Mastopexy (Breast Lift)

Candidates for a mastopexy are women seeking a solution for sagging breasts with stretched skin, possibly with stretch marks, and a reduction in volume over the years; Patients must be at least 18 years old, in good physical and mental health, not pregnant (nor planning to become pregnant in the near future), and of stable weight.

Many women consider a breast lift after childbirth and breastfeeding for two reasons: after pregnancy, the breasts sag, lose volume, and stretch marks appear; on the other hand, during pregnancy the breasts enlarge, and many women like the appearance of their breasts during this period—an appearance that is lost after childbirth.

A mastopexy does not interfere with pregnancy or breastfeeding; in other words, after the surgery, patients can give birth and breastfeed without any problems. However, the breasts will sag again, which compromises the long-term results of the surgery. Therefore, it is best to schedule a breast lift after the patient has decided not to become pregnant again.

A breast lift is also recommended following significant weight loss, when excess skin inevitably develops and the mammary gland loses volume. In these cases, mastopexy is often combined with other procedures, such as abdominoplasty and a full body lift (thighs, buttocks, arms). These procedures are performed after the patient has stabilized at a consistent weight and does not plan to lose any more weight. A mastopexy restores the normal appearance and volume of sagging breasts. This is achieved by lifting the breasts, and, in certain cases where necessary, the lift is combined with the insertion of an implant. There are several types of mastopexy procedures, depending on the degree of breast ptosis (how much the breast has sagged); however, all involve incisions—longer or shorter—through which excess skin is removed.

Periareolar mastopexy: This is recommended for breasts with the least ptosis, and the incision is made only around the areola; with this procedure, the breasts are lifted only slightly (about 2 cm at most) and it is rarely performed on its own; It is most commonly combined with the insertion of an implant;

Vertical (lollipop) mastopexy: This is the most commonly performed procedure worldwide today and is indicated for most cases of moderate-to-severe ptosis; the resulting scar runs around the areola and continues vertically down to just below the inframammary fold; it can be performed on its own (if the breast gland has sufficient volume) or in combination with the insertion of a silicone implant;

anchor-shaped mastopexy: this procedure is indicated for severe cases of breast ptosis; the resulting scar is around the areola, continuing with a vertical incision down to the inframammary fold and another horizontal incision in the fold, which may be longer or shorter depending on the amount of excess skin; it may also be combined with the insertion of a silicone implant.

Breast lift surgery combined with augmentation (lifting and enlarging the breast at the same time), when a silicone implant is used to restore volume, involves removing less skin, as the implant partially fills the skin envelope. Sometimes, in cases of mild ptosis, simply inserting the implant can lift the breast sufficiently, so that no additional incisions are needed.

Typically, the implant is placed under the muscle, since placing it under the gland will cause the breast to sag over time. For the same reason, implants that are not too large are used to prevent the skin from sagging over time (given that patients who undergo breast lift surgery usually have skin with low elasticity, as evidenced by the presence of stretch marks, and therefore tend to sag over time if large implants are used). The procedure is considered one of the most difficult types of breast surgery and combines the increased risks of a mastopexy (on the one hand) with those of breast augmentation (on the other), effectively combining two procedures into one. The procedure is technically challenging because it is difficult to determine the size of the implant to be used, and it is difficult to predict the postoperative outcome. Some surgeons do not perform the two procedures as a single operation but separate them, performing them several months apart (3–6 months); thus, they either perform the lift first and then insert the implant, or vice versa—insert the implant first and perform the lift a few months later. The disadvantage of this technique is that the patient will undergo two surgeries, and between the two procedures, the appearance of the breasts will be quite unsightly. Two weeks before surgery, it is advisable to avoid smoking and alcohol consumption. You should also avoid certain vitamins (such as vitamin E), aspirin and its derivatives, ibuprofen, spirulina, and ginkgo biloba, as all of these products increase the risk of bleeding during and after surgery.

Your doctor will order the necessary tests, including a mammogram. It’s a good idea to arrange for someone to pick you up and drive you home after the surgery.

Do not eat or drink anything for 6 hours before surgery, as the procedure is performed under general anesthesia. Before surgery, your doctor will mark the area with a marker; this marking is extremely important for the upcoming procedure. The resulting scars and the size of any implant to be inserted are discussed in detail during the preoperative consultation(s).

Anesthesia is usually general, with intubation; the patient feels nothing and will remember nothing;
The incisions are made according to the preoperative markings, the excess skin is removed, and the nipple is repositioned higher;

The skin is excised

Gland reshaping: the skin beneath the nipple is largely removed, the nipple is elevated, and the overlying skin is pulled downward; in some cases, the gland is reshaped internally and anchored with sutures high on the chest wall to fill the upper pole and prevent sagging over time; the technique is chosen by the surgeon based on their experience and expertise. Reshaping the gland will result in firmer, more lifted, fuller, and symmetrical breasts; the breasts can be made symmetrical during the surgery if they were previously asymmetrical. The surgery also allows for the creation of normal-sized, symmetrical areolas (in most cases, patients present with asymmetrical breasts and large, enlarged, asymmetrical areolas). The implant is also inserted during this stage, usually under the muscle.

The nipple and breast are lifted

The incision is closed with fine sutures, usually absorbable ones, so they do not need to be removed later; the sutures are placed under the skin so that no marks remain and the scars are as inconspicuous as possible

Like any other surgery, a breast lift requires time for recovery. During the first 2 weeks after surgery, the patient may experience some discomfort, which does not necessarily mean pain. Swelling, bruising, and discomfort last 10–14 days. Patients are advised not to sleep on their stomachs and to avoid baths. Showers may be taken after 3–4 days. Stitches are removed (where applicable) after 10–14 days. The patient must wear a special compression garment for at least one month (we recommend two months), day and night. Underwire bras should be avoided for at least three months. Light daily activities may be resumed after 7 days. Smoking should be avoided during the first few weeks after surgery, as it interferes with blood oxygenation and, consequently, with normal healing. Swelling will persist for a month or longer until the final result is achieved. There may be slight numbness around the nipple, which disappears after about 6 weeks. In rare cases, the numbness may become permanent. As the nerves regenerate, you may experience tingling or a slight burning sensation.

The patient should avoid lifting weights above her head for the first 3–4 weeks and should generally avoid lifting heavy weights for 4–6 weeks.

The scars will be visible, red, and firm for the first 2–3 months, after which they will gradually fade, becoming white and soft, but they will never disappear completely. The appearance of the scars can be improved with various creams, silicone sheets, and by avoiding sun exposure for the first 9 months after surgery. Most women consider the scars a more than acceptable trade-off for beautiful, more youthful breasts. If the patient becomes pregnant again after surgery, there is a risk that the breasts will sag again, though not to the same degree as before the pregnancy. Another breast lift is possible in this case.

Breast lift, achieved by removing excess skin and restoring volume lost due to weight loss, pregnancy, breastfeeding, or aging; by lifting and reshaping the breasts, it is possible to achieve breasts that look younger, fuller, and more symmetrical.
Restoring the youthful appearance of the breasts—"young" breasts have volume and sit high on the chest wall; as we age, the skin stretches, the gland atrophies, and the breast loses volume, resulting in a sagging appearance; These changes are even more pronounced following childbirth, breastfeeding, or weight loss;
A wider and more varied selection of clothing options—many women avoid certain types of clothing, feeling frustrated and discouraged by the way their breasts look; Women report that after a breast lift, they feel very comfortable and can wear clothes they would not have worn before the surgery.
Increased self-confidence—women report that their quality of life has improved after surgery; they feel more confident and no longer feel frustrated or self-conscious about the shape of their breasts.

These are normal reactions that typically subside on their own or with medication within a few days.

Discomfort is usually minor, primarily limiting the ability to bend over and lift objects.
Swelling and bruising—swelling lasts for 2 weeks, and bruising disappears in 7–10 days
Numbness or tingling in the nipple—this usually goes away within a few days or weeks.
Itching around the incisions—this is normal because the scars are very recent; it is treated with creams or oral medication (antihistamines).

a) Complications of breast lift surgery without implants

Infections—may occur between 1 and 6 weeks after surgery and are characterized by swelling and pain in the breasts, redness, discharge, and fever; the most common infections are caused by Staphylococcus aureus. Treatment consists of oral or intravenous antibiotics and drainage in more severe cases
Hematoma—a collection of blood beneath the incision; it manifests as pain and a feeling of tightness; if small, they are absorbed by the body; if larger, they require surgical drainage; if left untreated, they can lead to infections
Abnormal scars—hypertrophic scars (larger than normal but not extending beyond the original scar) or keloids (which extend beyond the original scar and are red and firm) may develop. Hypertrophic scars and keloids occur particularly in people predisposed to such scarring and usually appear along the scars in the inframammary fold on the medial side. Scars around the areola and vertical scars usually heal very well, even in people prone to abnormal scarring. The quality of scars depends not only on the patient’s biology but also on the surgeon’s skill and suturing technique, as well as the quality of the suture material and needle used. Preventing keloid scars involves a meticulous suturing technique, the use of various scar-healing creams or silicone sheets, avoiding sun exposure for the first 9 months after surgery, or injections of corticosteroid derivatives. Once they appear, hypertrophic scars can be corrected by excision and re-suturing.
Asymmetry – Minor asymmetries are normal, as no woman has perfectly symmetrical breasts; more significant asymmetries require additional surgical procedures.

b) Complications of breast lift surgery with silicone implants

In addition to the complications listed above, there are those that may be caused by the presence of silicone implants

Muscle contracture – manifests as a firmer consistency of the breast, which may also be deformed at the same time; mild contracture may go unnoticed, but severe contracture requires additional surgery, possibly involving implant replacement; It is more common with silicone implants than with saline implants, and the risk is lower when the implant is placed under the muscle rather than under the gland.
Decreased or lost nipple sensitivity—this is usually temporary, but there are cases where it can be permanent;
Implant rupture—particularly in saline implants that are not fully filled; in this case, the shell forms folds that, due to friction, cause it to wear out; The leaked serum is absorbed by the body, and implant rupture is detected immediately, unlike with silicone gel implants, where rupture can go undetected for months because the gel has a thicker consistency and does not flow. The risk of this complication is 4% in the first year and decreases thereafter.
Formation of visible and/or palpable folds—more common with saline implants and those with a smooth surface
Implant malposition—the implant shifting upward or downward, laterally, or medially; more common with smooth implants, which slide more easily than textured ones
Infection—this is more serious than in the case of a mastopexy without implants, as it requires removal of the implant, which can be reinserted only after a minimum of 6 months.