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Breast lift (Mastopexy)

 
  The position of the areola of the ideal-aesthetic female breast changes in relation to age and anatomy, but is generally higher than the submammary fold. In each case, where the lower rim of the areola reaches the level of the submammary fold or descends even below it, a breast lift is required to reconstruct the aesthetic breast shape.


 
 
Drooping breasts requiring mastopexy


It is a delusion that drooping breasts can be corrected with placing relatively big implants, because these would lift the breasts!
Only a small extent of drooping can be “fixed” this way and only if the lower rim of the areola isn’t below the level of the submammary fold. If the drooping is bigger than this and only implants are placed without a mastopexy, the drooping will be even worse and several complications will probably come along, a good result is not to be expected either implants are placed under the muscle or over the muscle.


 

  The extent of drooping that just can’t be fixed with implants only, but requires also a mastopexy


Breast drooping before childbirth and breast feeding might origin from the family and habit, or can be the result of significant weight loss, but certainly comes most often after breast feeding. It is a delusion that any kind of training of the pectoral muscles could prevent or correct it, unfortunately the pectoral muscles are not responsible for keeping the breast shape at all, rather the connective tissues and the septal structure of the glandular tissue accordingly, and the skin to a small degree. (Consider that body-builder ladies can also have drooping breasts like small bags!)
The most frequent problem after breast feeding is, that both the volume of the glandular tissue will decrease (the volume of the breast will be smaller), both the shape will get droopy. If the volume loss is significant and the patient haven’t had oversized breasts for her chest, a single breast lift is not enough to restore the ideal-aesthetic breast shape, only a breast lift with a simultaneous augmentation can give the ideal result. The demonstration before the mirror makes this fact really convincing for the patient during her examination. In such case a properly full breast shape on top can be created only by pushing the glandular tissue upwards with our hands, so if a volume is missing from the breast, it can be replaced only by an implant. A drooping breast always seems bigger optically, than a lifted one, therefore the patient realizes it sometimes only at certain manoeuvres before the mirror, that for the upper fullness she expects is a simple breast lift not enough and she needs a simultaneous breast augmentation as well.

 
 

Patients requiring breast lift with augmentation


Breast lifts always mean scars more visible, than the almost invisible ones at transaxillary breast enlargements, but for the ladies not expecting that nobody could see the ideally faded scars at a very close distance after months or half a year, it will give an attractive and spectacular result, since they can wear any clothes, occasionally also without a bra. The ideally thin and faded scars on breasts with a beautiful shape are not visually determinant, but the spectacle of their shape and fullness.

In our opinion, a mastopexy which isn’t more than the “retailoring” of the skin, is not modern and doesn’t give a long lasting result, also isn’t able to give even a proper shape, because the lift of the glandular tissue with its anchoring to the pectoral muscle and forming a conical shape is essential. If these are not carried out, the “retailored” skin will quickly stretch, the scars will be wide and the breasts will droop again. In a modern procedure we remove only the skin which is strictly necessary, making the less skin incisions. Of the traditional periareolar plus vertical and often very long submammary scars in most cases we do not need the submammary ones, only rarely at extremely drooping breasts. Still, unfortunately, most plastic surgeons in our country perform the outdated inverted “T” scar mastopexy. At only a small extent of drooping the operation can be carried out with periareolar scars only, especially if a simultaneous augmentation is also performed, which advances the flat breasts at such time. In cases where the areolas are below the submammary fold, the operation can be carried out with periareolar and vertical scars (a vertical line connecting the periareolar scar with the submammary fold), without any further inverted “T” shape scars, but it takes 3-6 weeks more in these cases that this area becomes smooth. Special suture techniques, postoperative bandaging methods and wearing a special bra are needed for this.
 
 
Sketch of a modern mastopexy without inverted “T” scars


For our own practice, even before a breast lift we make the breast ultrasound and/or mammography obligatory, that we organize if needed, recommending an appropriate professional. Furthermore, detailed laboratory tests and ECG, chest X-ray when needed, and an anesthetist consultation and examination take place. Operations are performed in narcosis with the safe background of a private hospital, mainly with a 1 day stay and attendance.

The suture technique means the use of such modern American suture materials in multiple layers that must not be removed. Under the skin surface they assure the formation of a fine scare until their complete absorption without the troubles of the traditional suture removal.

It is necessary to wear a special bandage (for 1-2 weeks) and bra (for 1.5-2 months) after the operation. Who needs a breast lift because of her anatomical conditions, must take note of it, that she has to wear a bra for life (except some occasions), or the result won’t be long lasting. Of the instructions to keep before and after the operation our patients get detailed written information. The final result can be seen in 2-3 months after the operation, with all the details. The somewhat decreased sensitivity of the nipples occurs only after the corrections of very extensive drooping in about 1-2%, after all the healing of smokers can be slower and complicated! After a breast lift one can also breast-feed safely later on (pregnancy is better to avoid within one year), however to avoid another significant drooping it is recommended to stop breast feeding after 2-3 months. Postoperative controls are recommended for years with growing but regular intervals and are free of charge for our patients. Further pregnancies and significant weight changes can spoil the result to some degree, but these can be corrected later.

We have several patients who underwent this operation after the birth of one or more children, feeling now self confident and attractive again, and with the result of the operation they have even changed their way of dressing.


THE TWO MOST FREQUENT QUESTIONS, DELUSIONS REGARDING BREAST LIFTS


Is there a breast lift without visible scars or through the axillary approach?
Unfortunately not! Who wants invisible scars, shouldn’t want to be operated with a breast lift. Certainly most of the patients can be satisfied with a tendency for good scar formation, modern techniques, only fine periareolar and/or vertical scars without the ones in the submammary fold, beautiful breast shape and full breasts. The patient should be well informed about the expected scars looking at the before & after photos showed by the plastic surgeon and she should understand her individual characteristics. In suspicion of an individual tendency for unfavorable scar formation such a scar treatment should be started right after the early wound healing, which results the best possible scar.

Can the breast augmentation with implants correct the drooping breasts?
Unfortunately not! That is to say only if the drooping is so small, that the nipple is not lower than 1 centimeter compared to normal, and/or there is no droopy glandular tissue causing also a skin excess at the lower part of the breast below the nipple. If the drooping is bigger than this and an augmentation without a breast lift would be carried out with subglandular implants, the bigger breast would be drooping even more and other early complications could be expected requiring correction. And if submuscular implants would be placed without the mastopexy of the drooping breasts, they might stay in the right place and the breasts would be drooping below them, and the aesthetic result would be bad in each case.
Solution: some form of the mastopexy and a simultaneous breast augmentation with submuscular implants, even if this means more scars. If the lower rim of the areola reaches the level of the submammary fold or is below that, the mastopexy is inevitable even if the simultaneous breast augmentation with implants is also carried out.


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