Breast Lift

A breast lift, also known as mastopexy, is a breast enhancement procedure designed to reconstruct a breast that is lacking in an aesthetic shape and restore its youthful appearance. From a technical standpoint, a pure mastopexy is just a breast lift. However, many mastopexies involve adding volume with an implant or fat grafting to take volume away by tissue removal. A youthful breast is one where the nipple-areola complex centers on the breast mound and there is no skin overhang. As time and other factors affect the breasts, the nipples start to point toward the lower part of the breast and women get some overhang in the skin. Volume loss can cause the breasts to become droopy and deflated. It is not always true that big breasts are droopy and small breasts are perky, it can be the exact opposite situation. Some people may need a breast lift as well as some volume added while others just need a lift only.

Am I a Good Candidate for Breast Lift?

A GOOD CANDIDATE for a breast lift is:

• A person whose breasts have lost their aesthetic shape due to multiple pregnancies, breastfeeding, time and gravity, weight loss or genetics
• Anyone that is unhappy with the appearance of their breasts and has overhanging skin or low position of the nipples
• Patients who need additional volume or the removal of tissue at the same time
• Patients with dense breast tissue and skin that is very elastic

Patients who are NOT GOOD CANDIDATES include:

• People who are droopy in the breast and have weakness and loss of elasticity in the skin
• Patients with a skin envelope that is not very strong
• Patients who smoke since smoking can slow down the healing process
• Someone under the age of 18 since the breasts are still developing unless the person has physical symptoms like back and neck pain

How is a Breast Lift Performed?

There are quite a few breast lift options and the technique used depends on the nature of the breasts:

• Crescent Lift – A tiny breast lift done in conjunction with a breast augmentation. With this technique, surgeons take a little crescent of skin above the areola to shift it upwards by a centimeter or so. A crescent lift does not really lift the droopy breasts. It is more for smaller adjustments in areolar positioning.
• Circumareolar or Periareolar Mastopexy – The surgeon makes a circle around (or within) the areola and then makes a bigger circle around that area. The doctor then takes the doughnut of skin, in-between the two, and tightens the larger circle down to the size of the smaller circle with a “purse-string” suture. The final scar is just a circle scar at the edge of the areola. This technique is only appropriate for some patients as it is relatively limited in regards to how much of the breast can be tightened.  Tightening around the areola cinches up loose skin and can raise the areola position by 1-2.5 centimeters.  This technique has a natural flattening effect on the breasts due to the circumferential tightening.  This effect is good for pointy breasts because it will change conical-shaped breasts into rounder, more aesthetic breasts.  With breasts that already have a flattened appearance, this technique is not appropriate because it can exaggerate a shape that is already not round enough. Circumareolar mastopexies work well with implants since the implants take up some of the skin excess and the lift can further refine the areolar position and improve skin contouring.
• Lollipop Lift – A technique that creates a circle scar that runs at the edge of the areola in addition to a line that runs down the lower breast. It reshapes the breast 3-dimensionally and is very effective for moderate to more severe drooping.
• Inverted T Lift – A technique that is also called an anchor scar or Wise pattern. They are different names for the same technique that involves a scar going around the areola, down the lower breast and then underneath the breast in the breast crease. It is the most powerful technique as far as skin removal on patients that have a lot of overhang and excess skin. 

Please note that with all of the above techniques, the nipple stays connected to the underlying breast tissues and is shifted to where it needs to be without detaching it. Patients who have loose skin tend to have little wrinkles, stretch marks and irregularities. Filling the volume back, and tightening the skin, causes most of those irregularities to go away or just look less noticeable. Tightening the breast skin makes a lot of the irregularities smooth out. Doctors cannot make stretch marks go away but they can make them look less noticeable by retightening the breast.

Maintaining the Blood Supply

When doing a breast lift, the surgeon needs to maintain the blood supply to the nipple on the underlying breast tissue while keeping the underlying breast tissue oriented from whichever direction he (or she) wants. Some people maintain it from the bottom of the breast, some from the top and others from the upper middle. As long as there is good blood supply to the nipple, the surgeon can move that tissue around.

Some of the most effective directions for maintaining blood supply to the nipple are the superior and the superomedial pedicles. The pedicle is the name of the tissue that carries the blood supply to the nipple. Superior pedicles come from the top of the breast while superomedial pedicles come from the upper middle part of the breast. These help suspend the breast tissue from above and provide fullness in the upper and inner breast where patients want to maintain fullness.

Placing Implants

Many patients need volume so surgeons can do a breast augmentation with the lift. One of the best ways to do this is with a silicone implant placed in the dual plane (partially under the pectoralis muscle) for the most natural feel. This places the implant in a way that the pectoralis muscle is covering the upper and middle part of the implant while giving a more natural slope in the upper chest and better looking cleavage. When people say “under the muscle”, they are generally referring to partial muscle coverage where the pectoralis muscle is covering much of the upper and middle half of the implant.

Fat Grafting

For patients who need a lift, a common issue is if the person does not have a lot of natural tissue or they have natural breast tissue that is very soft. In these situations, the breasts can be moved higher with the nipples centered on the breast after the lift. However, the upper pole of the breast can look deflated or the tissue can settle into the lower part of the breast giving a scooped out upper breast appearance.

Traditionally, the way to fix this issue was to add a breast implant to fill up the upper part of the breast. However, fat grafting is now a very popular technique to fix this issue. If somebody has extra fat they do not want in areas such as the love handles or the thighs, the surgeon can harvest the fat from those areas with liposuction, process the fat and then re-inject that pure fat back into the upper breast to add fullness. The “added in” fat does not have the same pull on the skin that an implant might have on a person. It is a good technique for patients that do not need a lot of extra volume and have fat in other areas they do not like.

Non-Surgical Alternatives

There are not many non-surgical options for ptosis (drooping) of the breasts. Some lasers tighten the skin a little bit but they generally do not have impressive results. Patients can try to slow the drooping process by wearing bras as much as possible, avoiding sun damage to the skin and not having many pregnancies. Ultimately, the genetics of the patient is a large factor in how the breasts change over time.

What is the Cost of a Breast Lift?

The cost of a breast lift depends on the technique used by the doctor, the area of the country where it is performed and any fees charged by the surgeon or the facility. A crescent lift usually costs $5500-$7500 while a circumareolar or periareolar mastopexy is in the range of $6000-$8000. A lollipop lift is around $5000-$7500 while an anchor scar lift is $9000-$12,000.

Recovery and Downtime

In general, the RECOVERY process is relatively easy because it is all soft tissue. Most people feel somewhat sore or tired after surgery. The healing process takes energy so patients may not have as much energy as they are used to the first few weeks after surgery.

Most patients are off pain medication after a week and they generally go back to light work within that week. Patients have a little bit of DOWNTIME from exercising but they can usually resume exercising within four to six weeks.

Results

Scar tissue reaches its maximum level around three months after the surgery. The appearance of the scars continues to improve during the year. After six months to a year, most of the scar pinkness has faded to more of a regular skin color. The scar remodeling process can take a year, or longer, to complete.

There are so many variables involved in the results that it is hard to say how long the results will last. Droopy and overhanging breasts will lose their perkiness as times passes after a breast lift. The length of the results also depends on genetics and if fat grafting or implants were used during the surgery.

To help maintain the results, patients can wear a bra for support to take some of the tension off the skin in order to preserve the results and avoid more damage to the skin. The most common ways people damage their skin is sun exposure, UV exposure, smoking and tanning booths. Avoiding these things helps improve the elasticity of the tissue and gives longer results.

Anybody having breast surgery needs to keep in mind that it is a maintenance surgery. It is not a one-time deal and, at some point in the future, the patient may want another surgery to maintain the youthful appearance of the breasts. Normally, the surgeon can reuse the original scars and just take more skin out.

Limitations of Breast Lift

Some limitations of a breast lift include:

• Surgeons cannot really lift a breast much higher than the natural inframammary fold (the crease that runs under the breast). In some people with “perkier” breasts, the crease is where the breast starts and for other people with “droopier” breasts, the breasts overhang at the crease. Somebody with a high breast crease usually gets a more lifted looking breast because everything sits above the crease after the lift. Some patients have a very low natural crease and, even with the lift, the breasts are still going to be lower on the chest.
• The skin quality of the patient limits what results the surgeon can achieve for the patient. Patients with thicker, tighter and more elastic skin are going to get a better, longer-lasting result. People with thinner, weaker skin are going to stretch out or re-droop faster.
• The actual native breast tissue helps determine what a surgeon can accomplish. Some people have very soft and fatty breast tissue that tends to settle more to the bottom of the breast. Other patients have dense, firm and glandular tissue that is easier to reshape. A person with a low fold and soft tissue might consider adding an implant or fat grafting to help improve the appearance of the breasts. Patients need to understand there are some things the plastic surgeon cannot change without causing deformity or distortion.
• A breast lift is not a permanent correction. The surgeon is essentially setting the clock back by resetting the breast into position and then gravity and time will start to work again.

Risks of Breast Lift

Some common breast lifts risks include:

• Wound healing
• Reduced sensitivity or too much sensitivity
• Infection
• Bleeding
• Asymmetry
• Affecting the ability to breastfeed (in rare cases)

Breast Lift is not an Easy Surgery

Breast lift surgery is not an easy and many variables go into it. It is important for patients to see a surgeon with a lot of expertise in performing these surgeries. Patients need to keep their eyes open and make sure they are going to somebody who really understands how to perform these techniques properly. They should also look at “before and after” photos to get an idea of the skill level of the surgeon before making the final decision to have a breast lift.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Robert Cohen, MD in Paradise Valley, AZ