Mastopexy or Breast Lifting Procedures

Ptotic, or droopy breasts are a real concern for many women. Weight loss, a severe diet program, pregnancy, and breast-feeding can all contribute to the development of droopy breasts. Women with pendulous or droopy breasts of satisfactory, comfortable size are good candidates for a breast lift. The problem may be that the breasts lack substance or firmness, nipple areolae point downward, and nipple position is below the breast crease. The “pencil test” is a good way to determine eligibility—if a woman places a pen or pencil underneath her breast and the item stays in place without assistance, she would benefit from a breast lift.

The most common patient is one who has had two children and has breast-fed them. After pregnancy and breast-feeding, the top half, or superior aspect, of the breast loses some of its fullness due to involution of breast tissue. Some patients are luckier than others and actually develop fuller breasts after pregnancy, but this is rare. Breast-feeding is extremely important for the baby, and no woman should avoid this important part of the nurturing process just because it might affect the appearance of her breasts.

The most common breast lift operation is the mastopexy. It involves repositioning the nipple areolar complex to a location higher on the chest wall. The incisions are located around the nipple areolar complexes depicted in Figures 14-2 through 14-6. This operation is usually performed with the patient under general anesthesia or heavy IV sedation. It can be done as an outpatient procedure in a hospital operating room or in a physician’s operating room, and it takes approximately three hours.

Some patients will have lost quite a bit of breast fullness and may require the placement of breast implants in addition to the lift. In this case, the lift is performed in the usual way, and the implants are placed most often underneath the muscle. Some before-and-after pictures which depict the expected result postoperatively are shown in Figures 14-1 and 14-2.

There are several degrees of ptosis: type 1, the minimal ptosis requiring only a breast implant; type 2, where the nipple areolar complex is approximately two centimeters below the inframammary crease and requires a small circumareolar lift; and type 3, which is depicted by a patient who has a much more ptotic breast and possibly loss of fullness at the same time, and will most likely require a formal lifting procedure either with an implant or by itself; and the patient with significantly ptotic breasts who needs a full breast mastopexy incision or an anchor-type incision. Your plastic surgeon may also categorize your breasts in terms of “mild,” “moderate,” or “severe” ptosis, and based on that evaluation, decide what type of operation will be necessary to place your nipple areolar complex in the correct location on each breast.