INTRODUCTION Droopy breasts usually occur after pregnancy or major weight loss. The medical name for this condition is ptosis. Sometimes the breasts are normal in size, and sometimes the are slightly too big or too small. Ptotic breasts can be a source of discomfort for many women. Breast lift surgery (known as mastopexy) can restore droopy breasts to a normal size and shape. This operation, although similar to breast reduction, is considered cosmetic and is rarely covered by insurance.

BEFORE BREAST LIFT AFTER BREAST LIFT W/ IMPLANT CLICK ANY IMAGE TO ENLARGE AND FOR ADDITIONAL PATIENT EXAMPLES

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AM I A GOOD CANDIDATE FOR BREAST LIFT SURGERY?
Any woman with droopy, pendulous breasts who is bothered by the shape and position of her breasts is a candidate for surgery. The ideal patient is a generally healthy non-smoker.

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HOW BREAST LIFT SURGERY IS PERFORMED
To understand how the surgery is done, first one must understand that the ptotic breast has 3 different problems:

• Too much skin
• Breast tissue too low
• Nipple malposition (the nipple points downward and is too low on the breast)

Therefore, in order to be successful, the operation must reshape the breast tissue, remove the extra skin, and reposition the nipple to its proper location.

Wise pattern technique: The traditional and most commonly used technique in the U.S. is the "Wise pattern" breast lift. This results in an excellent breast shape and has an " inverted T" or anchor shaped scar. The nipple is left attached to a cone of breast tissue to allow for function and sensation after surgery. We shape our cone as a central pedicle, because we believe that this best preserves nerve and blood supply. Some surgeons prefer the inferior pedicle technique, but we think that the breast shape is flatter in appearance with this style. In our hands, the Wise pattern central pedicle technique works safely and reliably for almost any patient. (Click here to see a picture of a Wise pattern breast lift)

Lejour technique: The Lejour style is a European technique, which is gaining popularity in the U.S. The advantage of this technique is that it greatly reduces the amount of scarring. Instead of an "inverted T" shaped scar, the Lejour incision heals in the shape of a lollipop. The long-term result is an excellent shape with a significantly shorter scar. This technique is safest and most effective in women with moderately droopy breasts, and may not be as effective in those with extreme amounts of extra skin. (Click here to see a picture of a Lejour breast lift)

Implants: Some women with ptotic breasts would also like an increase in size of their breasts in addition to a lift. This situation is not uncommon in post-partum women who have lost volume in their breasts after breast feeding. To restore volume, an implant may be placed at the same time as a lift. For more information about implants, click here.

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THE SURGERY AND RECOVERY
The surgery is performed in the hospital under general anesthesia, and takes from 2–4 hours. Patients may or may not need to spend the night in the hospital. Most patients need a follow-up appointment in the office the week after surgery, and then another one in 2 weeks for suture removal. Some doctors use dissolving stitches, but we have found that the type of suture that requires removal actually results in less scarring in many patients.

Activity level after surgery usually needs to be limited for the first 3 weeks. We recommend gentle walking beginning the day after surgery, and resumption of normal exercise in about 3 weeks. Most patients are surprised to find that the operation is much less painful than they expected. We recommend taking about 2 weeks off from work, although some patients can return to work sooner.

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ADVANTAGES OF BREAST LIFT SURGERY

• Restores breasts to normal shape and proportion
• Can alleviate
  • neck and shoulder pain
  • rashes and chafing from bras
• Can improve
  • posture
  • self-esteem
  • ability to exercise

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DISADVANTAGES OF BREAST LIFT SURGERY

• There is a permanent scar. Some patients form better scars than others do, which is a function of heredity.
• Possible lost of or diminished nipple sensitivity
• Reduced chance of breast-feeding in the future

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POTENTIAL RISKS
Bleeding: Heavy bleeding after surgery is unusual in our experience (<1% of the time), although it is a risk of any surgery. We make every effort to lose as little blood as possible during the operation, and none of our patients has ever required a blood transfusion after surgery. If bleeding does occur, however, re-operation may be necessary to stop the bleeding. To reduce the risk of this happening, patients are advised not to take aspirin or NSAIDS (ibuprofen, Alleve, Motrin, Advil, etc.) for three weeks prior to surgery because these medications reduce the blood’s ability to clot.

Infection: This is also very rare in a healthy patient. Patients receive antibiotics during and after surgery to reduce this risk as much as possible.

Loss of Nipple Sensation: This is an occasional occurrence and cannot be predicted, as innervation to the nipple is slightly different in each patient. The chance of losing nipple sensation initially after mastopexy is approximately 15%. However, after 2 years, 85% of these women have recovered some or all of their sensation.

Loss of Circulation to the Nipple: This is unusual in a healthy patient. Patients at higher risk for this problem are those who smoke, have diabetes, have high blood pressure, and have extremely ptotic breasts. Even in this higher risk group, however, the risk of losing the nipple is very low. We recommend that all patients who smoke quit at least 2 weeks prior to surgery and for one month afterward to reduce the risk of this problem.

Problem Scars: In the breast area, some patients will form red, itchy, raised scars, which are known as hypertrophic scars. They are similar to keloid scars, and tend to form within the first few months after surgery. To this date, no one knows why some people tend to develop this type of scar, although it seems to be an inherited characteristic. These scars are not preventable, although some techniques exist to minimize their formation. We recommend that all patients massage their scars with lotion twice a day once the sutures are removed because pressure reduces scar formation. Some patients benefit from applying topical silicone (either Kelocote ointment or gel sheeting such as Rejuveness). We like to follow our patients closely after surgery for the first few months, so if hypertrophic scars begin to develop, we can treat them. However, even with the most meticulous surgical technique and postoperative follow-up, approximately 5% of patients may need a scar revision later. The Lejour technique, because it is a short-scar technique, does significantly reduce the incidence of hypertrophic scarring.

Reduced Ability to Breast-feed: Very little data on breast-feeding after breast surgery exists. Small studies show that between 20 and 70% of women can successfully breast-feed after breast lift. These numbers, however, depend somewhat on the technique used and the amount of breast tissue removed. The Wise pattern central pedicle technique theoretically offers the best chance of breast-feeding. Little data exists on breast- feeding following the Lejour technique. The bottom line is, if a woman wants the best chance of breast-feeding she should wait until she has finished childbearing until she has her breast lift.

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LONG TERM RESULTS
Generally results of breast lift surgery are permanent although breast size can change with major weight gain or loss. Breast shape also may change after pregnancy, although we rarely see patients who require any further corrective surgery. All in all, the vast majority of patients feel much better physically and mentally after breast lift.

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