Case Studies

Breast Lift (Mastopexy)

Breast Lift or Mastopexy is designed for the woman with sagging breasts which can occur as a result of several conditions:  postpartal atrophy when the breast tissue shrinks leaving stretched-out empty skin after child birth and/or breast feeding; massive weight loss; congenital asymmetry with ptosis (sagging); etc.  Some women are just born to have sagging breasts due to their skin type.  The breast is contained within the skin and as such, there are no muscles, tendons or other structures which are attached to the breasts to hold them up.  If the skin stretches for whatever reason, the breasts sag.

Before Surgery

Surgery removes the excess skin in such a way to allow the nipple/areola complex to be elevated along with the attached breast tissue.  There are several types of mastopexy procedures but all fall into two general types:  traditional mastopexy that results in a scar around the nipple/areola, then extending vertically downward to meet a roughly horizontal scar under the breast but above the fold.  There are multiple variations on this theme.  Then there are the procedures that only make a circular incision around the nipple/areola (without the vertical and horizontal incisions).  Which one is best for you will depend on the amount of breast tissue you have, the size of the breast, how much sagging there is, and many other factors.  Not everyone is a candidate for each of these procedures and it is necessary to determine which will work for you.  As you can see, a traditional mastopexy will result in more skin scarring but the circular incision or Benilli type breast lift will result in flattening of the conical shape of the breast.  Every aesthetic surgery is a compromise, even if the only thing you must accept is the presence of a scar.  It is not possible to do surgery without a scar.

In many cases a breast lift will be combined with a breast enlargement.  If you have small, sagging breasts then the combination of breast augmentation and mastopexy may be your choice.  However, do not expect the breast implants alone to correct any significant breast ptosis.  You may find that just implants alone will just produce bigger, sagging breasts.  If you try to correct the ptosis with larger implants than normal, you may wind up very unhappy with the final result which can look bizarre.

Scarring from a traditional mastopexy is the single most dreaded condition expressed to me during a consultation for breast lift. Certainly no one wants to have a scar.  Not even me.  I try to plan my procedures in such a way that the resulting scar is a short, thin and as natural looking as possible.  But some procedures do not allow much variation in creation of the scar.  In most women, the scar of a mastopexy will fade in time, usually 12 to 18 months.  But if you look for the scar you will always be able to see it.  Because of this, you, the patient, must have a serious talk with yourself to decide whether a scar or the sagging breast would bother you most.  There is no way out of this dilemma.  It is one or the other.  And if the answer is equivocal and you are banking on the smaller Benilli-type scar, what will you do if you are not a candidate for that procedure?

All of these things must be discussed and decided on during the consultation.  After a physical examination to determine the physical condition, there will be a lengthy discussion of the options available – and those that are not.  Should you decide to have breast implants in addition, implant size, style and position will be determined, too.  It is most important to have all the variables decided upon by the time surgery arrives.

The Surgery

The time in the operating room is determined by the type of breast lift chosen and whether implants are being inserted at the same time.  Anesthesia will be administered by a Board Certified Anesthesiologist, a doctor.  The average time in the OR for a traditional breast lift is about 3-4 hours.  Mastopexy is usually an outpatient procedure so once the surgery is complete and the patient has been awakened in the recovery room, the patient is released to a responsible adult to be taken home.  For my patients, there will be no stitches to be removed at a later date.

Post Surgery and Recovery

As in most aesthetic surgery procedures, bed rest for 24 hours is the best way to start off your healing.  Sleeping allows the body to summon all of its resources to begin the healing process.  It also lowers the blood pressure and heart rate so that bleeding is less likely a factor.  A long-acting local anesthetic is instilled into the area about the breasts to reduce or eliminate postoperative pain during the first 10-12 hours.  You will be given prescriptions for pain meds and antibiotics and perhaps muscle relaxants which you will begin once you are at home.  For a week, no driving the car, usually no work, no cooking, cleaning, lifting or reaching.  Take a vacation from all that!  You will have been given a 2 page instruction sheet when surgery was scheduled with before and after surgery instructions and you must follow those instructions exactly.  Nobody wants a complication and these instructions have been specifically designed to prevent postop complications.

Your visits to the office after surgery usually begin 5 days after mastopexy (2 days after mastopexy with augmentation).  Then you will be seen each week for 2-3 weeks, then at 6 weeks, 3 months, 6 months and 1 year.  If you had breast implants inserted, you will seen annually.  The skin incision will heal in about 10 days but the interior area (particularly about any implants) will require 6 weeks to heal.  Don’t expect the breasts to look perfect when the bandages come off.  This isn’t the movies.  Warm soaks to cover the breasts will help also in getting rid of swelling.  All of these things will be covered in your instruction sheets.  Photographs will be taken frequently.

Risk and Complications

This is a surgical procedure and therefore complications may occur.  I can’t imagine how many times I have said this to patients during the consultation.  Frequently about this time, a glaze comes over the eyes and the patient “tunes out”.  Risks of surgery and possible complications are not the most pleasant thoughts when you are excited about getting your new look but my advice, pay attention.  The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period.  Simply reaching over your head to get something out of the cupboard in the early postop period, or picking up the baby – these things stretch the pec major muscle and stretching the muscle can cause bleeding or a hematoma that sets off a string of complications.  The list of usual complications and their causes are covered in detail at the consultation so listen attentively.

The Cost

When budgeting for breast implant surgery, remember there is the fee for the surgeon, the fee for the implant manufacturer if you are having an augmentation too, the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, postop bras, etc.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

note: If you are having both a Mastopexy and Breast Implants you should read the section of Breast Augmentation.

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