BREAST LIFT (MASTOPEXY)
Either because of changes following pregnancy or merely with the passage of time, breasts can begin to droop and look aged. This represents the effects of gravity and tissue stretching and leads to a disproportion between the amount of skin and the amount of breast gland. In severe forms, the nipple points downward rather than forward. The procedure known as mastopexy is done to rearrange the skin and breast in such a way as to give the breasts a more youthful, firm appearance. Mastopexy can also decrease the size of the pigmented area around the nipple known as the areola. If the volume of breast tissue has decreased, as often occurs after breast feeding, then a breast implant can be placed at the time of the mastopexy to make the breasts appear larger and firmer.
The best candidates for mastopexy are healthy women who do not smoke cigarettes and are realistic about what the surgery can accomplish. The best results are obtained in women with small, sagging breasts; in larger breasted women, the results may not be as long lasting, because of the weight of the breasts. Mastopexy results in a scar that goes around the areola and then vertically down to the bottom of the breast and sometimes in the fold under the breast. The procedure has a relatively quick recovery and excellent cosmetic results. Patient satisfaction is very high.
A thorough medical history and directed physical examination are obtained at the time of your consultation. Dr. Creasman will examine your breasts, making measurements of the amount of drooping and sizing the proportions of your existing breast tissue with respect to your rib cage size. Any existing scars are evaluated to give the doctor an idea of your scarring potential.
Photographs of Dr. Creasman’s results are shown in the Photo Gallery in this website, but can also be viewed in the office. He will tell you at the time of your visit exactly the approach he would recommend to provide you with the best possible result, while minimizing scarring. Other details, such as whether a breast implant would be of benefit in your particular situation, are discussed. Every patient is different and so no “recipe” description of your treatment can be given over the web. The doctor uses 3D imaging to simulate the effects of the lift and can also show the effect of placing a breast implant. If you wish, the images can be sent to you through a secure server so you can show your spouse.
Risks of Mastopexy
Complications of breast surgery are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, or a reaction to the anesthetic or sedative medications. You may have temporary or even permanent areas of altered sensation, including numbness. There is usually some difference in the size of breasts normally, and this is almost never perfectly correctable. There are fairly lengthy skin incisions that require a period of up to a year or two for completion of the scarring process for optimal appearance. In some ethnic skin types, scarring can be more prominent, and may require further treatment. The doctor will discuss your particular scarring potential in more detail at the time of your consultation.
When breast augmentation is performed in combination with the mastopexy procedure, you need to be aware of the additional risks this imposes.
Before Your Procedure
It is imperative that you refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery. Per current American Cancer Society recommendations, in women aged 40-45, a baseline mammogram is optional prior to surgery and the report faxed to Dr. Creasman.
In women aged 45 and older, a baseline mammogram is recommended prior to surgery and the report faxed to Dr. Creasman.
Antibiotics are administered intravenously just prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written for you at your preoperative visit, so that you have your pain pills when you return home from the operation.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 – 6 months after your procedure.
You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.
You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.
Breast lifts are done under a general anesthetic, which means that you are put to sleep by a board-certified anesthesiologist. Occasionally, Dr. Creasman does a very minor type of lift, which can be done with a local anesthetic with an intravenous sedative. A breast lift usually takes two to three hours. There are several techniques that Dr. Creasman utilizes. The most common involves “lollipop” shaped incisions following the natural skin grain and the breast contour (also known as a “short scar technique”). The incision outlines the area of skin to be removed, and the new position of the nipple and areola. The nipple is not removed from your breast, but rather the skin is rearranged below the nipple creating a “dart”, as in a dress, to tighten the breast tissue and the envelope of skin in such a way as to give the breast more projection away from the chest. The nipple is positioned at approximately the level of the fold beneath the breast. Stitches are placed entirely beneath the skin, avoiding the need for later removal.
If a breast implant is placed, that is done through these same incisions, and is placed beneath the chest muscle.
Some patients, in whom the degree of sagging is less severe, may be candidates for a procedure involving only an incision around the areola. This procedure is known as a “concentric mastopexy” or “Benelli procedure”. In this procedure, circular incisions are placed around the areola, and a donut of skin is removed. A permanent stitch is placed like a purse string within the deeper layers of the outer skin, and the breast skin is cinched down to a smaller circle. The remaining areola is then stitched to the outer rim of skin. Though outwardly, this appears to involve less scarring, the Benelli procedure is actually more involved, and requires a greater degree of surgical skill than the standard (vertical scar) mastopexy. Not every patient is a candidate for the Benelli procedure. It is not a breast lift, it is just a repositioning of the nipple.
The Post-Operative Period
At the conclusion of your procedure, you will be placed into a bra and dressings. The breasts become bruised, swollen, and tender for a week or so, but the pain should not be severe, and is usually well controlled with the pain medication that is prescribed.
After two to three days, Dr. Creasman or his nurse removes the dressings, and the incisions are checked to ensure that there are no problems or complications such as infection. You will then be able to shower. You will be asked to wear a bra around the clock for 4-6 weeks for support of the incisions during the early stages of wound healing. Though the skin of the breast may feel numb for a while, usually the feeling returns in 6-8 weeks. The breasts are placed in an “over-corrected” position with surgery, as there is normally some settling and it is desirable to preserve as much projection and “lift” as possible over the long term. The skin beneath the breast may look gathered, particularly at the lower end of the vertical closure, where the breast meets the chest. This is temporary and typically takes 3 or more weeks to smooth out.
It normally takes approximately 6-8 weeks for all of the swelling to subside, and it takes one to two years for the scars to mature and fade. Dr. Creasman will ask you to use a topical scar treatment to optimize the appearance of the scars. This will be detailed in the post-operative period.