Breast ptosis or droop is usually caused by in-elastic or stretched skin, repetitive pregnancies, weight gain or loss, breastfeeding or simply not wearing a supportive bra over a period of years. A mastopexy can be performed in conjunction with a breast augmentation or by itself. In general, there are three designs for mastopexy. The smaller operation for a less ptotic (droopy) breast is simply an excision of a circle of skin around the areola with re-closure. This gives a circular scar around the areola and a small amount of lift to the breast. The advantage of this particular mastopexy design is that the scar is small. The disadvantages are that the degree of lift is small as well, and it can flatten the contour of the breast. The areola can also unpredictably spread post-op, so I try to avoid this procedure.
The second design for a mastopexy involves a circular scar around the areola as well as a vertical scar, and the third involves the vertical as well as a variably long horizontal scar in the fold itself. More incisions mean more tightening of the breast, but it is at the expense of more scars. Over time, all scars do fade to varying degrees. I will be glad to discuss the pros and cons of this procedure with you in the office.
Obviously, a lift will not make you “firmer.” All breasts naturally lose firmness with time, but sometimes an implant can help mask this. Placing an implant behind any one of these designs will raise the breast where fullness is most needed. I think it is perfectly safe to perform a minor mastopexy at the same time as augmenting the breast, but there is greater risk to placing an implant behind a more extensive “T” mastopexy because the pressure of the implant can push against the incisions leading to wound healing problems, and a minor wound healing issue can lead to an implant infection or in an extreme case, the loss of an implant. For that reason, if a more extensive mastopexy is needed as well as an implant, I will often recommend that this be performed as a staged procedure to avoid complications.
You should be aware that when a mastopexy is performed with or without an implant behind it there will be some recurrent droop to the breast over time, although never to the degree that there was pre-operatively. For this reason, I will offer to remove some of the tissue of the lower breast either by liposuction or excision so that the lower breast will be less heavy and will drop less over time. Mastopexy alone usually cannot give fullness in the upper part of the breasts. This can only be accomplished by an implant (which you may or may not want) or fat grafting if only a little fullness is needed.
Complications from mastopexies alone are rare but they include wide or thick scars, bleeding or infection. Wound-healing problems are more likely in smokers. If you are a smoker, I would ask you to quit smoking two months before and after surgery to avoid these problems. Nicotine screening may be necessary the day of your surgery. IF THE TEST IS POSITIVE, YOUR SURGERY WILL BE CANCELLED.
If you do develop a medical complication from a cosmetic procedure, I have purchased health insurance for you through the CosmetAssure program, as your own health insurance does not usually cover medical complications from a cosmetic procedure.
It will be a pleasure discussing mastopexy with you. Please call my office with any questions (804-320-8545).