As women age, breast tissue become less firm and tends to sag, while the overlying skin loses its elasticity. The process is accelerated if a woman has had children, or if she has lost a significant amount of weight. Also, over time, the size of the breasts may grow or shrink, depending on the individual.
A breast lift, known as a mastopexy, is a surgical procedure designed to lift sagging breasts by tightening the breast gland, tightening the overlying skin and repositioning the nipple to a higher position on the chest. Often some of the breast gland is removed from the lower portion of the breast to help prevent further sagging in the future. A variety of incisions are available, depending on the amount of lifting required.
One shortcoming of a mastopexy is that this procedure does not permanently increase youthful fullness in the upper portion of the breast – something that can be solved by adding a small breast implant. This procedure is called an "augmentation-mastopexy," which, in my practice, is the most common type of breast lift performed.
If you are considering surgery, you can request a consultation with Richard J. Warren, MD. A staff member will contact you to discuss the procedure, Dr. Warren's availability, and additional scheduling information.
Frequently Asked Questions
Breasts look completely different when a woman lies on her back, as is the case during surgery. For this reason, most of the planning for a breast lift is done before the procedure when accurate drawings can be made on the breast with the patient sitting or standing. The actual surgery is performed at the Vancouver Plastic Surgery Center, under a light anesthetic.
There are two objectives for breast lift surgery: to rearrange the tissue which makes up the breast gland and to tighten the overlying skin. To rearrange the breast tissue, internal "flaps" of breast tissue are created and are used to support the breast in its new position. Some breast tissue is usually removed from the sagging lower portion of the breast. If the breast has lost volume in the upper portion (the "ski-jump" effect), volume can be added, most commonly with a breast implant or with fat grafting. When an implant is used, the procedure is called an augmentation-mastopexy. At some point during the surgery, the patient is placed in a sitting position to fine tune breast shaping and determine the correct position of the nipple. Long-lasting local anesthetic is injected into the breast to control pain post-operatively. The incisions are closed with hidden running stitches.
Breast lift procedures are usually performed under a light general anesthesia, although small procedures can be performed under local anesthetic with or without conscious sedation. Either way, the anesthesia is provided by an anesthesiologist who is certified by the Royal College of Physicians and Surgeons of Canada.
The type of skin incision depends on the amount of loose skin and the degree to which the nipple needs to be lifted. I use 3 different types of incisions: the circumareolar, the vertical, and the inverted "T."
The smallest incision is the circumareolar, which results in a circular scar around the outside of the nipple/areola complex. Sometimes called a Benelli mastopexy, this procedure requires a permanent purse string stitch around the nipple/ areola complex and will lift the nipple up only 1 or 2 centimeters. This method is also useful to reduce an overly large areola, or to flatten an overly pointy breast.
If more loose skin is present and if the nipple must be raised more than 1 or 2 cm, a vertical scar mastopexy, sometimes called a lollipop incision, is used. This combines the circumareolar scar plus a scar which runs vertically from the nipple down to the bottom of the breast.
For breasts requiring the greatest lifting, an inverted T incision is used, which uses both the circumareolar and vertical scars plus a transverse incision in the inframammary fold (where the breast meets the chest wall). Because of its pattern, this incision is sometimes called an anchor incision.
While these various incision patterns are important, the most important variable in maintaining a long lasting result from mastopexy is to do something for the breast gland itself. For larger heavier breasts, simply tightening the skin will not give a lasting result.
For most women, this is the single biggest concern about mastopexy surgery. For the first few months after surgery scars usually look pink, but over about a year, they gradually fade to white. There is a wide variation in the type of scar which finally results. In some people, the scars are almost undetectable – like a thin white pencil line. In most cases the scar is a flat white line, about 2 or 3 millimeters wide. Unfortunately, a small percentage of people develop thickened scars which may require subsequent therapy.
Initially after surgery, there will be some numbness of the skin surrounding the nipples; this normally returns to normal within a few weeks. When performing a breast lift, the nerves to the nipples are usually untouched and, therefore, the feeling in the nipples will be unaffected except for two situations: when the breasts are being reduced in size, or when they are being enlarged with breast implants.
The actual surgery takes about 2 hours, and you will be kept in the recovery room for at least another 2 hours before you are discharged home. Your breasts will be lightly wrapped, and you will be given specific instructions about when you may shower, and when to start wearing a bra. We will speak to you by phone the following day.
There will be mild pain for the first 12 to 24 hours, but this can be treated with simple oral medication. The breasts will seem firm, swollen, and overly lifted, but this always settles down within a few weeks. You will be seen back at the office in 2 weeks for the removal of stitches, and then again at 2 months. You will be asked to refrain from athletics for about 4 weeks. Post-op photos are taken at your final visit, around 6 months after surgery.
Like any surgery, there are potential complications. The most common surgical complication is hematoma; this is a collection of blood under the skin which requires a minor surgical procedure to drain it. The main problem in the short term is the visibility of the scars which can stay pink for a few months; there is much variation in this regard. The most common long term problem is "bottoming out," where the lower portion of the gland tends to re-stretch over time. Fortunately, this can be corrected with a skin tightening procedure using the existing scars.