The final article in our series on breast surgery covers the breast lift—known technically as mastopexy—a surgical procedure to raise and reshape sagging breasts. As a woman ages, her skin loses elasticity and breast tissue loses some of its firmness. The result is sagging breasts. Pregnancy, nursing, and, over time, the force of gravity all contribute to breast sagginess. During mastopexy a surgeon can also reduce the size of the areolae—the pigmented circles surrounding the nipples—which tend to enlarge over time.
Mastopexy can also be combined with the insertion of breast implants to reshape and firm up the breasts.
According to the American Society of Plastic Surgeons, the best candidates for mastopexy are women who understand that, while the surgery will improve their appearance, it will not make their bodies perfect. Having realistic expectations beforehand will increase a patient’s satisfaction with the results of the surgery. Women with small sagging breasts usually have the best results from mastopexy. A surgeon can perform the surgery on breasts of any size, but the results may not last as long in larger, heavier breasts as in small breasts.
Mastopexy doesn’t usually interfere with breast feeding; however, women planning to have more children are advised to postpone mastopexy because subsequent pregnancies are likely to stretch the breasts and offset the results of the procedure.
As with all surgery, mastopexy carries the possibility of complications, which your doctor should discuss with you if you’re considering this surgery. The procedure leaves permanent, noticeable scars, although the scars usually can be covered by a bra or bathing suit. Smokers often experience poorer healing and more scarring than non-smokers. Mastopexy may also produce unevenly positioned nipples and the loss of sensation in the nipples or breasts.
The procedure can be performed in a hospital, an outpatient surgery center, or a doctor’s office-based surgery facility. It is usually performed on an outpatient basis, which means that you will return home the same day. If you’re having outpatient surgery, you should arrange to have someone drive you home afterwards. In some cases mastopexy patients may be admitted to the hospital for a day or two.
Mastopexy is usually performed under general anesthesia—being “put to sleep”—and commonly takes from one and a half to three and a half hours. There are several mastopexy techniques, but the most common one involves an anchor-shaped incision that begins on the top of the breast and moves toward the areola, then radiates from the area around the areola toward the inside and outside of the breast, following the breast’s natural contour. The surgeon removes excess skin from the area of the incision, moves the nipple to a new higher position, and then brings the edges of the remaining skin together underneath the areola to reshape the breast. The stitches that close the incision are usually located around the areola and in a vertical line extending downward from the nipple and along the lower crease of the breast. Patients with smaller breasts usually require less extensive incisions than women with large breasts.
After surgery, the breasts will be bruised and swollen for a couple of days. Patients normally wear an elastic bandage or surgical bra over gauze dressings for a few days, then switch to a soft support bra that they must wear over a layer of gauze 24 hours a day for three to four weeks. The stitches will usually be removed after a week or two. Patients should plan on missing a week of work or more, depending on how they feel and how strenuous their job is.
The results of mastopexy will not last forever. Eventually gravity, the aging process, and weight fluctuations will make the breasts sag again.