Breast Lift: Reducing the size of large breasts

During the natural aging process, with weight gain and loss, and following pregnancy, the breasts support structures become stretched, leading to a change in the shape of the breasts and sagging.
The breast lift, or mastopexy, encompasses several different surgical procedures designed to restore a woman’s breasts to a more youthful, firm, and shapely appearance. In a breast lift surgery the breasts are raised, the nipples are repositioned and the areolas (the darker skin around the nipples) may be reduced in size if you desire. If you have lost breast volume over the years and you want to add more fullness, implants may be inserted during breast lift surgery to increase breast size. Breasts can form a variety of different shapes which have been given different names. For example, some woman have an enlarged bulging nipple relative to the rest of the breast; this is commonly called a “snoopy” breast. A “tubular” breast refers to a breast with a narrow base and prominent breast tissue in the front of the breast, leading to a tube shaped breast. Asymmetry (one breast is different size or shape than the other) is another normal finding in women’s breasts that can be corrected with mastopexy.
Mastopexy, with or without augmentation is designed to rebuild the support structures of the breast, reshape the breast, and remove excess skin to restore a more youthful appearance.

Do I Need A Breast Lift?

Well there are many different ways that you can determine whether you need a breast lift. Below we have put a few of your options but please realize that there is nothing that can substitute a consultation with a surgeon for a proper diagnosis.

First method

Essentially breast ptosis indicates that the breast is falling on the chest as well as rotating downward. Plastic surgeons usually divide ptosis into degrees to describe various amounts of the descent of the breast. The basic criteria for ptosis frequently accepted by most plastic surgeons looks at the relative position of the nipple areolar and the fold under the breast known as the inframammary fold. Remember that the fold is essentially stationary as the breast is falling. Therefore, if the nipple areolar is above the level of the IMF there is no sag.

When the areola is at the same level or slightly lower than the mammory fold this is known as first degree ptosis.
If the areola is 2-3 cm below the fold this is second degree ptosis

If the areola is lower than 2-3 cm and pointing toward the floor (rotated 90o) this is third degree ptosis.
Other important relative measurements include the distance from the notch in the top of the sternum (breast bone) to the nipple and the distance from the areola to the mammory fold.

There are two other conditions that need to be mentioned and distinguished from ptosis.

The first is an empty sac syndrome. Here there is a loss of volume of the breast while the skin envelope remains the same size. The breast appears empty and is often confused with ptosis, but the areola and mammory fold are in the correct relationship. The procedure to correct an empty sac syndrome is to fill the breast with an implant.

The second condition is called pseudoptosis. Here a large percentage of the breast volume is at or below the level of the areola creating a hollow in the upper part of the breast. In this condition the relationship of the areola to the mammory fold is acceptable and again the usual solution is an implant to acquire some volume in the part of the breast above the areola.

To calculate ptosis, a ruler is placed across the chest into the inframmary crease and the distance between the center of the nipple and the top of the ruler is measured. If the nipple is above or just over the ruler, this is called Grade 1 ptosis. Grade 2 ptosis is defined as the nipple measuring 1-3 cm below the ruler, If the center of the nipple is more than 3 cm below the top of the ruler, this is called Grade 3 ptosis. Pseudoptosis occurs when the nipple is above the mammary crease but the breast itself is flattened and droopy.

When should I have a breast lift?

A breast lift can be performed at any age but plastic surgeons usually recommend waiting until breast development has stopped. Pregnancy and breast-feeding may affect the size and shape of your breasts, so you may wish to postpone surgery until after having children. Still, many women elect to go forward with the surgery before having children, knowing that they can address any pregnancy-related changes later. The milk ducts and nipples typically are not affected during breast lift surgery, so usually the procedure will not alter your ability to breast-feed.

Difference between Breast lift and Breast Reduction

Breast lifts and breast reductions are two common plastic surgeries used for breast enhancement. Breast lift surgery and breast reduction surgery are actually very similar operations. Both the breast lift and breast reduction surgeries strive to raise the overall position of the breast mound and both also will reposition or lift the nipple and areolar tissue to a higher and more youthful position on the breast mound. The major difference between a breast lift and breast reduction is that a breast reduction surgery will reduce the overall breast volume and make the breast mounds smaller. A breast lift does not necessarily require that any breast tissue be removed. In fact, some breast lift operations are also performed while placing breast implants for breast enlargement. So a breast lift mainly is responsible for lifting the nipple and areolar position to a higher position, it does not imply a breast volume change. A breast reduction does lift the breast and does imply a breast volume change.

How is a breast lift performed?

Mastopexy can be performed with local or general anesthesia. The surgery can take anywhere from 1.5 to 4 hours under normal circumstances.
Below are descriptions of different procedures that are used; note that there are many different names for similar procedures.

The Crescent procedure involves removing a crescent shaped piece of tissue from above the areola (from 10 o’clock to 2 o’clock) and then suturing the incision closed which lifts the nipple and breast upwards. This technique is often done during a breast augmentation and is only recommended for those women who have only a small amount of ptosis.
The Benelli lift or Periareolar lift removes a donut-shaped piece of tissue from around the areola. Once this incision is made, the surgeon is able to tighten the breast tissue in all directions. The periareolar breast lift procedure can also enhance breast appearance by reducing the size of the areola and repositioning the nipple (slightly upward). A periareolar breast lift procedure is most appropriate for women with a small degree of breast and/or nipple malposition.

The Benelli-Lollipop uses the same technique as the Benelli lift but also includes an incision from the areola to the inframammary fold. This allows more skin and breast tissue to be removed and reshaped. This is for those who have medium ptosis, too much for the Benelli only and too little for a full anchor incision.
The most common approach, the “anchor” incision, is actually three incisions. The first incision is made around the areola. The next runs from the bottom of the areola down to the breast crease and the third incision follows the horizontal breast crease. Working through these incisions, excess skin is removed from the lower portion of the breast. Areolas that have been stretched over time can be resized and the tissue is repositioned to reshape the breast. The breast tissue and nipple are lifted into the higher position, and the nipple is repositioned

What is the recovery period like after a breast lift procedure?

Immediately after surgery, your breast will be sore and swollen. You will have bandages, sometimes a drain (to drain excess fluid), and a supportive bra. You will need to wear a supportive bra twenty four hours a day for several weeks. Drainage of fluid and crusting is normal. You should be up the first day after surgery but most patients do not return to work for about a week. Strenuous activities, including sexual activities, should be avoided for several weeks. Your breast shape will appear flat at the bottom and full on the top for several weeks but will gradually take their natural shape.

After surgery your skin may be dry and the skin may appear to be thin. Your breasts may also have “tingling” sensations, occasional pain and loss of nipple sensation. Incisions need to be cleaned regularly and may become bright red and raised during the healing process but after 6 months to a year incisions should become less noticeable.

Depending on the surgeons technique of choice he may use internal sutures that will not need to be removed at any time and will slowy dissolve or he may use external sutures to close the incision which will need to be removed 2 to 3 weeks after the surgery.

What are the risks of mastopexy or breast lift?

There are multiple risks associated with mastopexy. It is critical to understand these risks and to have realistic expectations about the outcome of your surgery. Only through an in-depth discussion with your surgeon will you be able to understand the risks, benefits, and expected outcomes. Nipple necrosis leading to loss of the areola and/or nipple is a rare but serious side effect. Nipple necrosis is caused by impaired blood flow to the nipple and areola after surgery. The risk of this complication is higher in smokers. Asymmetry of the size, shape and level of the nipple is a common complication. It is impossible to create perfect symmetry and small differences should be expected. Major asymmetries can be corrected through an additional procedure. Inability to breast feed after breast lift can occur but many of the procedures used today usually do not affect breast feeding. The risk varies with the type surgery. Mastopexy can lead to changes in the skin sensitivity because removal of skin involves cutting through nerves that are in the skin. Often, sensation in the nipple returns over months to years. Fluid accumulation in the breast, called a seroma, can occur after mastopexy. Seromas can be drained and usually resolve within a few weeks. Accumulation of blood in the skin after surgery is called a hematoma and usually must be removed surgically. Hematomas can increase the risk of infection and may increase the scarring. It is important that you stop all over the counter, herbal, and prescription medications and vitamins that affect bleeding to decrease your risk of hematoma formation. Scarring occurs with any surgery and final scar appearance cannot be predicted. A scar can vary from a nearly invisible line to a large, raised, discolored scar. Unattractive scars can be treated through medical or surgical intervention. Infection is always a risk of surgery. You may be given antibiotics after the surgery and post operative wound care is important as well.


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