Breast Lift/ Mastopexy
Also known as a mastopexy, breast lift surgery is designed for women who have saggy breasts. It is considered the most difficult of cosmetic breast enhancement procedures and Dr Dona has become one of Australia’s leading provider of this surgery. Dr Eddy Dona has refined his techniques over the years and utilizes his own modifications of the latest, minimal scar techniques thus maximizing the likelihood of achieving an excellent result for his patients.
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:
- Initial size – gravity is less kind to larger breasted women
- Normal changes in breast volume and tissue elasticity over time
- Pregnancy – and weight gain during pregnancy
- Breastfeeding – and duration of breastfeeding
- Body weight fluctuations over time
- How your breasts respond to your body weight changes
YOUR CONSULTATION WITH DR DONA
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.
WHAT FACTORS DETERMINE THE TYPE OF SURGERY REQUIRED?
There are a number of factors that your surgeon needs to consider when deciding what surgical option is required. These include:
- Degree of ptosis (sagging) of the breast and how much does the nipple need to be lifted
- Skin quality – loose with many stretch marks or thick and firm without stretch marks.
- Breast tissue quality – firm or soft. Soft breast tissue is very difficult to handle and typically always wants to sag! Furthermore, soft breast tissue will always be soft – it can’t be made “firm”.
- Breast tissue volume – the greater the amount of natural breast tissue the more difficult the surgery.
- How “detached” your breast tissue is from the chest wall muscles.
- The distance from the nipple to the lower breast fold.
- Your desires.
WHEN EXTRA VOLUME IS DESIRED
As a general rule, there are a number of options available when someone needs a breast lift and also desires extra volume. These include:
Performing an augmentation only – if a mild or borderline sagging problem exists, sometimes a good result can be achieved with an appropriately planned augmentation alone. 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.
*Single Operation – Perform a combined breast lift and augmentation – if Dr Eddy Dona considers you suitable, then he will offer a single operation to address your concerns. 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, there is an up to 20% chance of you requiring further surgery to “fine tune” your results. However, you would need to wait a minimum of 3 months to allow the results to settle before contemplating this.
*Specialist Surgery – Breast lifts with augmentations, otherwise known as mastopexy augmentations, are the most difficult cosmetic breast surgical procedures to perform. This is why they are only performed by specialist plastic surgeons that have an expertise in these cases.
However, many plastic surgeons opt to not perform this in one operation, instead choosing to perform two separate operations for every patient.
Two Staged Approach – Performing a breast lift first, and an augmentation as the second operation at a later date – the typical patient who is offered this option is someone who has a significant amount of natural breast tissue that has sagged. Trying to do a lift and augment in one operation typically has a high chance (greater than 50%) of requiring a revision. That is, whilst only one surgery is planned, more often than not a second unplanned surgery is required. Therefore, Dr Dona recommends a two planned operative approach. The first operation is to perform a lift and create a good breast shape. The second operation, performed a minimum of 3 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 great breast shape!
THE DIFFERENT MASTOPEXY TECHNIQUES
When the breasts have sagged but have good volume, a mastopexy alone will restore shape and projection.
However, most of the time there has also been a loss of volume, and this is most noticeable in the upper half of the breasts. These women will achieve a better result if an implant is used in conjunction with a mastopexy.
A mastopexy involves removing overstretched sagging skin from beneath the breast and repositioning the nipple and breast tissue to a more youthful perky position.
During breast lift procedures the nipples and areolas remain attached to their blood and nerve supply while they are repositioned.
Depending on the size and shape of your breasts, the amount of skin to be removed, quality of skin and positioning of the nipples, Dr Dona will recommend one of the following techniques:
Circumareolar or “doughnut” technique – 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.
Vertical or lollipop technique – named so 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 large degree of lift.
Anchor technique – involves an anchor-shaped scar that extends around the areola, down the lower midline of the breast and along the lower breast fold. This is required in those who require a significant lift.
WHAT TO EXPECT DURING YOUR RECOVERY?
Typically patients are able to leave the hospital the same day as surgery. Before you leave, some discomfort and pain is normal. Routine post-operative prophylactic antibiotics are provided and pain relief is generally required for the first few days. During the beginning of your recovery, you should get lots of rest, drink plenty fluids and eat regular small healthy meals.
All surgery results in some swelling and bruising but should start to settle after a couple of weeks.
For the first two weeks it is recommended that you sleep on your back or side.
Smoking should be avoided for the two weeks prior and for at least two weeks after surgery as it impairs wound healing.
You will be advised by Dr Eddy Dona 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.
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.
Post operative photographs will be taken as part of your ongoing evaluation. Periodic checkups are required to observe long term results of the surgery.
WHEN CAN YOU EXPECT YOUR FINAL RESULTS?
Initially, you will notice some swelling and upper fullness to your breasts. This will slowly settle and most of the swelling has settled after six weeks. However, the “final” results take 3-6 months.
The normal process of ageing, gravity, weight gain, weight loss, childbirth, breastfeeding or hormonal factors will continue to affect the size and shape of your breasts.
WHAT ARE THE POSSIBLE COMPLICATIONS?
As with any surgery, there are always possible risks and potential complications. These include wound infection, bleeding, chest infection, poor scarring, blood clots, bruising and swelling.
Fortunately complications with breast lifts are few and infrequent. But they may 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.
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 –further surgery is required in up to 20% of patients to “optimise” the results
WILL PRIVATE HEALTH INSURANCE COVER COSTS?
Breast lift surgery is sometimes partially covered by Medicare and your private health fund. Dr Eddy Dona will advise whether this applies to you.