A Breast Lift, or Mastopexy, is performed to address breast ptosis (droop). A Breast Lift involves lifting the position of the nipple, tightening a hanging underboob, and often increasing the breast volume, especially in the upper part of the breasts.
A Breast Lift (or mastopexy) is performed to address breast ptosis (droop). 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 droop 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 usual shape of the breasts stretch and elongate. The resultant ptosis 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 ptosis that develops over time include:
During your consultation with Dr Dona in Sydney, he 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 ideally your breasts to look post-surgery and express your concerns. Photographs are taken before surgery for your records.
A Breast Lift (Mastopexy) procedure simply means lifting the breast tissue and nipple area. This can be done with or without the use of an implant.
There are numerous natural anatomical variables that Dr Dona 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 hopes for. This is when painting a clear picture of realistic expectations is required.
Perhaps the hardest thing for patients to accept is that they are needing a Breast Lift because they have weak and soft and weakened breast skin and 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 shape 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 potentially 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 optimal 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 often 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, approximately 20% of patients may benefit from 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. The typical patient who is offered this is someone who has a significant amount of natural breast tissue that has softened and dropped. 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 and Breast Augmentation surgery is planned, more often than not a second unplanned surgery is required to address 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 six months after the first, is to make that new 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 a Breast Augmentation so that they have the fullness they want in lingerie and clothing. Whilst when naked the breasts will continue to be ptotic, and with the implants the breast tissue will appear to be ‘hanging’ from or ‘falling’ from the implants, 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 at that stage.
A combined Breast Lift and Breast 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. 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 and Breast 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 Dr Dona 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, Dr Dona often needs to limit the ‘manoeuvres’ required to maximally lift the breast tissue. Dr Dona also needs 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 breast tissue 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 with a combined Breast 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 dropped – yet that same breast tissue and skin still exists after surgery, and it’s therefore still wanting to drop. No surgery and no surgeon can change the quality or consistency of the breast tissue and skin – the objective will be to try and reposition and shape 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 their 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 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 Dr Dona will recommend will depend on the state of your pre-existing breasts and the look you’re after. The two possible options include:
The rationale for a two staged approach in such women is simple:
– The breast lift alone is designed to create an improved breast shape. Then approximately 6 months later a well-planned breast augmentation is performed as it is ‘easy’ to make what is now an aesthetically improved breast shape larger. However, many patients don’t proceed with this augmentation as they are just happy with the lifted 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.
(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 satisfactory long-term result. This is far better than doing one planned operation, a combined lift-augmentation, where you have a high chance of needing further unplanned surgery and you are less likely to get a good long-term outcome.
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 Dr Dona’s opinion, give our office a call to schedule a one-on-one consultation.
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 six 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.
More information on general potential complications can be found on our site. LEARN MORE
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 at least 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 Ptosis (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 may be considered 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.
Whether your Private Health Insurance coverage will cover some parts of 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.
However, the vast majority of women having cosmetic Breast Augmentation and Lift surgery will not be covered by Medicare or any Private Health Insurance.
Call us 1300 DR DONA (1300 37 3662)