Many women, following the birth of their children and or breast-feeding, find that their breasts have deteriorated in terms of size, shape, and feel. As the skin loses its elasticity, the breasts tend to lose their shape and firmness and begin to sag. Even without pregnancies, the effects of time, gravity, and alternate weight gain and loss, can all take their toll. A Breast uplift or mastopexy, is a surgical procedure to reshape and raise sagging breasts without altering the overall volume of the breast. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple.
In contrast to the mastopexy procedure, the main aim of the breast augmentation and breast reduction procedures is to change the size or volume of the breast. In some instances however, particularly where the breasts have only slightly drooped, a breast augmentation alone may in fact provide an adequate lift as well as firming the breast. However in this situation you should bear in mind that as a breast implant carries with it a certain volume, this may cause an unacceptable increase in breast size. In other circumstances where an uplift and an increase in volume are both desired then BOTH a breast augmentation and an uplift may be performed simultaneously.
It is probably wise to defer a breast uplift procedure until after you have finished childbearing and breast- feeding. While a mastopexy doesn't usually interfere with future pregnancies or breast- feeding, it is important to understand that having an uplift will not prevent the breasts from drooping again if presented with the same circumstances that made them droop in the first place.
Only a consultation can determine this. During your consultation the Specialist will ask you about your general medical history including details about any previous breast surgery, and childbirth. The best candidates for a mastopexy are healthy, emotionally stable women who are realistic about what surgery can achieve. The best results are usually achieved in women with small, sagging breasts. Breast of any size can be lifted, but the result may not last as long in heavy breasts. While women of all ages can benefit, it's usually never performed before the breasts are fully developed. As previously mentioned, patients who plan to become pregnant should usually postpone the operation until after their family is complete. If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these.
As every patient and surgeon has a different view of what are a desirable size, position and shape for breasts, it is important that you discuss your expectations frankly at the time of the consultation. Following this you will be examined and your breasts will be measured with a tape measure in order to obtain an idea of the degree of droop present. A discussion will take place, in which the Specialist will try to encompass all the variables present- such as your age, the size and shape of your breast, and the condition of your skin, and whether or not a breast implant is advisable. You will be shown where the nipple and areola will be repositioned to, the site of the scars as well as how your breasts may be shaped following surgery. Please remember to ask any questions you may have, especially those regarding your expectations and concerns about the results.
Before going down to theatre, the Specialist uses a marking pen to draw on the breasts in order to determine the exact position and shape of the proposed breasts.
Stretched and loose excess skin is removed and the nipple and remaining underlying tissues are moved to a new higher location, according to the preoperative markings. The nipple is usually positioned in a line level with approximately the middle part of your arm. The suture line or incisions depend upon the degree of sagging. Thus for women who only have a moderate degree of sag an uplift can be achieved through a technique which confines the incision to the area around the areola (the dark pink skin around the nipple. In more severe degrees of sagging then the suture line will need to extend in a vertical line downwards toward the breast crease and occasionally, if necessary, along the breast crease line. The Specialist will be able to inform you at the time of the consultation, which will be the case.
Drainage tubes may be inserted under the breast skin, depending on level of bleeding during the operation, in order to remove any fluid or blood collection, which may occur immediately after surgery. Finally a firm bandage dressing is applied over the suture line.
A mastopexy is usually performed under general anaesthesia and takes about 2 hours.
A breast uplift procedure normally requires an overnight stay in hospital.
Following your recovery from the anaesthetic you will notice a drip in the back of your hand. This is there so that we may replace fluids lost during the operation. For a few days after your surgery, you will probably experience some moderate degree of pain, which should be controlled with painkillers. After surgery it is important that you maintain good circulation in your legs and thus you will be advised to actively move the joints in your feet, knees and hips quite regularly.
If drains are used (only occasionally) these are removed the following day. Normally the bandages placed whilst you are in theatre are left on for 1 - 2 weeks depending on your exact procedure. You will also be instructed to wear a moderately firm supporting bra without an under wire. The stitches used are usually dissolvable.
Following surgery you will experience some swelling and bruising of the breasts. The bruising usually lasts about 2-3 weeks. While most of the swelling will have dissipated by this time, some subtle swelling may still be present for up to 3 months.
Although preoperative markings always try to ensure that both nipples are placed in exactly the same position, natural tension forces within scars may however stretch these slightly which could result in unevenly positioned or shaped nipples postoperatively (always however take into consideration that normal breasts naturally have differences anyway!).
Whilst the techniques used by the Specialist ensures the best possible continuity between the breast and nipples, thus increasing the possibility of breast-feeding after breast uplift surgery, this cannot however be guaranteed.
After surgery you may notice that the breasts feel quite firm and taut, particularly along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by your surgeon will speed up the recovery. It gradually resolves in time but may take a few months to complete. You may also notice in the first few weeks that your breasts appear unnaturally high and very propped up. Don't despair as gravity always loosens them up quickly and brings them back to a more natural, desirable level.
You should expect the sensation to the skin in the nipples and surrounding skin to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. Although this usually recovers in a few months, permanent numbness may conceivably ensue.
Scars are not a complication but a normal event after any surgery. In a breast uplift, the scars, depending on the degree of sagging and the technique used, can be quite lengthy and take many months or years to settle. However as they are around and below the nipples, scars shouldn't be noticeable even in low cut clothing or a bathing suit. You should always expect the scars to be red, raised, lumpy and even itchy to begin with but with time they should fade and flatten. This is the natural evolution of the healing process. However it is important to keep in mind that this may take up to two years to complete. Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance. Although as mentioned, scars do fade and improve in time it is unlikely however that these could ever be characterised as being mainly only "hairline" in nature. As a result of the unpredictability of scars, in cases where breast droop is minimal, it may be advisable to opt against surgery rather than opting for a minor lift with major scars.
For a few days after your surgery, you will probably experience some moderate degree of pain, which should be well controlled with painkillers. This usually improves after the first 4-5 days.
Whilst it is true that when a breast uplift is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.
As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision sites, but usually subsides over a period of about 2 weeks.
Risks such as blood clots are rare. Early mobilisation by moving around as soon after the surgery as possible reduces this considerably.
As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very occasionally, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.
During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion or even chafing of the skin at any point of the incision sites. One of the most common sites is the point where the vertical scar meets the under-breast crease. This is a temporary complication, which will require regular dressing changes initially. Eventually a scab develops over this, which subsequently separates after 3-4 weeks. A padded dressing for a period of a few weeks decreases the likelihood of this occurring. However some distortion of the skin around the scar may ensue. Further revision surgery may be required if necessary.
Patients should always remember that healing is a gradual process. Despite being up and about in a day or two after this type of surgery, you should always try to make provisions to rest in the first few days after surgery. Although many people go back to light work duties by 10-14 days others find it more appropriate to take a further 1-2 weeks to rest. Remember variations do occur in the time individuals take to heal and in fact it may be that you may need a few weeks to pass before you feel yourself again. Walking is helpful in the first 3-4 weeks as this improves the circulation and helps reduce the swelling, as well as the chance of blood clots developing. Heavy lifting or strenuous activity is prohibited in the first 6 weeks after surgery. Overall common sense rules in the recovery period. If what your doing is uncomfortable then don't do it!
The results of this operation are usually excellent and you can expect less drooping of your breast with nipples in a higher position and a fuller shape in the upper half of your breast. It is important to note however that although immediately after surgery, your new breast will be apparent, the final shape will take approximately six months to fully emerge.
Every effort will be made to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars can be extensive and are permanent. Fortunately however, the scars can usually be placed so that you can wear even low cut tops without these being visible.
Your satisfaction with a breast uplift is likely to be greater if you understand the procedure thoroughly and your expectations are realistic. Whilst a well-performed mastopexy offers you many years of rejuvenated, younger looking breasts, it is important to remember that your breast won't keep firm and pert forever. With time and age, ultimately, gravity will always win the battle.