BREAST LIFT (MASTOPEXY)

Dr Chia Hui Ling
Breast lift, or mastopexy, is a surgical procedure to correct breast ptosis, or sagging breasts. Although tissue descent is a natural consequence of aging, development of breast ptosis is accelerated or exacerbated by factors such as larger breasts, breastfeeding, thin skin/weak tissues and weight fluctuations. The severity of ptosis is classified according to the level of nipple, relative to the inframammary fold (lower breast crease).

Grades of Breast Ptosis 

Mastopexy surgery addresses the problems of breast ptosis by removing excess loose breast skin and reshaping the breast tissue (parenchyma). The removal of breast skin will result in scars. In general, more skin removal will give rise to longer / more scars. The scars are placed strategically around the areolae, along the breast crease and down the lower vertical axis of the breast. 
 
In this diagram, the possible scar positions are shown on the right breast (R). In general, more / longer scars are expected if there is  more severe ptosis present. 
On the left breast (L), the coloured areas represent the skin that may be removed during a mastopexy to lift the breast.
Augmentation Mastopexy

In mild cases of breast ptosis, breast augmentation with implants alone can offer a modest breast lift without the need for a mastopexy. 

Breast deflation often accompanies breast ptosis and an augmentation mastopexy is suitable for those looking for both a breast lift and an increase in breast volume. Breast augmentation and mastopexy are often carried out together in the same setting, but some plastic surgeons may elect to stage the augmentation mastopexy and do them on separate occasions. Fat grafting is another option to augment the breast in a mastopexy.

TREATMENT

Have a thorough discussion with your plastic surgeon, including your surgical goals, medical conditions, drug allergies, medications and previous surgeries. Expected outcomes, such as breast size and scar placement, risks and other treatment options (like breast augmentation and fat grafting) should be explained to you.
  • Preparing for Surgery

    Do inform your plastic surgeon of previous breast conditions and surgeries, any medical conditions and medications. If you are approaching or more than 40 years of age, preoperative breast screening is recommended. Avoid blood-thinning medications, anti-inflammatory drugs or herbal supplementations as they can increase the risk of excessive bleeding during surgery, unless indicated by your doctor.



  • Surgery

    The surgery is usually perfomed under intravenous sedation or general anaesthesia, and often in a day surgery.


    The plastic surgeon starts with marking of the breasts in a standing or sitted position before the surgery. During the surgery, the excess skin is removed, breast tissue (or parenchyma) is reshaped and the nipples are lifted. 


    If an augmentation mastopexy is planned, implants are placed to augment the breasts at the same time.  Sometimes, the surgeon may stage the augmentation and breast lift surgeries and perform them on separate occasions. 


    Another option to increase the breast volume is to perform fat grafting with mastopexy. Fat is harvested from other areas of the body, processed and injected into deficient areas of the breasts.


  • Post-Surgery Care

    You may be asked to wear a support bra after surgery. The breasts will be more lifted and swollen straight after surgery and this will settle to a more natural shape over the next few months.

COMPLICATIONS AND MANAGEMENT

Risks of Mastopexy include:
  • Bleeding 
  • Infection
  • Poor wound healing
  • Nipple numbness
  • Nipple necrosis
  • Breast lumpiness
  • Unsatisfactory results, such as asymmetry or poor shape
  • Unfavorable scarring
  • Need for revision surgery