Breast uplift, technically called a mastopexy, is a commonly requested operation. All women would like to have their pert, firm teenage breasts for life. Unfortunately, pregnancy and nursing, major weight loss and the ravages of time and gravity all work to stretch breast skin and allow the breasts to go in only one direction: straight down. Going bra-less for an extended time or exercising and running without sufficient breast support will also accelerate the tendency to droop.
The problem is not with the breast tissue itself but with stretched out breast ligaments and breast skin. It is as if you were a size C cup bra and purchased a size DD bra – your breasts would be “swimming” in that larger bra. In a similar sense, your breast tissue is now “swimming” in a “skin bra” which is much too large. The treatment is therefore aimed at reducing the size of your “skin bra.”
While there is no way to tighten breast ligaments, there are several surgical methods to reduce the excess, stretched out skin and thereby lift the breasts. It is important to point out that in these cases, only the stretched out skin is removed – the breast tissue is left intact to preserve volume. In fact, on occasion, a recommendation may be made to place a small breast implant at the same time to restore any lost volume and to add fullness to the upper portions of the breasts.
Breast uplift surgery always involves removal of excessive skin, elevation of the nipples to a higher more youthful position and a lifting of the entire breast as well. The goal is breasts which are fuller, firmer, symmetric and lifted. It is a complex, demanding operation and should always be performed by an experienced, board certified plastic surgeon.
This surgery is considered entirely cosmetic and is not covered by insurance.
At your initial consultation, an extensive discussion will cover every aspect of the proposed procedure. An examination will determine the health, size, shape and density of the breasts. Measurements of the breasts and nipple locations will be taken and recorded. Varying degrees of breast asymmetry will be addressed – surgery provides an excellent opportunity to make the breasts more symmetric Notation will be made of any additional fat deposits which should be treated with liposuction, such as in front of the armpit or extending along the sides of the chest beneath the arms. And a decision will be made as to whether to add an implant in order to improve the volume while still lifting the breasts.
Finally, there will be discussion about where and how the surgery will be performed. Many factors, such as age, general health, anticipated length of surgery, patient preferences, etc, will determine whether the surgery should be done in a hospital under general anesthesia or in the office surgical suite under sedation anesthesia. For most cases, this will be a 3 – 4 hour operation.
Next, a decision will be made as to the type of implant: saline filled or silicone gel filled. Both of these implants are safe! Examples of each implant will be demonstrated and the characteristics, pros and cons of each will be discussed.
Next, there will be a description of the various surgical methods for the operation and the scars to be anticipated with each technique. Although there are a number of distinct surgical techniques, not every technique will be applicable for every patient. However, every procedure will leave permanent scars – and some techniques leave more scars than others. These scars will fade in time but will always be there. Therefore, the patient must be willing to accept the scars in trade for an uplifted, more youthful breast.
The various surgical techniques will be diagrammed and each, together with its pros and cons, will be discussed in detail.
Classic (“inverted T”) breast uplift: The gold standard for this surgery and proven for many years. There will be scars around the areola, then vertically downward from the areola to the fold under the breast and then continuing in both directions in the fold under the breast. It is used for larger breasts.
Vertical breast uplift: There will be scars around the areola and then extending vertically downward from the areola to the fold under the breast and perhaps continuing slightly further downwards beyond the fold. It is sometimes called a “lollipop” incision.
Peri-areolar breast uplift: There will be scars only around the edge of the areola. This technique preserves most of the architecture of the breast gland (nerves, milk ducts, etc) and is my preferred technique.
WHAT TYPE OF ANESTHESIA IS USED?
All operations in the office surgical suite are performed under sedation or “twilight sleep” anesthesia. The anesthesiologist will monitor your vital signs for your safety and administer small, frequent doses of a variety of medications through a vein. The result is a gentle, relaxed sleep while your operation is performed. There is no pain and no awareness and you will awaken quickly and comfortably in the operating room just minutes after the completion of surgery. There is usually no hangover or nausea afterwards.
Operations performed in the hospital are done under general anesthesia, which is administered by an anesthesiologist or nurse anesthetist. This is deeper anesthesia and recovery will be somewhat longer.
HOW IS THE OPERATION PERFORMED?
Photographs are taken prior to surgery. There will be extensive drawings on your breasts to guide the surgeon during the operation. You will be taken to the operating room and prepared for surgery. The surgery will be performed according to the chosen technique. If there are fat deposits in front of the armpit or extending around the sides of the chest, then additional liposuction will be performed on these areas. If an implant has been chosen, it will be placed either over or under the muscle. All wounds are closed with multiple layers of dissolving sutures on the inside so that there are no stitches to be removed afterwards – only some tapes on the skin. Drains may be utilized to remove any fluids that might collect inside the breasts. The procedure takes about 3-4 hours to perform. At the end of the operation, you will be placed in a post-operative bra and brought to the recovery room. Once you have recovered sufficiently from surgery, you will be discharged in the care of another responsible adult.
WHAT CAN I EXPECT AFTER SURGERY?
You will have some soreness, tightness and tenderness of the breasts, which will last for several days. Appropriate pain medication will be provided. There will also be some bruising and swelling of the breasts which will disappear within 1-2 weeks. Recovery takes about 7-10 days although there is considerable healing during the ensuing months as well. You may drive a car within one week and perform only sedentary activities for two weeks. Strenuous exercise training can be resumed in one month.
Dr Jacobs will schedule several post-operative examinations after your procedure.
WHAT CAN I EXPECT IN THE LONG TERM?
Amazingly, within a week after surgery, your body image in your brain will change and you will accept the look of your new breasts as if you had always been that way!
Your breasts will be swollen for a while. If you have opted to have an implant placed, it would be wise to defer shopping for new bras and bathing suits for a few weeks. If you had just an uplift, then your present bras should be just fine. The final shape of your breasts will take at least three months to be seen and there will always be some relaxation of the tissues – and perhaps even some mild droop – when everything is healed. You should wear a bra at all times and in particular, a strong support bra when participating in sports or exercise.
The scars will be red initially and then fade to pink and eventually to white – this may take anywhere from 6 to 24 months. Sometimes the scars may thicken and Dr Jacobs may treat this with injections or prescribed skin creams. Strong sunblock should be applied to the scars for a year – even if you are wearing a bathing suit.
You are encouraged to have a post-operative mammogram anytime between six months and a year after your surgery. This will establish a baseline “normal” mammogram so that any future mammograms can be compared to it.
It is important to understand that the goal of this operation is to lift the breasts to a more youthful yet adult-type breast. It is impossible to replicate the firm, high-placed, pert breasts of a teenage girl.
You should return for routine follow-up examination on an annual basis. Any changes in your breasts in-between scheduled appointments should prompt a call to our office.
FREQUENTLY ASKED QUESTIONS
Is there an added risk of cancer if I have breast lift surgery?
Absolutely not!!! There is no added risk of breast cancer if you have breast surgery – but you must be aware that breast cancer remains a risk for all women and that periodic self-examination, physician examination and mammograms are essential.
Can I become pregnant if I have had a breast lift?
Yes! Having had breast surgery does not affect your ability to become pregnant. Bear in mind, though, that women sometimes have trouble becoming pregnant, regardless of whether they have had breast surgery. Remember, too, that your uplifted breasts will naturally become larger during the course of your pregnancy and you should wear a good support bra. Despite any precautions, however, it is probable that you will lose some of the benefits of your breast uplift surgery and your breasts will droop somewhat.
I had a pregnancy after breast uplift surgery and my breasts have drooped again. Can something be done about this?
Yes, a second uplift can be performed. It would be more difficult to perform due to the natural scarring that occurs after any prior surgery. It would also be very helpful for you to bring a copy of the original surgeon’s operative report to your initial consultation.
Can I nurse a child if I have had a breast uplift?
During the course of breast uplift surgery, some of the milk ducts may be interrupted and may adversely affect your ability to nurse. Some breast uplift techniques, such as the peri-areolar technique, do preserve breast tissue continuity more than others. Remember, some women may have an inability to nurse regardless of whether or not they have had breast surgery.
Will I still maintain sensation in my nipples?
During the course of breast uplift surgery, some of the nerves providing sensation to the nipples may be interrupted. Fortunately, there are a great many small nerve fibers which provide nipple sensation so if some are lost, the others will “take over.” Immediately after surgery, sensation may be diminished but it usually returns, to some extent, in the majority of patients. In some cases there may be permanent diminished sensation.
I have had a breast uplift already and am unhappy with the scars. Can anything be done about this?
Once there are scars on the breasts, they are permanent and no-one can remove them. However, sometimes improvement of the scars can be obtained through scar revision surgery.
Must I stop smoking prior to breast uplift surgery?
Absolutely!!! You must stop smoking at least two weeks prior to and two weeks after the operation. Failure to do so will substantially increase your risk of complications. No nicotine patches or gum either – they contain nicotine which is the main cause of the problem.