Droopiness of the breast called ptosis is a common legacy of motherhood, body weight fluctuations and ageing. The fibrous bands which support the youthful contour of the breast break down and the skin stretches. Ageing, weight loss or gland involution post pregnancy empties the breast. The unsupported breast envelope is pulled down by gravity and finally, the empty breast settles bellow the inframmamary fold (a crease under your breasts) with the nipple pointing to the floor.
While it is impossible to surgically reconstruct the natural supporting structure of the breast, we can remodel the breast into more youthful, uplifted and perkier contour. The operation is called a mastopexy. Excess of redundant skin is removed from underneath the breast, the breast itself is reshaped into a tighter cone, and the nipples with areolas (the darker skin surrounding the nipple) are repositioned higher up on top of the breasts. The size of the areolas can be reduced in the process, if desired.
We can enlarge and lift small and droopy breast by placing silicone breast implants underneath the tightened breasts (augmentation mastopexy). Breast augmentation alone will help to lift mildly ptotic breast by filling the empty envelope. However, a combined mastopexy and augmentation procedure is necessary, if there is a significant droopiness of the breasts. The implant will add volume and mastopexy will remove the excess skin and reshape the breast envelope. The goal is to increase the breast size and projection without a push-up bra with padding.
Mastopexy can be carried out by a number of different techniques based on the shape of the breast, the degree of skin redundancy and nipple ptosis. Each technique creates a circular incision around the areolas. This enables us to reposition the nipples on the breast and reduce areolar width as necessary. With small lifts scar can be restricted to the areola (periareolar mastopexy), but larger procedures involve vertical scar from the areola to the infammamary fold (vertical mastopexy). In the case of particularly extensive lift a horizontal scar of varying lengths is added in the inframmamary fold (inverted T incision). We always minimize the length of the incision as much as possible.
Mastopexy is usually carried out under a general anaesthetic and depending on the extent of the procedure, will sometimes require an overnight stay in the clinic. Bleeding is carefully stopped during the procedure and only rarely the drain is inserted. Drain evacuates the blood and is removed on the following morning. Painkillers are necessary in the first few days to ease the moderate pain. A well-fitting bra should be worn for comfort in the first weeks. The patient can take a shower after a couple of days and a bath after two weeks. After healing in 14 days fresh scars are covered with surgical tape for a couple of weeks. It is preferred that they are not exposed to the sun for at least 6 months (protect them with sun-block while sunbathing). Any sporting activity should be avoided for at least two weeks, after which it can be gradually reassumed. The final size and shape of the breasts may not be revealed for several months until the scars mature and gravity settles the breast in a new position. There can be some tenderness and lumpiness of the breasts for several weeks or even months following surgery.
Postoperative bleeding can cause the blood to accumulate (haematoma) in the breast. It is a rare occurrence (less than 1%) as all bleeding is carefully stopped with cautery. However, if bleeding does occur, it is sometimes necessary to reopen the incision, remove the collection of blood and stop the bleeding.
Rarely, infection from bacteria harboring in the ducts of the breast can cause part of the wounds to brake down which prolongs the healing and degrades the quality of the scar. Infection is treated with antibiotics.
Sometimes skin can slough and form a scab which leaves a broad scar. Smokers are at greater risk of this happening.
Usually the scars mature and fade to white lines that are hardly noticeable. However, some women have an in inborn tendency for scars to become stretched or remain thick, red and irritable for a long time.
There is no hint of evidence that mastopexy causes breast cancer, or prevents your breast from being examined for cancer in the usual way.
If you are planning to have more children, we recommend postponing the operation. Though there are no risks for future pregnancy, it is likely that the breast will change again and this could work against the results of the operation.
For potential risk and complications of augmentation-mastopexy with silicone implants, please refer to breast augmentation.
Normal breasts have a tendency to sag with time, and you can expect some change in shape to occur after mastopexy. This can be delayed with stable body weight and by supporting the breasts in well-fitting bras while engaging in sports. The extra weight of the silicone implants after augmentation mastopexy accelerates the reoccurrence of the droopiness. This can be minimized by choosing smaller implants.
A lift operation does not normally involve risking of losing the ability to breast feed. After a mastopexy, sensation should gradually return to the nipple; however, this can take many months.