Mastopexy or Breast upliftment

1. Introduction

Mastopexy or Breast upliftment can help improve the shape of drooping (ptotic) breasts by ‘lifting’ the breasts. At times very droopy breasts can cause;

  • Breast discomfort
  • Neck ache
  • Backache
  • Shoulder pain
  • Skin irritations underneath the breast fold
  • Problems with clothes
  • Indented bra-straps

On a purely cosmetic level, the operation can help patients who are unhappy with the shape and droop of their breasts, by creating more uplifted breasts. Some patients droopy (ptotic) and ‘emptied’ out breasts particularly after significant weight loss, pregnancy or with age elect to have a breast enlargement (augmentation with breast implants alongwith a mastopexy or breast upliftment.

2. What surgery is available, and what techniques are involved?

Most breast upliftment surgery begins with the nipple, which is lifted into a new position and kept alive on a pedicle, of tissue. Excess skin and breast tissue is then removed, and the remaining breast tissue reshaped to create a smaller and more elevated breast.

The methods of breast upliftment (mastopexy) and reshaping vary, and depend upon the patient’s breast size, wishes and needs. While the principle of all breast upliftment remains the same, different techniques do result in different types of scarring in the breast area.

In breast upliftment the breasts are ‘lifted up’, the nipples elevated and the breasts are reshaped. The resultant scars depend on the technique that is most suitable and is often related to the amount the breast has to be lifted up. The scars vary from a circular scar around the areola, one passing vertically downwards and a scar in the crease below the breast.

Anchor-type or Inverted T mastopexy (breast upliftment)

This technique uses an anchor-type incision, also known as an inverted T, usually for more droopy breasts. This technique results in an anchor-shaped scar, starting around the nipple, travelling vertically down and then horizontally across the breast crease.

Vertical scar mastopexy (breast upliftment)

In vertical scar breast upliftment there is a circular scar around the areola and a vertical scar passing downwards.

Another common type of breast upliftment procedure is the vertical pattern breast reduction. With this technique, patients end up with a scar around the nipple that travels vertically down, but with no scarring underneath the breast. The vertical pattern is less effective and reliable when dealing with particularly large breasts. Furthermore, because there is no horizontal excision (removal) of skin, the vertical incision is ridged up. This can cause the skin around the scar to look gathered in the early days after the operation, and a vertical pattern breast upliftment will in general take longer to settle than an inverted T procedure.

Circumareolar mastopexy (breast upliftment)

In Circumareolar breast reduction the only scar is a circular scar around the areola It is possible to carry out a relatively modest breast upliftment by using a scar only around the nipple. This technique is suitable when only a small amount of breast pliftment is needed.

3. Who will I see as patient?

You should ensure that your initial consultation will be with the surgeon who will be doing the operation. You should expect to pay for this consultation. You should check in advance that the surgeon is on the specialist register of the GMC in plastic surgery. You can check here to see if they are a full member of BAPRAS.

At your first consultation you will be asked what is bothering you about your breasts and about your expected outcome from the surgery. You will be examined and some discussion will follow about scar patterns and what size of reduction is appropriate. If you are considered suitable you will be told about the operation, the expected outcome and possible risks and complications.

Patients should be given a ‘cooling-off” period before booking surgery, and will usually have a second consultation. You will be sent a quote regarding the cost. You should avoid any deal in which you are asked to pay any form of non-returnable deposit. Most hospitals will offer a package price that covers the cost of treating any complications arising in the initial weeks after the operation.

5. What should I expect in terms of treatment, procedures and outcomes?

Breast upliftment surgery or mastopexy usually involves fairly complex operations that take between one to three hours to perform. The operation is usually carried out under general anaesthetic. Patients can go home the same day, though with larger procedures are usually required to stay in hospital for one night. You will have some dressings on your breasts. You will be given instructions about your dressings and stitches when you go home. Most surgeons will use mostly dissolving stitches, but some stitches might need to be removed. Post-operative pain in these procedures is easily controlled. Patients will be mobile from day one and should be back to full exercise within six weeks. Patients are recommended to take at least two to four weeks off work immediately after the operation in order to ensure they recuperate fully.

All breast upliftment (mastopexy) operations result in some scarring although the nature of the scars will depend on the technique that has been used. Scars tend to be quite red in the first six weeks, changing to purple over next three months and then fading to white. Most patients will form good quality scars over time, but occasionally and unpredictably some patients will get red lumpy scars that do not improve.

6. What complications can occur?

Whilst these operations are generally regarded to be highly successful, there are various negatives and complications that patients need to consider. This is a major operation and you must be prepared for the process and recovery period. Most patients are delighted with the physical and cosmetic improvements that breast upliftment brings. However, it is impossible to guarantee that a particular cup size will result. There will be minor asymmetries between your breasts and the scars. Occasionally patients will bleed immediately after the operation and need to go back to the operating room for this to be dealt with. Wound healing problems could occur. Most wound problems are minor and can be managed with simple dressings. However, more major wound problems can arise such as infections, skin loss, wound separation and delayed healing. Sometimes some fat beneath the skin will die. This can result in wound problems or lumpiness that takes time to settle. Very raely, the operation can result in the loss of the nipple. Wound problems, if they occur, can delay your recovery and result in worse scarring. Some patients will get alteration in the feeling of the breasts, this will often improve after the operation, but it is possible that you will lose feeling in a nipple. After this surgery the ability to breast-feed might be lost.