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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.

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INTRODUCTION

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
  • Lifestyle
  • Genetics
  • 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?

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:

  • Your Skin quality– is the skin loose with many stretch marks or thick and firm without stretch marks. Often the skin in someone requiring a lift has lost much of its elasticity. Thin skin with loss of elasticity means things have a much greater risk of re sagging.
  • Degree of sagging of the breast and how much does the nipple need to be lifted. Is it sitting below the level of the lower breast fold and by how much? The lower they are sitting, the greater the degree of difficulty in lifting it and keeping it up.
  • The nipple direction – is it pointing downwards or just droopy but still pointing forwards.
  • The skin distance from the nipple to the lower breast fold – if it’s too long that’s a slight problem. But if it’s very short then that’s potentially a greater problem.
  • Nipple areolar size – a very large areolar size can be a potential problem with surgery.
  • Breast tissue quality – is it firm or soft. Soft breast tissue is very difficult to handle and typically always wants to sag! Another extremely important thing to understand is that soft breast tissue will always be soft – nothing can be done to make soft breast tissue firm again. Surgery simply redistributes or repositions the breast tissue. Even with an implant it will still be soft, and it has a much greater risk of re-sagging.
  • Breast tissue volume– the greater the amount of natural breast tissue the greater the degree of difficulty with the surgery. Lifting a large volume of breast tissue and trying to keep it up is difficult and indeed often not possible. The more natural weight the more that gravity is going to affect it!

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.

  • How “detached” your breast tissue is from the chest wall muscles is another issue that’s often difficult to explain. Sometimes the breast tissue is very mobile with loose attachments to the underlying muscle and effectively your breast tissue is sliding around over your chest wall. This makes the breast tissue extremely difficult to handle and therefore difficult to effectively lift.
  • Your desires – what look is the person wanting?
  • Time – the final variable which is impossible to work with is time. How much your natural breast tissue changes after surgery based on your genetics and personal circumstances is impossible to know. Often women will achieve an excellent result early after surgery, but within a relatively short period of time their breast have continued to sag or change. This can be due to natural breast tissue volume fluctuations, weight changes, hormonal changes etc, and these things will negatively affect the results.

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.

THE DIFFERENT TECHNIQUES – WITH OR WITHOUT IMPLANTS

Whether an implant is required or not, there are three types of scar patterns that can be used for breast lift surgery.

Circumareolar or “doughnut” technique  or Benelli technique – 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.

Vertical or lollipop technique – 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.

Anchor technique – 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:

Breast Implants only – 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.

Combined Breast Lift and Implants* – 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.

*Specialist Surgery – 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.

Two Staged Operations – 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.

SINGLE OR TWO STAGE BREAST LIFT & IMPLANTS SURGERY

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.

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.

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