All About Breast Lifts (Mastopexy)
The Breast Lift (Mastopexy)
This is one of the more challenging procedures undertaken by plastic surgeons, especially when it involves placement or exchange of implants. There are different types of breast lifts, and each lift has different benefits and liabilities. At its foundation, however, a breast lift seeks to reduce the amount of tissue beneath the inframammary fold, and replace the nipple-areolar complex in its appropriate anatomic position.
I) The Crescent Lift – In this type of breast lift, a crescent of skin above the nipple-areolar complex is excised, and the nipple is sewn into its new superior position. This type of lift, in general, should be avoided. I do not provide this lift to women seeking cosmetic breast surgery for a number of reasons.
- i. Reason #1 – It does nothing to the overall architecture of the breast gland, and because of this, the results are very short lived.
- ii. Reason #2 – Because it does nothing to the breast gland, the gland tends to weigh down the incision, and the incision grows over time into a noticeable scar. BAAAAD….
- iii. Reason #3 – The lift is based upon an excision of skin in a crescent shape above the nipple. When the nipple is sutured into the new position, it tends to lose its oval or round shape, and become an egg.
II) The Circumareolar Lift – This type of breast lift involves an incision around the entire nipple-areolar complex. This incision allows the surgeon to redrape the both the nipple position as well as the breast gland. This is a fantastic approach as it allows the incision to be well camouflaged while providing good access for the surgeon to work his or her magic. I use this incision commonly in my practice, especially in younger women who require a mild to modest lift with minimal tissue removal. When used in conjunction with breast augmentation, I commonly get fantastic results. However, if you are looking for a very large augmentation, it is safer to stage that procedure. Placing too large of an implant in conjunction with breast lift procedures can lead to the devastating loss of the nipple-areolar complex.
III) The Circumvertical Lift – An outstanding procedure that provides consistent and safe results. The only liability of this procedure is that a vertical scar (lollipop) is required. With this procedure, almost any degree of breast “fall” can be offset with outstanding results. As well, combination augmentation with this procedure offers excellent and consistent results. In patients with moderate to severe ptosis (aka breast fall), this is the best procedure in my hands. The scar is minimized at my center with three complimentary laser scar resurfacing sessions postoperatively, as well as silicone sheeting.
IV) The Anchor Lift – This is the most common procedure performed by plastic surgeons nationwide for breast lift procedures. It is my least common, because the scarring underneath the breast is largely unnecessary in many patients. I use this incision only in patients with breast diameters greater that 14.5 centimeters, patients who have undergone massive weightloss, and patients with significant excess skin laterally in the armpit area. This is a great operation, but if you are going to receive that much scar, there had better be a better reason than “Well that’s the way I do it.” Using a vertical lollipop scar tends to be much more technically challenging, but the results for the patient are outstanding and the scarring is much less. Remember, once you have this scar, it cannot be taken away. Make sure you need this much incision before you buy it.
These are the broad strokes of breast lifting. Again, I prefer the circumareolar (around the nipple), or circumvertical (lollipop) incisions. In conjunction with appropriate postoperative laser and skin care, scarring is minimized, and cosmetic results are maximized. I very commonly employ these procedures in conjunction with breast augmentation. Not everyone is a candidate for combination lift with augmentation. Whether these procedures are done simultaneously or staged, however, I routinely achieve excellent results in almost all types of breast patients. The key concept is careful and thorough preoperative evaluation, wide open communication between my patient and I, and complete focus in the operating room. One of our primary tenets regarding these procedures is not to do more than one per day at our surgery center. I believe that each procedure deserves our utmost attention. We are not out for volume. We are out for quality. By focusing on each patient on a daily basis, we achieve outstanding results routinely, and have maintained a flawless safety record over a fourteen year period.