1. What is breast ptosis?
2. Classic breast lifting (with skin reduction)
3. Breast lifting with implant (hidden scar)
4. Mini-breast lifting (peri-areolar mastopexia)
5. Contact, make an appointment
7. Blog ‘Breast augmentation Geneva’
By Dr Xavier Tenorio
Also known as mastopexy, a breast lift is a surgical procedure used to lift and reshape breasts that have become less firm, often secondary to pregnancy, nursing, weight loss or gravity. The areola is repositioned in the ideal position. At times, the diameter is reduced and the gland reshaped.
A breast augmentation with implants can also be done in conjunction with a breast lift, thus improving the final outcome.
“Mammary ptosis” is defined as the sagging of the gland and the distension of the breast skin. Consequentially, the nipple takes a very low position usually associated with a constant “emptiness” of the upper part of the breast. Breast ptosis most often results from a significant loss of weight, after a pregnancy with breast-feeding. It can also be isolated “pure ptosis” without any other associated factor and can also be observed in association with a certain degree with breast hypertrophy (heavy breast).
Classic breast lift with skin reduction and gland remodeling
The purpose of this surgical procedure is to reshape the tissues to obtain symmetrical breast with nipples located in the normal position. After the excision of the excessive skin, the residual glandular volume is reorganized, concentrated and reshaped. The cutaneous envelope is the adapted to the new size and shape. Often, the resulting scars look like an inverted “T” with three components: a periareolar scar (around the nipple), a descending scar from the areola to the fold under the breast and a horizontal scar (not always necessary) located in the mammarian fold.
In the presence of a moderate mammary ptosis, a ” vertical ” technique can be practiced which removes the necessity for the transverse scar in the mammary fold and reduces the scars to peri-areola and vertical components.
Breast lift with implants and hidden scar.
In mild to moderate cases (breast ptosis type I and II) the breast can be lifted with an implant. I particulary prefer to use anatomical implants designed for breast reconstruction in stead of breast augmentation.
These implants are longer and have more projection and volume in the lower pole. The aim is to fill the skin of the lower pole lifting the areola and nipple complex. At the same time I expect to give volume to the upper pole without the need of removing skin and creating visible scars
This procedure is controversial because the implant will increase the weight of the breast leading to further ptosis. However I use it importantly in young patients in which I do not believe a visible scar is reasonable. The patient will have beautiful breast for few years that will need to be lifted in the future when the volume and the shape will probably not be so relevant.
In certain cases of minimal mammary ptosis, a correction can be performed by a peri-areolar incision exclusively.
In cases where the ptosis is associated with insufficient volume alone, correction can be achieved with the use of breast implants.
A breast reduction can be performed from the end of the puberty. A further pregnancy and breast-feeding is always possible, however, we advise to wait at least six months after the surgery. The risk of cancer is not increased.
Before the surgery (breast lift)
A usual preoperative assessment is carried out in accordance with the federal regulations. The anaesthetist will see you at latest 48 hours prior the operation.
In addition to the usual preoperative examinations, some imagery exams may be prescribed (mammography, echography). Drugs containing aspirin have to be stopped at least 10 days before the surgery.
Classic breast lifting with skin removal and gland reshaping
The removed tissues are systematically addressed to a specialised laboratory for microscope examination (histological examination). At the end of the surgery a modelling bandage, with elastic bands is made. The surgery can last from two to three hours.
Follow-up after a breast lift.
The immediate post-operative pain is treated with appropriated medication. Swelling (oedema) and bruises (blue) are normally observed and resolved spontaneously. The first dressing is changed 24 or 48 hours after the surgery. The second dressing is lighter and easy to handle. The patient is discharged from the clinic 24 to 48 hours after the surgery, and is re-examined in consultation two to three days later.
An elastic sports bra ensuring a good application (the size will have been evaluated before being discharged from the clinic) is advised to be used night and day during approximately a month. Generally, we use resorbable sutures, however, if non-absorbable sutures were employed, they will be removed 10 days after the surgery. It is advisable to consider a convalescence sick leave from 8 to 15 days. A period of two months is recommended before resuming sports.
Results of a breast lift
The final result can only be judged one year after the surgery: the shape of the breast is then generally harmonious and symmetrical or close to symmetrical. However, most patients are very satisfied during the immediate postoperative period. Beyond the local improvement, this surgery has a favourable repercussion on the weight balance, the practise of sports, the possibilities of using more styles of clothes and the psychological state.
Imperfections and complications of a breast lift surgery
The maturation of the scars can be different from person to person, that is the reason why they are the subject of an attentive monitoring. Frequently, that the scars get a pink tint during the second and third post-operative months; they then gradually flatten and get paler over the duration of one year. They can however remain widened, or remain active for longer than a year. Scars do not disappear completely, but their aspect improves over time.
Asymmetries of volume, height, size or orientation can be seen. In all the cases, a secondary surgical correction can be made, after at least a year or two.
Complications related to the anaesthesia, will be discussed during the consultation with the anaesthetist.
Regarding the surgical procedure: choosing a qualified Plastic Surgeon decreases to the minimum these risks, however, it does not remove them completely. Fortunately, the true complications following a breast reduction are rare. In practise, the vast majority of the cases are without any problem and the patients are fully satisfied with their result.
Rare but possible complications: Infection requiring an antibiotic treatment and sometimes a surgical drainage. Haematoma formation requiring a drainage (evacuation). Decrease of the sensitivity, in particular in the nipple area, however the normal sensitivity generally reappears within 6 to 18 months. Troubles of the wound healing process seen in heavy smokers and diabetic patients. Hypertrophic scars and even keloides, in patients with unfavourable wound healing process.
To resume, there is no need to overestimate the risks, but it is important to become aware that any surgical operation, even apparently simple, always comprises a small share of risks.
Having a qualified surgeon ensures that these complications can be identified and treated effectively.
I advise to preserve this document, to read again it after the consultation. Perhaps this reading will bring out new questions, that our team will be ready to answer effectively.