Breast lift or mastopexy is requested by a woman who, for personal reasons want to raise and reshape sagging breasts. As no surgery can permanently delay the effects of gravity and time, the effect is not permanent.
Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman’s breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag.
If your breast size is too small, if you want to correct the breast volume after pregnancy, to balance different breast size or you need a reconstructive technique following breast surgery or after substantial reduction of weight, the breast implants in conjunction with mastopexy may be solution for you.
By inserting an implant behind each breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes.
Breast lifts will be in most cases performed with a general anesthesia, so you’ll sleep through the entire operation. Typically, people are requested not to drink, eat and smoke for about 6 hours before the general anesthetic and may need overnight stay in hospital.
Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.
The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the “doughnut (or concentric) mastopexy,” in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed.
If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.
A breast lift can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently.
The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.
Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you’re planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies or breast-feeding, pregnancy is likely to stretch your breasts again and offset the results of the procedure.
During your initial consultation, your surgeon will explain the surgery in detail, explaining which surgical techniques are most appropriate for you, based on the condition of your breasts, its shape and skin tone. The surgeon will examine your breasts and measure them while you’re sitting or standing.
He or she will discuss whether an implant is advisable. You should also discuss where the nipple and areola will be positioned. Depending on your age and family history, your surgeon may require you to have a mammogram (breast x-ray) before surgery.
Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternativesand the risks and limitations of each.
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You may be asked not to use any medications containing acetylsalicyclic acid (such as Acylpyrin, Aspirin, Alnogon, Mironal, etc.). It can increase bleeding during and after surgery.
It is assumed that no acute illnesses occurred in the period of at least three weeks before the planned operation (viral illness, cold, etc.). Report any illness to your doctor.
If you smoke, plan to quit at least one to two weeks before your surgery and not to resume for at least two weeks after your surgery.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
You’re likely to feel tired and sore for a few daysfollowing your surgery. Your breasts will be bruised, swollen, and uncomfortable for a day or two. Most of your discomforts can your doctor control by the painkillers or other medication.
You will be released from the clinic the following morning. Before you leave, the bandages are changed.
For several days you are recommended to avoid physical strain.
The stitches are removed approximately by week after the surgery.
Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You should wear it as directed by your surgeon.
Healing is a gradual process.
Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks.
If you have any unusual symptoms, don’t hesitate to call your surgeon.
You may resume routine activities after 7 to 10 days. After a six-month period, regular check-ups at a mammary clinic are recommended.
Swelling and bruising in your breasts may take three to five weeks to disappear. You should be able to return to work within a few days, depending on the level of activity required for your job.
Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.
Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.
You should see your surgeon any time when your breast shape change, when the consistencychanges (your breast become hard) or any inflammation manifestation appears.
If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.
Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it’s important to remember that mastopexy scars are extensive and permanent.
Duration of results is variable depending on size (effects of gravity), pregnancy, aging, and weight fluctuations. Women who have implants along with their breast lift may find the results last longer.
Interview with Dr. Petra Berger, board-certified plastic surgeon (Frankfurt am Main and Zurich), on implant removal.
Dr. Berger, after seeing a real boom in breast augmentation using silicone implants in recent years, it now seems the opposite trend is ocurring. More and more women are having their implants removed. Am I wrong? What is your experience in your practice?
Dr. Berger: It varies greatly. On the one hand, silicone implants are still a very good choice for women with smaller amounts of fatty tissue, who wish to fulfil their dream of having larger breasts. I have patients who weeks after surgery still stand in front of the mirror every day, congratulating themselves on their decision. On the other hand, there is also an increasing number of desperate women considering implant removal who are turning to me for advice.
And what do you advise these women?
Dr. Berger: That obviously depends on each individual case. Some women want to go too big and are then surprised by the obviously unnatural result. In this situation, one solution might be to change to a natural shaped implant. Then, there are also women where the breast augmentation appears successful and yet despite this they are completely unhappy.
What are the reasons for this?
Dr. Berger: The phenomenon behind this is the feeling of a foreign object in the body. Silicone – and let’s not kid ourselves here – is not a natural material. In some women, it causes a sensation of having a foreign object in the body, which doesn’t go away if you try to convince them otherwise or with time. You cannot predict which patient will suffer this effect. Some have no problem with it, others are troubled by it. When lying in bed on their silicone breasts, when going for a swim or doing some other kind of sport, their thoughts are always fixed on their implants. In this instance, only their removal will help. We’re actually participating in one study in order to learn more about this phenomenon.
Why might it be appropriate to remove the implants?
Dr. Berger: In some cases, implanted silicone gel causes pain, which has been described to me by some patients as similar to being pricked by a thousand small needles. It may be that there is pain in only one breast, while the other is perfectly fine. Another problem is capsular fibrosis (scarring and hardening of the tissue – Editor’s note), which can occur at any time after silicone breast augmentation.
There seems to be reason enough to argue for implant removal. Certainly a lot of women will try and avoid this step for fear of making things worse, but is this fear justified?
Dr. Berger: The result really depends on the initial state of the breasts, but of course it also depends on how they were operated on previously. Nevertheless, I can reassure the patient. Generally we can help make a big improvement with some minor breast remodelling – sometimes even without it. Especially when used in conjuction with insertion of the person’s own fat you can sculpt beautiful breasts.
Does this mean that affected women can choose either a) continuing to live with artificial breasts and the feeling of a foreign object in the body or b) Going back to having small breasts that they were unhappy with before?
Dr. Berger: No, you can choose between a), b) or c).
That sounds promising. What does option C) entail?
Dr. Berger: Breast augmentation using natural materials – for example, Macrolane made with hyaluronic acid. This is a kind of natural sugar, which is broken down if it is not topped up at regular intervals. For women without their own fat stores, it is a method worth considering. For women with their own cushions of fat there is yet another rather innovative option for breast enlargement: lipocondensation.
Please could you explain that in more detail, Doctor?
Dr. Berger: Lipocondensation uses the patient’s adult stem cells as starting material, which then undergo a complex process of enrichment and purification. With that we get very pure additional fatty tissue, which promises yields of 70-90% above average when compared to conventional practices. Certainly because it comes from the patient’s own body cells, the final product is not only suited to breast augmentation, but can be used anywhere on the body. This is so-called BioShaping we’re talking about here.
That sounds really innovative. Patients will certainly not then be able to complain about this sensation of a foreign object in the body. This will give new hope to all concerned.Thank you, Doctor, for your clarification on the subject of implant removal.
Breast plastic surgery is the most popular and well-known type of plastic surgery. Reasons for a surgical change of shape or size of breasts are not only aesthetic but also medical. Shape, symmetry and the size of breasts can affect a woman psychically and can even influence how they are perceived by others. Large breasts can cause back or vertebral pain. How does breast plastic surgery work and what can a patient expect following it?
First the surgeon will take measurements in order to find out specific distances (see below) so the breasts will have as close to the same shape and size after the surgery. Complete symmetry can never be achieved.
We usually measure the following distances:
1. nipple – jugulum (the pit on the upper edge of the breast bone)
2. further distance nipple – middle line
3. nipple – inframammary fold
4. the incision is then set according to the drawings
Next, the surgeon sets the position level of the areolas so the breasts are of an adequate height based on the patient’s figure, shape of her chest and also according to the planned size of the breasts after surgery (in a breast reduction). The areolas must be well positioned on the breasts. The shift of the areolas is not done through cutting and then suturing on the elevated breasts. The areolas are only shifted up together with the gland.
For the actual surgery, first we make the incisions according to the drawings, make incisions around the areolas, remove the extra skin and eventually any extra breast tissue (for reduction). Breast reductionis performed by removing the wedge on the lower half of the breasts. The wedge can be moved differently depending on where the most tissue is. We also reduce the so-called breast basis, which is the part of the breast connected to the muscle. It shortens the breast’s projection, i.e. how the breast protrudes forward. We sew the breasts and form them with absorbable material.
The fixation of the gland to the muscle in specific heights is to prevent its early and excessive droop after the surgery and therefore sagging breasts as well. Absorbable as well as non-absorbable material is used. Then the skin is sutured and so-called sucking drains are inserted. The wounds are covered with gauze and the breasts are bandaged with elastic bandages.
The drains are kept in for 2 to 3 days on average, depending on the bleeding. The patient uses a bandage bra for approximately 2 weeks. After the largest swellings fade, normally in 2 to 3 weeks, patients can use a normal bra, a so-called push-up is not recommended. It is necessary to wear a bra for a longer time during the day until the scars around the gland are so firm that the breasts do no sag at all or minimally. Such a period usually lasts around nine months. In general, the larger the breast, the longer the time needed to wear a bra after surgery. It can be even one year.
Usually pressure massages are recommended for minimizing scars, although it is not necessary. The pressure of the breast against the bra is an optimal permanent pressure massage. It can eventually be completed with a local application of ointment with silicone (Prosil, Dermatos and others). It is necessary to emphasize that the most significant factor in softening the scars are pressure massages.
Sometimes a slight deformation of an areola might occur, which changes its round shape to ellipse in some time. It is caused by the tension of the scars and the drooping of the breasts. Scars on the edge of the areola do not look good. In these cases we recommend considering a correction of the slightly deformed areolas and eventually perhaps camouflaging them through tattooing.
Every surgeon will proceed with specific differences; he/she has had different experiences. The important thing is that the client is satisfied with the result of the surgery and as we say all the ways lead to Rome.