A mastopexy or breast lift is just that: it’s a lift for a droopy breast. Sometimes we put an implant in, sometimes we won’t. Some of that is what the patient wants and some of it is because the breast tissue is so soft, the patient lies down on her back the breast pancakes, a small implant is sometimes necessary. A lot of times we have the skin envelope elevated or lifted a little bit. We can sew the breast tissue into itself. I have had many patients wake up saying you put an implant in here and I said no I didn’t that’s all you. Sometimes we can do that and it really takes a consultation for me to see what the breast looks like.
What about the scars? Some women are very concerned about the scars, others aren’t. I don’t want to leave scars on the breast and I want to leave as minimal scars as I can. Scars that we have designed really heal pretty nicely and they are not that visible. Most plastic surgeons take their pictures postoperatively, certainly I do at three months. When you look at my website those scars are still kind of red, you have to keep in mind they’re going to turn white, they are going to be pale in six months to a year.
Basically, there are three types of lift. The first type is for a minimal lift, the second type is for a more modest lift, and third type is for a bigger lift. The analogy I like to give is: if you want me to take a dress from a size 12 to a size 10, I’ll open the seam in the back and I’ll tighten it up a little bit. For me to take a dress from a size 12 to an 8, or 12 to a 2, etc, by the time I have to do a big change, I am going to cut a whole new pattern.
The scars are around the areola: that one’s called either a purse-string mastopexy, donut mastopexy, or periareolar mastopexy. It leaves a fine line scar just around the areola that is meant to just tighten up the breast a little bit, lift up the nipple and reduce the areola size. I often do that with a breast augmentation.
Then there is a vertical mastopexy which leaves a scar around the areola and vertically downward. We are taking the skin envelope and tightening it up. Remember none of these operations does the nipple come off and go back on. I have heard that a lot. We never do that. The nipple stays where it is. On the breast tissue everything gets rewrapped around it to tighten it up. For a big lift when the breast and the nipple is very low, we wind up with what is called the anchor incision or the T incision. Again, these scars heal very nice and they’re hardly visible within about a year. As scars around the areola vertically downward and in the inframammary fold or underneath the breast. When the skin flaps are opened up or elevated is when we imbricate or sew in the breast tissue to make it firmer and lift up the breast. Despite our best attempts, sometimes you lose upper pole fullness a few months after surgery. The breast is lifted and everything is in a nicer position but the tissue itself just does not have the umph and it just sags back down again not the breast itself just the firmness of the breast. In some patients if they want a fuller breast or a larger breast and they need a lift also, sometimes I’ll do them together, sometimes I’ll stage it.
Breast augmentation with lift is the number one reason plastic surgeons are sued. It is unfortunate to talk about what is the truth and thank God I haven’t had any of those. I think is because I stage them. If a woman needs a really big lift and she wants a good size implant I feel like these two operations are working against each other. One is trying to tighten and lift the breast, the other one is trying to make it bigger and lift it out and that’s where we get in trouble. Those scars are under a lot of tension and they can break down, they can open up, you can get an infection. Sometimes, I’ll do a breast lift and three months later through a tiny incision underneath we don’t open up all the incisions, we’ll do the breast augmentation with great result.