If
you're considering a breast lift...
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. Breastlift, or mastopexy, is a surgical procedure to
raise and reshape sagging breasts--at least, for a time. (No surgery
can permanently delay the effects of gravity.) Mastopexy can also
reduce the size of the areola, the darker skin surrounding the nipple.
If your breasts are small or have lost volume--for example, after
pregnancy--breast implants inserted in conjunction with mastopexy
can increase both their firmness and their size. If you're considering
a breast lift, this brochure will give you a basic understanding of
the procedure--when it can help, how it's performed, and what results
you can expect. It can't answer all of your questions, since a lot
depends on your individual circumstances. Please be sure to ask your
doctor if there is anything about the procedure you don't understand.
The best candidates for breast lift
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. Before you decide to
have surgery, think carefully about your expectations and discuss
them with your surgeon. 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 (for
example, mastopexy usually doesn't interfere with breast-feeding),
pregnancy is likely to stretch your breasts again and offset the results
of the procedure.
All surgery carries some uncertainty and risk
A breast lift is not a simple operation, but it's normally safe when
performed by a qualified plastic surgeon. Nevertheless, as with any
surgery, there is always a possibility of complications or a reaction
to the anesthesia. Bleeding and infection following a breast lift
are uncommon, but they can cause scars to widen. You can reduce your
risks by closely following your physician's advice both before and
after surgery.
Mastopexy does leave noticeable, permanent scars, although they'll
be covered by your bra or bathing suit. (Poor healing and wider scars
are more common in smokers.) The procedure can also leave you with
unevenly positioned nipples, or a permanent loss of feeling in your
nipples or breasts.
Planning your surgery
In your initial consultation, it's important to discuss your expectations
frankly with your surgeon, and to listen to his or her opinion. Every
patient--and every physician, as well--has a different view of what
is a desirable size and shape for breasts.
The surgeon will examine your breasts and measure them while you're
sitting or standing. He or she will discuss the variables that may
affect the procedure--such as your age, the size and shape of your
breasts, and the condition of your skin--and whether an implant is
advisable. You should also discuss where the nipple and areola will
be positioned; they'll be moved higher during the procedure, and should
be approximately even with the crease beneath your breast.
Your surgeon should describe the procedure in detail, explaining its
risks and limitations and making sure you understand the scarring
that will result. He or she should also explain the anesthesia to
be used, the type of facility where the surgery will be performed,
and the costs involved.
Don't hesitate to ask your doctor any questions you may have, especially
those regarding your expectations and concerns about the results.
Preparing for your surgery
Depending on your age and family history, your surgeon may require
you to have a mammogram (breast x-ray) before surgery. You'll also
get specific instructions on how to prepare for surgery, including
guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications.
While you're 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.
Where your surgery will be performed
Your breast lift may be performed in a hospital, an outpatient surgery
center, or a surgeon's office-based facility. It's usually done on
an outpatient basis, for cost containment and convenience. If you're
admitted to the hospital as an inpatient, you can expect to stay one
or two days.
Types of anesthesia
Breast lifts are usually performed under general anesthesia, which
means you'll sleep through the operation. In selected patients--particularly
when a smaller incision is being made--the surgeon may use local anesthesia,
combined with a sedative to make you drowsy. You'll be awake but relaxed,
and will feel minimal discomfort.
The surgery
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.
After your surgery
After surgery, you'll wear an elastic bandage or a surgical bra over
gauze dressings. Your breasts will be bruised, swollen, and uncomfortable
for a day or two, but the pain shouldn't be severe. Any discomfort
you do feel can be relieved with medications prescribed by your surgeon.
Within a few days, the bandages or surgical bra will be replaced by
a soft support bra. You'll need to wear this bra around the clock
for three to four weeks, over a layer of gauze. The stitches will
be removed after a week or two.
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.
You can expect some loss of feeling in your nipples and breast skin,
caused by the swelling after surgery. This numbness usually fades
as the swelling subsides over the next six weeks or so. In some patients,
however, it may last a year or more, and occasionally it may be permanent.
Getting back to normal
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.
Your surgeon will give you detailed instructions for resuming your
normal activities. You may be instructed to avoid sex for a week or
more, and to avoid strenuous sports for about a month. After that,
you can resume these activities slowly. 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 new look
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. They often remain lumpy and red for months,
then gradually become less obvious, sometimes eventually fading to
thin white lines. Fortunately, the scars can usually be placed so
that you can wear even low-cut tops.
You should also keep in mind that a breast lift won't keep you firm
forever--the effects of gravity, pregnancy, aging, and weight fluctuations
will eventually take their toll again. Women who have implants along
with their breast lift may find the results last longer.
Your satisfaction with a breast lift is likely to be greater if you
understand the procedure thoroughly and if your expectations are realistic.