Breast Lift Surgery (Mastopexy)
Fat Grafting, Breast Implants and Skin Excision
As with most things, our breasts change shape over time. Our perky signs of womanhood show fatigue as the years pass. Repeated pregnancies, breast feeding or extreme changes in weight can stretch fragile skin leaving breast tissue sagging without support.
When breast tissue lowers with age, physicians relate the degree of change as “ptosis”.
A minor degree of ptosis is related to a loss of upper pole fullness with only minor relative skin excess. The nipple and areola are measured to drop slightly below the mid-portion of the humerus (upper arm bone). The lower pole of the breast tissue may hang below the inframammary fold or the line under the breast where the wire from a bra lies.
There are several surgical approaches that can be used to address minor ptosis. Additional volume can be added to the breast to fill the excess skin with either fat grafting or a silicone or saline filled breast implant. Fat grafts are harvested using liposuction from a variety of areas of the body. These types of “filling mastopexies” are performed through limited incisions and may be preferred by many patients whom are deemed good candidates. The areola is not re-sized in this form of mastopexy and, in fact, may appear larger in diameter as the breast mound is enlarged.
With progressive ptosis, attention must be placed on reducing the excess breast skin with or without the addition of fat grafts or a breast implant. Incisions for this more formal form of breast lifting or “skin excision mastopexy” can include a vertical limited scar approach or possibly an inverted-T or anchor incision. The nipple areola is downsized to a more youthful appearance using this approach even if the final breast volume is considerably larger i.e. with the addition of a breast implant. Care is taken to ensure placement of the nipple and areola centrally on the repositioned breast mound. Patients with adequate breast volume need not undergo fat grafting or placement of a breast implant. Patients wanting more volume and lifting can be pleased with a combined approach.
All patients interested in breast lift surgeries should be abstinent from all tobacco or nicotine replacement products for a minimum of 3-months prior to surgery.
Massive weight loss patients should maintain a goal weight for a minimum of 6-months prior to proceeding with breast lift surgery. Many elect to undergo lower body lift surgery as an initial surgical intervention after massive weight loss prior to proceeding with breast surgery combined with upper arm rejuvenation.
Patients with poor skin quality, history of smoking or presenting with profound ptosis after massive weight loss may require “staging” of a breast lift procedure. Skin is reduced during the initial surgery and volume with fat grafting or a breast implant is added thereafter during a second surgery. The goal of staging a complex breast lift is to reduce the possible risk of a wound healing complication or necrosis and permanent loss of the nipple and areola requiring reconstructive surgery.
Bilateral breast lift surgery is considered to be a cosmetic surgical intervention and is not covered by US health insurance companies.
Unilateral mastopexy for contra-lateral symmetry after mastectomy or breast conservation may be covered by your insurance company. Given the profound changes in health care, all breast cancer patients are encouraged to work closely with their assigned health insurance company case managers to explain their personal benefits and coverage.
Breast cancer patients seeking nipple sparing mastectomy may require staging mastopexy prior to their definitive mastectomy for appropriate nipple position prior to breast implant reconstruction. Failure to reposition the nipple and areola prior to mastectomy in the setting of breast ptosis may prevent you from preserving the nipple and areola at time of implant reconstruction. Moving the nipple and areola after breast implant reconstruction is very difficult and should be addressed prior to the placement of any incisions on the breast for lumpectomy or mastectomy.
Breast lift after natural breast reconstruction is common and is completed as a part of Stage 2 formal flap revisions. The areola is easily down-sized to a youthful diameter and placed centrally on the reconstructed breast mound. Breast lifts in this context of natural breast reconstruction are covered by the majority of US health insurance companies and Medicare.
All mastopexy patients (cosmetic or cancer reconstruction) require a detailed personal and family breast cancer health history, review of prior screening mammograms and dedicated breast examination at the time of your consultation. Establishing a good understanding of breast health is important for both cosmetic and breast cancer surgical patients.
Dr. Marga is pleased to address all of your concerns regarding breast lifts at the time of your consultation. This aspect of breast surgery is a complex aspect of achieving a beautiful breast over time. Extra time will be allotted for the discussion of the management of ptosis given the numerous approaches currently available.