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Breast Lift


Overview

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

  • 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.

  • 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.

  • 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.

  • 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.

  • Arrival. It is important to arrive on time so everything goes as planned. Please be sure to have someone else drive you.

  • 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

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.

  • Past Surgical History

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.

  • Medications

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.

  • Allergies to Medications

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.

  • Smoking, Drinking and Drug Use

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.

  • Observation

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.

  • Palpation for masses

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.

  • Measurements

All plastic surgeons will take measurements. Most will take pictures; others will directly measure and write everything down.

Here are the most important measurements.

  • Distance from sternal notch to nipple.

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.

  • Distance from nipple to infra mammary fold (IMF)

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.

  • Relationship of nipple to infra-mammary fold (IMF)

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.

  • Width of breast

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.

  • Separation of Breasts

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.

  • Areola size

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.

  • Augmentation alone

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. )

  • Peri-areolar breast lift

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.

  • Peri-areolar with vertical incision breast lift

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.

  • Peri-areolar with vertical and horizontal incision breast lift

Many 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.