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After photos were taken 9 Months after
surgery.
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Another name for breast lift is mastopexy. Female breast
ages over time like any other part of the human body. In
the youthful breast, the breast tissue is held up by suspensory
ligaments. Over time and with the changes associated with
childbirth these suspensory ligaments stretch and the breasts
become saggy. The first thing a woman notices when her
breasts begin to sag is change in the nipple position. In
youth, the nipples are pointed directly forward. With aging,
the breast tissue sags and the nipples begin to point downward. The second thing a woman notices is a loss of fullness in
the upper part of the breasts. This results in a significant
loss of cleavage. Often the woman will resort to under
wire bras or other special bras to lift up the breast to reclaim
the cleavage that she once had.
With aging, there may or may not be a loss of breast volume,
but there certainly is a change in breast positioning. This
is why a breast lift can be so helpful. By regaining
proper nipple positioning and cleavage, not only does a woman
look more youthful but she feels younger as well. The
mind is very powerful. It is common for us to hear a
woman say that she feels great until she looks at her breasts
in the mirror and realizes her breasts look old and saggy. The
fortunate thing is that this can be remedied predictably and
safely with a breast lift.
Often, the sagginess and loss of cleavage can be corrected
simply by performing an augmentation. The implant does two very important things. First, it fills
the skin envelop and essentially performs a mini breast lift. Second, it dramatically restores upper breast fullness and
cleavage. The amount of cleavage obtained is completely up
to the patient. Often, women simply wish to return to their
youthful state. Commonly, however, they may wish to create
even more cleavage than they have ever before. These options
will be discussed during consultation with your plastic surgeon.
If your sagginess is very pronounced, however, a formal breast
lift my be necessary often along with an augmentation. The most significant downsides to a breast lift are the incisional
scars. These scars cannot be avoided. Often, this scars can
be limited to just around the areola especially if an implant
is inserted. But, if the sagginess is significant, it may
be necessary to extend the incision directly down from the
nipple to the fold just beneath the breast. This incision
is well hidden but it is still a scar. This may be necessary
in order to obtain the youthful, full projecting breasts with
cleavage that you are looking for. The type of breast lift
that would be best for you will be discussed during your consultation.
If you are considering having more children you should understand
that the childbirth process will most likely change the shape
of your breasts. This is not to say that you should wait until
you are done having children to have the look you want. Frequently
the way a woman feels about her body has a huge impact on
how she feels in general.
After a breast lift, a patient may have some decrease in
sensation of the nipple. This usually returns to normal
in 6 to 12 weeks. More commonly, the nipples become hypersensitive
and even erect. This is because the nerves to the nipples
are over stimulated. This too will go away with time.
 Benefits
There are many benefits to having a breast lift. They
range from improved appearance to better fitting clothes. The
fact remains that aging and the effects of childbirth can
have significant consequences on breast appearance that can
only be corrected with a breast lift with or without implant. The
most dramatic improvements of a breast lift are repositioning
the nipple to a more youthful position and regaining cleavage
and upper breast fullness. The benefits of breast lifting
can be summarized.
- Repositioning nipple to a more youthful location.
- Creating more cleavage.
- More projected breasts.
- Better fitting clothes.
- Improved self-confidence.
- Better proportion between breast and buttocks.
- It can be easily done in conjunction with breast augmentation
for a dramatic enhancement.
Are
you a good candidate?
The best way to decide if you are a good candidate is to
look at the benefits listed above. If these benefits
are something you would like to obtain then it is likely that
a breast lift would be helpful. Sometimes, all that is
necessary is to augment the breast. Usually, however, some
skin needs to be removed leaving a thin scar around the areola
and possibly down to the fold underneath the breast. As mentioned
before, these scars are very acceptable and few woman are
even the least bit concerned about them. The addition of an
implant in conjunction with a breast lift will cause the scar
to be shorter.
Possible
complications
The most common complication after breast lifting is asymmetry. It
must be pointed out, however, that all breasts have some asymmetry. A
breast lift, in fact, can do much to correct asymmetry but
it is unreasonable to expect both breasts to be exactly identical.
Another potential complication is - inadequate volume. This
is not the fault of the procedure, but rather, is the result
of lack of breast tissue because of either childbirth or aging
or simply because it was never there even during youth. This
must be discussed preoperatively. This can be remedied
by the addition of an implant.
Incisional scarring is not a complication but is a necessary
part of the procedure and must be accepted. Over time the
scar will fade but will never go away completely. Some people,
however, scar very poorly and the scar never fades away or
may even keloid. A keloid is a very poor scar and is more
common in Afro-Americans. A good indication as to how your
breast may scar is to look at other scars or incisions on
your body. If they have healed well it is unlikely that you
will scar poorly during the breast lift.
Other possible complications that must be considered are
those associated with any surgical procedure. These include
infection, wound healing problems, fluid or blood collection
and contour irregularities.
Do's
and Don'ts prior to surgery
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Medications. Certain medications thin
blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood
and should discontinued. Your doctor will go over this
more thoroughly prior to the procedure.
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Sleep. It is important to get a good
night's rest prior to the procedure. If you think this
may be a problem, please, do not hesitate to ask your
doctor for something to help you sleep.
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Smoking. You must not smoke within 3
weeks before and after surgery. Smoking has a profound
effect on reducing wound healing capabilities. It significantly
increases the likelihood of infection, wound healing problems,
and scar formation. It also affects your airway, what
makes anesthesia much more difficult.
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Eating. Do not eat within 8 hours of
surgery and do not drink within 6 hours of surgery. It
is OK to take medications with a sip of water. Please
discuss all medications with your doctor and the anesthesiologist.
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Arrival. It is important to arrive on
time so everything goes as planned. Please be sure to
have someone else drive you.
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State of mind. Remember, this should
be a happy and exciting time. A certain amount of nervousness
is normal but you should not be overly concerned. Our
specialists are professional, well trained and experienced. Excessive worrying can actually be detrimental and you
should discuss this with your doctor prior to surgery
so that something can be prescribed to make sure you remain
calm.
Anesthesia
The anesthesiologist will discuss with you what type of anesthesia
is best for you prior to the procedure. He/she will take into
consideration your medical history, the procedure, and your
personal wishes.
In general, most doctors prefer general anesthesia when performing
breast lifts to make sure their patients are completely comfortable
throughout the procedure.
After
the procedure
The procedure itself will take approximately 3 hours.
Immediately. You will notice a big difference
in breast size and position. Right after the operation you
will be nursed for one to two hours and encouraged to walk
around. You will be given as much pain medication as necessary
both immediately after the operation and for the postoperative
period. You will have a surgical bra on.
That evening. It is recommended that you
take it easy. You can walk around, eat, but not much more. It is very important not to move your arms that much especially
if implants have been used. Aggressive arm movements should
not be done within the first 6 weeks after the procedure. You should take as much pain medication as necessary and try
to go to sleep early. Be sure to take your antibiotics. Do
not take aspirin or aspirin containing products and do not
smoke for the first 3 weeks. It is best if you sleep with
your head and chest slightly elevated to promote proper lymphatic
drainage.
First 48 hours. You can take a shower the
day after. Just be gentle. Take the surgical bra off and let
the cool water run over your breasts. Do not move your arms
that much. It is wise to have someone wash the bra while you
shower as there may be dried blood on it. When you're done
with the shower put the bra back on with a little bit of gauze
over the incisions. The bra should be firm but not tight. The incisions will continue to ooze for about 3 days. You
will probably notice some rippling within the incision. Do
not be concerned. This will resolve anywhere from 6 weeks
to a year.
First week. At about day 3 you can move around
normally. Keep limiting the motion of your arms. The bruising
and swelling will go away in about 2 to 3 weeks. Your first
postoperative appointment with your surgeon is at one week. He/she will instruct you on proper bra placement and breast
exercises. You should purchase a sports bra that fits snug.
Afterward. Begin applying SCAR GUARD two
weeks after the surgery. Scarguard is painted onto the incision
like nail polish. It contains a steroid, Vitamin E, and silicone,
all of which dramatically help decrease scar formation. Swelling
will not completely resolve for about 6 months but the majority
of it will be be gone by 3 weeks. You can start moving your
arms aggressively at 6 weeks at which time you can start doing
gentle upper body workouts. Lower body workouts and brisk
walks(no running) can be done as early as 1 to 2 weeks. A
good rule to go by is if it hurts-don't do it. The scars
will look the worst at 6 to 8 weeks after surgery but they
will fade over time and usually become very difficult to see
by 6 months.
Be sure to follow up at your three-month scheduled appointment
to make sure all is well. At that time postoperative pictures
will be taken and you will be most likely given a copy of
your before and after pictures side-by-side. Everyone loves
this and the difference will amaze you!
Recovery
time
Some people with sedentary jobs go back to work as early
as 3 or 4 days. If your job, however, requires aggressive
arm movements it may take as long as 4 weeks to return to
work. You should discuss this with your doctor. Most people
return to work after one week as long as reaching above shoulder
level is avoided. Heavy lifting must be avoided for 6 weeks.
Consultation
We have outlined below what you can
expect from your breast lift consultation. Read carefully,
as there are many suggestions that will save you time, clear
up questions, and help you convey to your plastic surgeon
what it is you want to accomplish.
Health History
All cosmetic surgery consultations
begin with a thorough health history. This is especially
true if general anesthesia is being used, but also applies
to local anesthesia. Breast augmentations are usually done
under general anesthesia. Rarely, if the implant is placed
above the muscle, local anesthesia can be utilized. Prior
to meeting with your plastic surgeon you will be given a health history questionnaire
to fill out in the waiting area. There are five areas of
your health you will be asked about. Be sure to answer
it with detail so that your surgery and anesthesia can be
optimized for you.
General health problems are important
to discuss so that your surgery is as safe as possible.
Be sure to mention any chronic illness. Of particular concern
are: high blood pressure, diabetes, heart problems, liver
and kidney disease, stroke, cancer, bleeding problems, and
wound healing problems.
What will the plastic surgeon do
if I have medical problems?
In short, he/she will make sure your
health is optimized as much as possible to ensure your safety.
This may mean referring you to your private physician.
If you have a
health problem or are over 50 years of age you can often
save yourself time by getting a letter from your private
physician prior to your cosmetic consultation stating what
the health problem is, how it is being treated, and whether
or not you are able to tolerate general anesthesia safely.
If you are seeing
any specialist (cardiologist, kidney doctor, psychiatrist,
etc. ) be sure to bring a letter from them stating that you
are able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your breast augmentation
to be done under local anesthesia if the implant is placed
above the muscle. This must be discussed with your plastic
surgeon.
Be sure to let
your plastic surgeon know if you have ever had a blood clot.
On your questionnaire you will be asked
about previous surgeries. Be sure
to identify any problems you may have had with anesthesia.
Of particular concern are previous cosmetic surgeries especially
if you do not like the result and are interested in revision.
With breast augmentation it is especially important to mention
all breast surgeries including breast biopsies.
Be sure to list all medications you
take including aspirin and over-the-counter medications.
These are important as they may increase bleeding and affect
your surgery. It is extremely important to stop taking
aspirin and aspirin containing products at least 10 days
before surgery. Tylenol is a good alternative. Here is
a partial list of aspirin containing products and other products
to be avoided prior to surgery.
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be sure
to include this information! Nausea is not an allergy but
it is important to mention as well.
These three will certainly affect your
surgery and MUST be mentioned so that your surgery can be
optimized. Smoking causes a profound decrease in wound
healing and will lead to worse scarring and a less favorable
result. With large procedures such
as a face lift, neck lift, tummy tuck, and breast lift smoking
must be stopped at least 2-3 weeks before and after surgery.
Otherwise, the results could be disastrous leading to non-healing
wounds, poor scarring, and/or infection.
With smaller procedures such as eyelid surgery, nose surgery,
breast augmentation, and liposuction smoking will hurt the
overall result but this may or may not be noticeable. In
this case smoking cessation is strongly advised but is not
mandatory.
Specific Breast
Issues
During your consultation you must
be very accurate with breast problems. Of particular
concern is a history of breast masses and/or breast cancer.
If you are over the age of 40 your plastic surgeon will
require that you have a mammogram. Bring the results
with you to your consultation so it can be documented.
If you or a family member has a history of breast
cancer than this age may be moved up to 35 or even 30.
Breast lifting with or without augmentation has no effect
on breast cancer. The only potential problem is mammogram
screening. Mammograms are harder to read when there is
an implant or if you have had previous breast surgery.
This problem is minimized by taking special mammogram
views called Eckland views. Eckland views show the breast
tissue in multiple planes to try and see around the implant.
It works very well but there still is a small (less than
10 per cent) amount of breast tissue that remains unseen.
Mammograms work better when the implant is placed under
the muscle if an implant is used in conjunction with the
lift. This allows better visualization.
What Do You Want To Change?
It is important to understand the
goals of breast lifting and to make sure your plastic
surgeon understands what you want. Are you happy with
the volume of breast tissue that you have but want them
lifted back where they once were? If so, then a lift
alone is probably all that is necessary. If you would
like a lift but with a somewhat more dramatic effect then
a concurrent augmentation may be more appropriate. This
will be discussed in more detail in the Physical Exam
section. See the section Breast Augmentation if you are considering an
augmentation with your breast lift.
Physical
Exam
Height,
Weight, and Bra Size
Typically, your exam will begin with
your height, weight, and bra size. You should be as accurate
as possible. If you have been pregnant or have had a
significant weight change be sure to let your plastic
surgeon know.
Regarding breast size, tell your
plastic surgeon what you would like to be. For example,
I am a 34 B and would like to be a 34 B but with the breasts
lifted. Or, I am a 34 B and would like to be a 34 D with
my breasts lifted. While cup sizes are highly variable
depending on manufacturer, this does give the plastic
surgeon an idea of what you are looking for.
The second part of the exam involves
evaluating the breasts for size, shape, and symmetry.
It should be pointed out that all breasts are asymmetrical.
Some are extremely asymmetrical while others have only
minimal differences. If a woman has breast fed, it is
not uncommon for the breast used the most to sag more
than the other. These asymmetries will be markedly improved
but perfect symmetry is unrealistic.
Common causes of asymmetry include
size differences, sagginess, nipple location, areola size
and shape, scoliosis, chest wall asymmetries.
Typically, your plastic surgeon will
perform a quick breast exam. Monthly, self exams are
extremely important and are, far and away, the best way
to catch early cancers that are easily treatable.
All plastic surgeons will take measurements.
Most will take pictures; others will directly measure
and write everything down.
Here are the most important measurements.
This distance determines sagginess
of the nipple. Normal distances are less than 21-22 cm.
Over 21 cm usually means there is some component of sag.
Minor sag such as 21-22 cm can be corrected with augmentation
alone but anything more usually needs some type of breast
lift in conjunction. See the section on Breast
Augmentation for more information.
This distance determines if there
is a bottoming-out of the breast. It increases as the
breast tissue falls downward. Typical lengths are less
than 6 cm in the youthful breast but may be longer in
large breasts and still be acceptable.
This is, perhaps, the most important
measurement. It determines whether the nipple is on top
of the breast or has fallen. The ideal breast has a conical
shape with the nipple on the top. The nipple should be
at least 3 cm above the IMF. When the nipple falls below
the IMF it should be lifted. Nipples that are at the
same level as the IMF may potentially be corrected by
augmentation alone. This must be determined by your plastic
surgeon.
This measurement is important in
determining the maximal size of implant that will fit
on the chest wall if an augmentation is also going to
be done. This measurement can be anywhere from 11 cm
to over 16 cm.
This is the distance between the
breasts. Most people relate it to cleavage but cleavage
also is dependent on breast size as well. Typical separation
is about 3 cm. This distance does not normally change
significantly with a breast lift unless an augmentation
is also performed. It can be made closer by elevating
the pectoralis major muscle along its medial border.
Point this out to your plastic surgeon if this is important
to you.
The areola is the colored area around
the nipple. It often enlarges after pregnancy as well
as changes shape. Ideal areola size is subjective. Areola
reduction is often done at the same time as breast lifting.
Breast Lift Procedures
The type of breast lift procedure
that you require depends on how much sag you have. As
mentioned above, the single, most important measurement
that determines which procedure is necessary is the relationship
of the nipple to the infra-mammary fold (IMF). This is
outlined below. The measurements are not absolute but
they at least give you a very good idea of what is necessary.
Keep in mind, a concurrent augmentation will fill extra
volume and, therefore, will decrease the need to remove
a lot of the skin envelope. This may make it possible
to perform the least invasive lift.
Depending on the size of the implant
used, it can correct breast sag when the nipple is at least
at the level of the IMF or above. If it is lower then some
form of lift will most likely be necessary. This is somewhat of a controversial topic, therefore,
it is important that you are as educated as possible so
that you can have done what is best for you. It is controversial
because you must weigh the advantages of a properly positioned
nipple versus a scar that goes completely around the areola.
This is a decision that you and your plastic surgeon must
make together. Hopefully, this has helped. (One caveat, if you are on the fence about whether or
not you want to have a lift you can take some solace in
knowing that it can be done later. If, after the augmentation,
you are not happy with your nipple/areola location it can
be done as a secondary procedure usually under local anesthesia. )
It is best when the nipple is no
more than 2 cm below the IMF.
This procedure involves excising
the appropriate amount of breast tissue around the areola
so that the nipple/areola are positioned on top of the
breast mound. This procedure creates a small amount of
rippling at the incision but this usually goes away within
a year or less.
It is best when the nipple is greater
than 2 cm below the IMF.
When the nipple descends greater
than 2 cm below the IMF it is often necessary to incorporate
a vertical incision in order to take up the additional
skin that must be removed.
Men'sy variables determine when this
horizontal incision becomes necessary.
When the skin excess is greater than
even the vertical incision can take up, it is necessary
to remove the rest via a transverse incision. Sometimes
even the plastic surgeon is not sure whether it is necessary
until he begins to operate. The length of the horizontal
incision is, once again, determined by the amount of redundant
skin.
It is easy to see the progression
of how the procedure must be individually matched to each
patient.
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