amount of changes that occur over time. Having a lot of breast tissue can be considered a blessing when it’s all sitting right, but over time it’s going to change far more compared to those with minimal breast tissue.
Perhaps the hardest thing for patients to accept is that they are needing a breast lift because they have weak and poor-quality breast tissue which has sagged – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to sag. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin. All the surgeon can do is try to reposition and sculpt the breast tissue on that day of surgery.
Whether an implant is required or not, there are three types of scar patterns that can be used for breast lift surgery.
– this involves a circular incision made around the areola. This technique is a minimally invasive procedure that achieves a small degree of lift. It results in a scar around the areolar and is also suitable for reducing the size of the areolar. However there is a limit to how much the areolar can be reduced as they typically tend to stretch back out again especially when implants are also used. It can also create a very flat looking breast.
– this is named a lollipop because of the type of scar it leaves. It results in a scar that extends around the areola and down the midline of the breast to the lower breast fold. Although this procedure is slightly more invasive, it achieves a larger degree of lift with some slight reduction in natural breast tissue volume.
– this is the same as a lollipop technique, but also includes a scar along the lower breast fold – hence an anchor pattern. This is required in those who require a significant lift and possibly need a reduction in natural breast tissue volume.
Often extra volume is required as well as a lift of the breast tissue – therefore implants are used.
When performing a breast lift with implants, the basic principle means that the surgeon must use the correct technique for that patient to ensure that the breast tissue is lifted in such a way that there is a uniform distribution of breast tissue over the implant to create a uniform breast shape.
There are several options available when someone needs a breast lift and also desires extra volume. These include:
– if a mild or borderline sagging problem exists, sometimes a good result can be achieved with an appropriately planned augmentation alone. In other words, no formal breast lift scar, just a routine augmentation scar. Of course once things have settled and if the results are not ideal, then you can still proceed with a lift at a later date.
The ideal candidate for this is someone who has minimal breast tissue. However, there are some technical limitations with the implant size that can be used with such an operation. Furthermore, even in the ideal candidate, I would typically quote around a 20% chance of patients requiring further surgery to “fine tune” the results. However, you would need to wait a minimum of 6 months to allow the results to settle before contemplating and planning this.
It is important to note that a combined breast lift with implants, otherwise known as mastopexy augmentations, is the most difficult cosmetic breast surgical procedures to perform. Therefore, they should only be performed by specialist plastic surgeons that have an expertise in these cases.
However, many plastic surgeons opt to not perform this operation because of the inherent difficulties in doing it.
This typically means performing a breast lift first, and then at a later date performing breast implant surgery as the second. The typical patient who is offered this is someone who has a significant amount of natural breast tissue that has softened and sagged. Trying to do a lift and implants in one operation in these patients generally has a greater risk of complications and a very high chance of requiring further surgery. That is, whilst only one combined breast lift augmentation surgery is planned, more often than not a second unplanned surgery is required to fix problems and improve the results.
Therefore, in these patients a two planned surgeries approach is preferred. The first operation is to perform a lift and create a good breast shape. The second operation, performed a minimum of 6 months after the first, is to make that new good breast shape larger with a carefully planned augmentation. However, many patients don’t proceed with this augmentation as they are just happy to have a better breast shape with the nipples sitting at a better level.
Not to confuse the issue, but some surgeons may opt to do the two-stage approach in reverse – doing an augmentation first, and then performing the lift at a later date and there is nothing wrong with this approach.
Finally, many women who need a lift don’t want to pay the additional costs and/or have the scarring associated with a breast lift. Therefore, they only want an augmentation so that they have the fullness they desire in lingerie and clothing. And whilst they will not look great naked with breast tissue hanging from an implant type look, this is not a concern to them because they simply state that everyone sees them in clothing and extremely few people see them naked. Of course, if later it does bother them, then they can have a formal lift then with no problems.
A combined breast lift/augmentation surgery is the most difficult of all cosmetic breast surgery procedures performed and because of this many plastic surgeons choose not to do them.
And whilst some are much easier than others, in general they are extremely challenging.
So prior to undergoing surgery patients need to be made aware of the complexity of this combination procedure, have realistic expectations, and understand that additional surgery (along with the additional recovery time, time off work, stress, expenses etc) may be necessary in the short or long-term.
A concept that one needs to understand is that a breast lift/augmentation surgery requires the surgeon to increase the breast size with breast implants, whilst at the same time reducing the breast envelope (that is, removing skin and breast tissue in order to achieve the breast lift). These two potentially counterproductive actions must be balanced as perfectly as possible in order to achieve the desired results.
Ultimately, the surgeon needs to lift the nipple and breast tissue to ensure a uniform and “tight” distribution of the natural breast tissue over the chosen implant to create a uniform appearing and feeling breast mound.
During breast lift procedures the nipples remain attached to their blood and nerve supply while they are repositioned. Some of the technical difficulties and limitations of a breast lift surgery is related to ensuring that you surgically don’t completely cut off all the blood supply to the nipple, which would basically mean the nipple would literally die and fall off!
Performing a breast lift without an implant allows the surgeon to apply more surgical “manoeuvres” designed to lift up the breast tissue to maximise the chance of the breast tissue remaining high. Every surgical step involved in a breast lift does to some degree cut off part of the blood supply to the nipple. When an implant is added to the equation, many of the steps involved in creating a pocket for the implant, and the pressure effect from the implant, further compromises the blood supply to the nipple. Therefore, the surgeon often needs to limit the “manoeuvres” required to maximally lift the breast tissue. They also need to reduce the “maximal size” of the implant that could otherwise be used for a simple breast augmentation. These limitations can add to the potential issue of the breast tissue re-sagging early after surgery.
The potential for “re-sagging” is even greater with breast tissue problems such as:
– large volumes
– breast tissue that is very soft and lost its elasticity
– breast tissue that is “detached” from the underlying muscle and slides around
– skin that is thin and has lost its elasticity
Given that women wanting a breast lift typically have one or more of these problems, then you can appreciate that one of the main issues with a breast lift/augmentation is that the breast tissue doesn’t stay where we want it to stay.
Essentially the patient is needing a breast lift because they have weak and soft breast tissue quality which has sagged – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to sag. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin. All the surgeon can do is try to reposition and sculpt the breast tissue.
In addition to breast tissue that doesn’t necessarily stay where it’s meant too, breast implants don’t necessarily stay where we wish they would. Therefore, breast implant related problems such as positioning (too low, lateral slide etc.) can occur and may be a reason for returning to the operating room for further surgery. This is especially the case in those women needing a breast lift because there breast tissue envelope is typically soft without any structural support so it easily stretches again resulting in a very mobile implant.
In the end, often the “full perky” look that many women want is simply not achievable due to the persons chest wall shape, breast footprint, and nature of the persons natural breast tissue.
If you need a breast lift and also want implants, then the surgical options I’ll recommend will depend on the state of your pre-existing breasts and the look you’re after. The two possible options include: the single combined lift/augmentation operation, or two separate operations.
The rationale for a two staged approach in such women is simple:
– The breast lift alone is designed to create an improved breast shape with the nipples sitting at the correct level. Then approximately 6 months later a well-planned breast augmentation is performed as it is easy to make what is now a good breast shape into a bigger good breast shape. However, many patients don’t proceed with this augmentation as they are just happy to have a good breast shape!
An important aspect of the breast lift alone is that such patients will most likely not achieve a long-lasting upper pole fullness as the breast tissue will settle into a lower position. Hence most of these women do want augments to address this problem.
I will briefly mention here that upper pole fullness can also be achieved to a lesser degree with fat transfers but that’s a separate topic.
So basically, you opt to do two well scheduled and well planned operations – a lift first then an augmentation later – to have the best chance of achieving a great long term result. This is far better than doing one planned operation, a combined lift augmentation, where we have a high chance of needing further unplanned surgery to try fix problems, patients not happy, surgeons not happy and we are less likely to get the best long term outcome.
Basically, we want to choose the best pathway, safest pathway, least potential problems pathway to achieve the best long-term results, and if that means two planned operations, then that’s how it needs to be.
And finally, with a planned two stage approach, the surgeon could potentially, and safely, use a larger implant than would otherwise be possible with a combined lift augmentation.
In the end, do your homework, always consider second opinions, and if you want my opinion, give my office a call to schedule a one on one consultation with myself.
Typically, patients can leave the hospital on the same day as surgery. You will, however, require a support person to pick you up from the hospital following your surgery. Depending on your recovery requirements, your support person will need to provide care and assistance, ideally for the first week.
Arrangements should be made so that you can rest without having to care for others. Therefore, those with young children will need to ensure enough support has been organised so this can happen.
It is normal to experience some discomfort and pain following your surgery, which is partly attributed to post-surgery swelling and bruising – this should start to settle after a couple of weeks.
Routine post-operative prophylactic antibiotics are provided, and pain relief is generally required for the first few days. Surgery and the associated pain medications can cause constipation. Therefore, you need to ensure you have plenty of fluid, fibre and laxatives to avoid this problem.
During the beginning of your recovery, you should get lots of rest, drink plenty of fluids and eat regular small healthy meals. For the first few weeks, it is recommended that you sleep on your back or side – this is mainly because any other position will be far too uncomfortable and put too much stress on your surgical site. Smoking (or any nicotine-based products) should also be avoided for the two weeks prior and for at least two weeks after surgery as it impairs wound healing.
You will be advised when you can return to normal activities and work. However, heavy upper body activities and sports should be avoided for at least four weeks after surgery.
Avoid any firm handling or pressure applied to your breasts for the first four weeks.
You will be provided with a post-operative surgical bra for support which you will need to wear for six weeks. Following this, you can go out and be fitted for your new bras.
Like any wounds, the surgical scar from the incision will be slightly red for a few months before it starts to fade. However, it does not fully mature for at least 12 months. We offer all our patients a post-op treatment plan to help optimise your recovery and wound healing.
Post-operative photographs will be taken as part of your ongoing evaluation. Periodic check-ups are required to observe the long-term results of the surgery.
Initially, you will notice swelling and upper fullness to your breasts. In addition to this, the underboob can often appear tight and “flat”. The upper pole fullness will slowly settle and the underboob will slowly drop and round out. Most of the swelling has settled after six weeks, however the “final” results take 6 months.
At this stage we will critically review your results. However, no surgery stops the ageing process. Therefore, after you have achieved your final surgical results, things will continue to change based on the normal process of ageing, gravity, weight fluctuations, childbirth, breastfeeding, hormonal factors, and genetics.
Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about then:
All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.
Some of the specific complications include:
Scarring – it is impossible to avoid with any surgery. The scar itself can have an unpredictable healing response and cannot be anticipated. The type and appearance of the scar will be influenced by personal, hereditary and racial factors. Like any scar, they will be red and very visible initially. It takes up to 12 months for the scars to fully mature, at which stage we would hope they are fine pale lines.
Asymmetry of breast shape and size – with or without surgery, each breast will always differ slightly. However, sometimes this can be significant enough to warrant further surgery.
Change in nipple-areolar sensation – Nipple sensation can sometimes increase (to the point of irritating) or decrease (potentially completely numb). If changes do occur it is typically temporary and within 12 months most sensation returns to the pre-operative state. However, permanently altered sensation can occur in up to 10% of women.
Loss of nipple and areola tissue – extremely rare. Occurs where the nipple and areola has lost its blood supply. Reconstruction can be performed at a later stage. Smoking, large lifts, large implants, diabetes, previous surgery are some of the factors that can increase the risk of this occurring.
Inability to breastfeed – any surgery that causes disruption to the breast milk ducts will result in a potentially reduced ability to breastfeed. The more substantial the lift required then the greater the risk that your breastfeeding ability will be reduced
Breast lumps – is likely due to a small collection of blood or dead fat cells that are still healing.
Breast sagging – despite performing a breast lift, unfortunately the breast tissue itself will always have a tendency of dropping down. It is therefore not uncommon for the upper part of the breasts to look great as this is shaped largely by the implant. However, the lower part of the breasts can often still look droopy as this is typically shaped mostly by the remaining breast tissue. Having a larger amount of natural breast tissue, and breast tissue that is very soft, are some of the factors that make this more likely to occur.
Upper pole emptiness – a breast lift is designed to lift up a low sitting nipple, tighten up a loose underboob, and provide a better breast shape. As a general rule, it does not provide significant upper pole fullness. This is especially the case for those women that have very soft breast tissue. Upper pole fullness is typically provided by an implant.
Inadequate cleavage – this can occur for many reasons even in a simple breast augmentation. However, having a breast lift with augmentation means there is an increased likelihood of this occurring due to technical limitations when combining the two operations. The greatest concern when doing this surgery is ensuring adequate blood supply is maintained to the nipple areolar region. Therefore limiting the amount of internal surgery near the cleavage is one of the surgical steps used to avoid compromising this crucial blood supply. This of course means that technically we are unable to maximise your potential cleavage.
Revision surgery – for those undergoing a breast lift with implants, further surgery is required in up to 20% of patients to “optimise” the results
Breast lift surgery is sometimes partially covered by Medicare, you may be eligible for a Medicare rebate. For example, if you suffer from a congenital anomaly of your breasts, such as tuberous breasts, you may be eligible for a rebate. The best method is to speak with your general practitioner and get a referral for a plastic surgery consultation. Without a referral, a Medicare claim cannot be made even if you are eligible.
Whether your private health insurance coverage will cover your procedure, largely depends on your policy and provider. If you have private health insurance with hospital cover, you may be eligible to have the hospital component subsidised. You should always confirm with your health fund what your level of cover will pay for your surgery. however, as previously stated, the vast majority of women having cosmetic breast augmentation surgery will not be covered by Medicare or any private health insurance.
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