Now that you are aware that you may need a breast lift and are taking the steps to bring you closer to a perkier, more aesthetically pleasing breast, you may be worried about the scarring that comes with Mastopexy.  Fortunately, medical science today brings us better options than being left with huge, ropey scars.  Although one must realize that not everyone will scar as well as the next there are factors which can lessen their appearance.  This also depends upon your health, heredity, eating habits, if you smoke, your post-operative protocol and your surgeon's ability.  Read on for more information, you may be surprised at your options...

What is Mastopexy? 
Mastopexy is the surgery of the breast that incorporates excision of excess skin and re-suturing of the tissue to literally lift the breast and give it a more youthful, perky appearance.  The anchor incision was once the only option and still may be your only option should you have excessive ptosis (or sag) to lift your breasts to their former appearance.

Only a qualified plastic surgeon can assess your needs and discuss with you the options that you may have involving a breast lift.  Be sure that you consult with several surgeons as not all doctors choose to offer their patients the newest of options or any options for that matter.

Are You a Candidate For Mastopexy?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.  Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.  Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.  If you are planning to still have children it is a good idea to wait until you no longer wish to have any additional children.  The skin will stretch and sag again after pregnancy.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  Cosmetic surgery is not getting a cavity filled.  This is an operation which requires patience and stability in dealing with the healing period.  There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

You will also discuss the available anesthesia that will be used for your procedure.  Most mastopexy procedures are performed under either General or Light Sleep Sedation.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.  If you do go under Deep General, ascertain that the anesthesiologist is certified.  Please read the All About Anesthesia Page -- the risks regarding anesthesia should be considered for a fully informed choice.  

Your Consultation Appointment
Once you have researched several surgeons, you will make consultation appointments.  The consultation  appointment is ultimately designed to interview the surgeon and discuss, in his/her opinion, what your options are.  Not all surgeons are going to offer the same techniques, have the same opinions, nor have the same aesthetic preferences.  It is usually best to get at least 3 opinions.  

At this appointment you will possibly bring a list of questions you have prepared to ask the surgeon, photos of what you like or do not like, and discuss any concerns you may have.  You will also discuss the available anesthesia that the surgeon prefers for this procedure.  

You may or may not choose to book a surgery with this surgery but if you do, you are more than likely expected to place a deposit down to hold your surgery date.  You will then possibly make an appointment for preliminary blood work, and probably even a pre-operative appointment.

The Benelli Lift (concentric, or peri-areolar or doughnut lift)
This technique is considered less invasive and was designed with the scars being around the areolae.  With the Benelli, a donut shaped piece of tissue around the areola border is removed and the surrounding tissue sutured to the areola.  The incisions are normally closed with purse string sutures.  Sometimes a little more tissue is removed above the areola (like the crescent) to compensate for a lifting effect when it is sutured.  The Benelli lift results in a flatter, rounder breast shape post-operatively as opposed to a sloped breast.

Other Available Breast Lift Techniques

  • The Crescent Lift: This technique involves removing a crescent-shaped piece of tissue above the areola and resuturing the tissue higher.  This creates a minor lift for patients who have slight ptosis. 

  • The Benelli-Lollipop: This lift is the same as the above but with straight incisions from under the areolae to the mammary folds (crease). This is for those who have medium ptosis, too much for the Benelli only and too little for a full anchor incision.  Although some surgeons are capable of giving good results with the peri-areolar lift only for medium ptosis patients.

  • Full Mastopexy (anchor): The most commonly used technique is with an anchor shaped incision that starts at the base of the areola, vertically to the where the breast meets the rib cage.  The incision then cuts out a crescent shape piece of skin right above where the  breast meets the rib cage. Nipple re-positioning is sometimes necessary with this technique as the nipple must be partially removed (see below) and left on a pedicle of flesh to retain the blood flow .  This is considered one of the major scarring techniques (with the below being the most scarring) but it sometimes necessary with severely sagging breasts.  With the Standard Mastopexy, the incisions are made in the shape of an anchor at the natural crease of the breast up to the areola (darker skinned area) and nipple area. 

  • Full Mastopexy (anchor) with an areolae reduction or relocation: This is sometimes needed or requested to decrease the size of the areolae complexes.  Sometimes you will get puckering with peri-areolar incisions -- be it a lift (Benelli, concentric, peri-areolar) or areolae reductions.  This usually flattens with time. Especially with the use of medical paper tape such as Steri Strips and/or silicone sheeting such as the BioDermis mastopexy forms.

Areola Reduction Surgery 
Some women may be displeased with the size of their areolae which may be enlarged due to genetic predisposition, previously having had large breasts then undergoing tissue loss, stretching of the areola due to implants or other reasons.  The areola reduction surgery is designed to remove the redundant areola tissue to improve the overall cosmetic appearance of enlarged areolae.  The reduction may result in a slight lift and may also produce  slight irregularities at the incision line if the reduction was significant.

A. larger than desired areola

B. incisions around areola

C. excess areola tissue is removed, and the area sutured.

D. scar after areola reduction; may have raised tissue around areola which may or may not flatten in time.

If a larger donut of skin is removed from the flesh colored area the result is often called a peri-areolar mastopexy (or Benelli Lift). 

This procedure is usually performed under light sleep sedation or general aesthesia in an O.R. setting.  For more information, please read the section below.

THE TYPICAL PATIENT AND PREOPERATIVE FEATURES

  • Desire for a smaller diameter and rounder and more proportioned size of your areolae.
  • Reduction of the puffy or large or bulging areolae that you would like flatter.

THE PROCEDURE

  • Anesthesia is usually a very light general and the procedure takes about two hours.
  • The procedure involves an incision around the areolar edge and a smaller incision with removal of the excess tissue in between, like a donut.
  • The incision is very inconspicuous and located around the final edge of the areolae.
  • Dressings and a light gauze bandage worn for several days.
  • This can be combined with other plastic surgical procedures.

THE RECOVERY

  • You can go home after several hours.
  • You can shower on the next day.
  • There is only minimal pain that is mostly gone by the second or third day and easily controlled by medications.
  • Minimal or no swelling is the usual.
  • Minimal or no bruising is the usual.
  • You can resume most activities in less than the first week.
  • The stitches are removed at seven days.
  • Expect to be off of work only two days or less.

THE RESULT

  • Beautiful, balanced and proportioned contour and size and shape to the nipples and areolae.
  • Lasts the rest of your life and always looks better than if you didn't do it.
  • Natural and presentable appearance in the first week that just gets better over the next three to six months.

Credit: Dr. James Romano, San Francisco, California Board Certified Plastic Surgeon

Risks, Complications & Contraindications of Mastopexy 
There are risks you need to know about so that you are fully informed. There are great benefits in getting a mastopexy to those who need it, but everything comes with risks.  There may be an allergic reaction to the anesthesia or medications.  Most risks usually come from anesthesia unfortunately.  Please read the All About Anesthesia Section for more information.

There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising.  Also, hematoma and seroma are possible, leading to additional surgeries to remedy.

A big fear is tissue necrosis (tissue death). I am serious, you do NOT want this. Tissue Necrosis happens when either you smoke and/or you have poor oxygen-tissue saturation or the surgeon did not use a pedicle to keep blood flowing to your nipple or other skin sections that were reattached. It also could be just bad healing or infection. This is an issue and by far the most worrisome and dangerous so do all that you can to keep this from happening -- like stop smoking several weeks beforehand!

Infections, although rare can happen when bacteria such as Staph, which naturally lives on your skin, gets into your incision area and multiply or develop.  That is why it is important to wash your breasts, neck and torso with an anti-bacterial soap like Hibiclens or even Dial anti-bacterial soap for several days up until your surgery.  This can reduce the amount of Staph on your skin.  Infections can also develop intra-operatively from unsterile equipment used by a surgeon or staff of the surgeon. Infections can also result from the introduction of bacteria post-operatively through improper dressing changes, bathing or swimming in water which contains infectious agents.  

Numbness and lack of sensation can be problematic -- although usually temporary.  Unfortunately this can be a permanent problem in some cases.  It is a complication we must be aware of before undergoing mastopexy or mastopexy with breast augmentation. 

Keloidal & hypertrophic scarring is possible in those who are prone to such.  This is when the scar tissue forms outside of the area of the wound.  It can result in thick, ropey scars.  There are many studies which report that keloid scars were prevented (and lessened in existing cases) with the use of silicone sheeting and gels.  One such scar treatment is made by BioDermis (www.BioDermis.com). 

Just make sure that you have a qualified plastic surgeon to perform your Mastopexy.  And if you smoke, quit before the surgery.  Since Mastopexy leaves relatively noticeable scars you should try everything in your power to lessen the risk of even more scarring.  When one smokes, their oxygen and blood flow to the skin diminishes considerably.  Please abide by your surgeon's instruction for a smoother, more pleasant recovery and results.

Scar Treatments


 

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