What is a Breast Lift?
Mastopexy (or breast lift) is a surgical procedure to tighten the skin envelope and reposition the breast mound and nipple at a higher position on the chest wall. It is performed under general anesthetic as out-patient surgery. Breast position may gradually descend (also referred to as breast ptosis) with natural aging as skin loses elasticity, following breastfeeding or significant weight loss. Breast lift may be performed to reposition breast tissue and to correct ptosis. The nipple is repositioned to a higher site on the chest, which may restore a more youthful appearance of the breast.
Who is a candidate for a breast lift?
A candidate for breast lift is otherwise healthy (or with well-controlled medical conditions) with well-defined surgical goals. It is important to understand the risks, benefits, and limitations of breast lift surgery and be able to comply with post-operative wound care instructions as well as activity restrictions as healing occurs. Smoking is a contraindication to breast lift surgery given increased risk of healing complications (infection and risk of skin flap or nipple necrosis, in particular). If future pregnancies are planned, it is also recommended to defer breast lift to lower the risk of recurrent ptosis and potential need for repeat surgery to achieve a desired aesthetic outcome.
What are different techniques of breast lift?
Incision placement will depend on breast and body measurements, ranging from periareolar (limited to a circular incision around the areola), to short vertical scar (the so-called lollipop) or Wise pattern incision (anchor pattern, extending the lollipop with a transverse incision in the breast fold). The periareolar (also called donut breast lift) may result in the least visible scarring. The incision is placed in a circular fashion around the areola at the junction between areolar and breast skin. Although it may result in the least apparent scarring, the lift effect is limited to approximately 1cm. It may be a useful technique for mild cases of breast ptosis. For patients with more pronounced ptosis, the vertical scar (lollipop) or Wise pattern may be required to achieve a more powerful lift effect. The horizontal incision below the breast is generally well-concealed within the natural breast fold.
Breast lift may achieve the following goals:
- Enhanced breast mound position
- Reduction in areolar diameter
What to expect during consultation for breast lift?
During consultation for breast lift, your aesthetic concerns will be discussed in detail. It is important to ascertain whether you are interested in a lift alone or whether you also wish to increase volume in addition to the lift. For patients in the latter group, augmentation mastopexy (breast lift with implants) may be required to achieve your aesthetic goals. A breast lift alone will not increase breast volume.
A complete medical history will be taken during consultation. Dr. Power will inquire regarding personal or family history of breast or ovarian disease. A detailed pregnancy and weight history will also be performed. If future pregnancies are planned, it is advised to defer breast lift until pregnancies and breastfeeding are completed. Smoking status is a key point in pre-operative assessment. Smoking has detrimental effects on healing and increases risk of infection and delayed wound healing. In the most extreme cases, smoking could lead to skin flap or nipple necrosis following breast lift. A patient may be a candidate for breast lift if smoking cessation is achieved and maintained for at least one month pre- and post-operatively, which has been shown to lower these associated risks.
During physical examination, breast and chest wall measurements will be performed to assess the degree of breast ptosis. The tissue under the arms toward the side of the breasts will also be examined (called the lateral thoracic region). This region is not addressed through breast lift. If fullness is present at this site, it may be amenable to correction through combined liposuction. It is important for patients to achieve a healthy body mass index prior to undergoing breast lift surgery. A BMI of 25 or less is recommended. If weight loss occurs following breast lift, breast ptosis may recur and volume may be less predictable.
How to prepare for breast lift surgery?
Specific instructions will be given to each patient pre-operatively. It is important to avoid anti-inflammatories (e.g. Advil, Aleve, and Aspirin) for one month before surgery to lower risk of bleeding. It is generally safer to hold herbal supplements as well since some may increase risk of bleeding. Dr. Power will give specific recommendations based on your particular medications and supplements. Your prescription for post-operative medications will be given to fill in advance. Prepare a comfortable bed with 2-3 pillows to maintain your head and back in elevation following surgery, which may reduce discomfort and further swelling. You will be given information regarding the time to present at the Surgical Suites at 199 Avenue Road. It is important to begin fasting (no eating or drinking) at midnight before surgery. If any prescription medications are routinely taken, Dr. Power will advise whether to take on the morning of surgery with a limited sip of water.
What to expect following breast lift?
Breast lift is performed under general anesthetic as out-patient surgery. You will awaken in the post-operative recovery room. It is important to wear a post-operative sports bra for one month following surgery. At that time you may get fitted for and resume wearing an underwire bra if desired. Prescription pain medication is generally required for a few days post-operatively. It is recommended to wean to Tylenol plain or extra-strength as soon as able to lower risk of narcotic side effects. Bruising will resolve within 1-2 weeks. The majority of swelling will resolve over the few first weeks, however final results will not be apparent for many months, even up to one year, as scar tissue matures and subtle swelling resolves.
What is anticipated recovery after breast lift surgery?
Once no longer requiring pain medication and able to mobilize appropriately, you may resume driving. Patients are generally able to return to light office work within a week of surgery. If job responsibilities are more strenuous, longer recovery may be required. Exercise and heavy lifting over 5 lbs should be avoided for one month following breast lift to lower risk of bleeding and further swelling.
What are risks of breast lift surgery?
Risks of breast lift surgery include infection, bleeding, hematoma formation, and delayed wound healing. If one breast becomes firm, enlarged, and more bruised compared to the other side during early recovery, this could signify hematoma formation, which refers to a collection of blood or ongoing bleeding post-operatively. A hematoma is the main cause for concern during early recovery and Dr. Power should be notified immediately.
Further risks include hypertrophic or thickened scarring, nipple sensation changes, asymmetry, and dissatisfaction with aesthetic outcome. If risk factors for increased scarring are identified during pre-operative assessment, silicone sheeting may be recommended. If worn continuously for 3-4 months following breast lift except when showering, silicone sheeting may improve scar appearance through hydration and increasing scar temperature. Scar massage is also recommended beginning a couple of weeks following breast lift to promote scar remodeling. As for any breast surgery, particularly when an incision is carried around the nipple, altered nipple sensation may result. The majority of cases will improve or resolve over time, however permanent sensation changes may occur. There is also risk of nipple necrosis, which is remote in healthy non-smoking patients.
Can breast lift be combined with other surgeries?
Breast lift may be combined with other surgeries based on a patient’s aesthetic goals, clinical presentation, and anticipated length of surgery. Common combinations in healthy candidates include breast lift and tummy tuck (the so-called mommy makeover) as well as breast lift with liposuction of the lateral thoracic region.
Will exercise achieve the same results as a breast lift?
Exercise will not achieve equivalent results to a breast lift and may in fact result in greater breast ptosis. During a breast lift, the skin envelope is tightened through skin removal and breast tissue is repositioned. Exercise may reduce fatty tissue within the breasts and increase the appearance of redundant skin. Once the skin has been stretched beyond a certain degree, it will not contract sufficiently following weight loss to resuspend breast position. During breast lift, the areola may also be reduced to achieve a more youthful position. This is also not affected by exercise. Exercise is still recommended for overall health benefits and to achieve a healthy body mass index before undergoing elective cosmetic surgery.
Will breast lift remove stretch marks?
The appearance of stretch marks may improve following breast lift, since the skin envelope is tightened and some breast skin is removed. Breast lift may not remove all stretch marks from the breasts however.
Are there any age restrictions relating to breast lift?
No. When considering breast lift at a younger age, the most important question relates to plans for future pregnancies. While breastfeeding may be performed following breast lift, breast shape and position may be affected by future pregnancies and breastfeeding. If planning future pregnancies, it is recommended to defer breast lift until at least 6 months following completion of breastfeeding.
There is also no upper age limit when considering breast lift. It is important for patients to be otherwise healthy or for medical conditions to be well-controlled before undergoing elective surgery under general anesthetic. Patients over age 50 are routinely worked up through blood work, chest x-ray, and EKG before surgery to ensure otherwise healthy. If being treated for other medical conditions, consultation with an anesthesiologist at 199 Avenue Road or another medical specialist may be required pre-operatively to ensure that surgery may safely be performed. This relates to a patient’s medical conditions and overall health as opposed to age alone.
How long will results of a breast lift last?
As swelling resolves and healing progresses, early results will be apparent within a few months of surgery. Final results, as for most cosmetic surgeries, may take up to one year as scar maturation completes. The breasts will still be subject to the ongoing effects of aging and gravity, however results of breast lift surgery should be long-lasting as long as one’s weight remains fairly stable. If pregnancy and breastfeeding occur following a breast lift, results may be less predictable and a repeat lift may be required based on one’s aesthetic goals.
Breast lift is an effective surgery to reposition the breast mound and nipple to counteract effects of gravity, pregnancy and breastfeeding, and weight loss. Please contact us to schedule a consultation if considering whether breast lift may be an option for you to achieve cosmetic breast enhancement.