Mastopexy is the cosmetic surgery procedure of raising sagging or droopy breasts (known as ptosis).
At each end of any spectrum, abnormalities will be easier to define. However to describe the normal dimensions and shape of a human female breast is very difficult. Like the concept of human height, there is no true definition of what a normal breast shape or size should be. This is because the perception of breast shape is affected by age, physical proportions, height, race and culture. Frequent concerns women express to cosmetic surgeon about their breasts often relate to size, symmetry and the degree of droopiness (ptosis). The motives women seek to correct breast ptosis are usually very personal. Discomfort in a bra or during exercise, aesthetic concerns or a desire to revert them back to their shape “as they used to be”, are some of the reasons for consultation. This short article is about breast ptosis (droopiness) and its surgical correction, which is known as mastopexy.
Causes of Breast Ptosis
It is important to be certain of the diagnosis. The breast can be ptotic because there has been a significant volume decrease of breast tissue. If the surrounding skin envelope has not shrunk in proportion to the decrease in glandular and fatty elements of the breast, ptosis will result. This can occur after significant weight loss or the intrinsic changes that can result in some women after breastfeeding. After the hormonal stimulation to lactate and cyclic engorgement, the breast tissue will shrink when lactation ceases. This can alter the shape of the breasts and the tension within. The reverse is also true. Weight gain can lead to breast ptosis along with the natural ageing process. Certainly woman with larger breast in youth will be more prone to ptotic breasts with age as the skin envelope stretches with time and the breasts become more pendulous. Sometimes this can occur with large breast implants which have been in place for many years.
It is essential that the cause of ptosis is fully evaluated and of course the needs and expectations of the patient are understood. It is important to determine whether the patient is actually requiring a volume change as well as correction of breast ptosis. Mastopexy is by definition surgery that does not effectively alter the volume of the breast but often involves adjusting the position of the fatty glandular tissue of the breast and re-shaping the skin envelope by tightening and re-draping. The aim is to create a tightened breast with elevation and re-orientation of the nipple position resulting in a more uplifted, youthful appearance. Some times this is not possible to form a satisfactory shape by tightening alone without volume change. Therefore mastopexy can be part of either a breast reduction or breast augmentation. The volume changes should be fully understood by the patient. It is often difficult technically to carry out breast augmentation with silicone implants and mastopexy at the same time and in my hands better results are achieved if carried out in two stages.
There are several types of mastopexy and this is dependent on the amount of uplift and tightening that is needed. For minor uplift the scarring can usually be minimised so that it is just situated around the nipple (known as peri-areolar scarring). For larger changes it is likely that the scarring will also be more extensive and a vertical scar will result and occasionally a scar running along the crease where the lower part of the breast meets the chest wall may also be needed. It is important for patients to understand that all mastopexies will result in some form of scarring. Selection is the key to outcome both of the patient and the technique. Complications are uncommon but unsatisfactory scarring, shape, asymmetry and nipple sensation changes can occur. The operation can be carried out under local anaesthetic and sedation as a day case. Recovery time is variable but within ten days to two weeks n
How is the risk of infection during surgery minimised?
Infection is prevented by the appropriate surgical technique. This means very strict sterility of instruments and the technique has to be meticulous. The environment and correct theatre air flow conditions are very important and there are very strict safeguard controls concerning this. We also reduce infection rates by making sure that the patient is fit and healthy and is MRSA negative pre operatively.
In terms of after care/follow up/complications such as seroma, bleeding, infection, what would be the costs involved?
These would be dealt with free of charge.
What makes a good cosmetic surgeon?
This is a complex question in reality. Firstly a cosmetic surgeon must be a good doctor. Cosmetic surgery should be no different from any other form of healthcare delivery. To be a good cosmetic surgeon one should have had thorough training. Experience and judgement are the keys. Also an ability to have the emotional intelligence required to fully understand the needs and expectations of the patient and to make sure that there is no mismatch with what is possible.
Can I have a tummy tuck and breast lift at the same time?
If this is clinically judged to be appropriate by your surgeon, then doing both these procedures at the same time is often a very good way of managing the dual cosmetic problem of excess tissue causing looseness and droopiness of the breasts and abdomen. However this will never be recommended if the patient has any significant problems such as a high body mass index (30 is a probably a universal cut off), diabetes or unstable weight or mood.
How soon after breast surgery can I resume exercising?
After breast surgery I believe that normal activity should be resumed as quickly as possible. Normal activity means walking and light duties and this can occur between 24 and 48 hours for some patients, and there is much individual variance.
I also believe that when the body is challenged, such as after surgery or any form of trauma, recovery is enhanced with sensible rest. Simple surgical wounds take ten days to heal primarily and three months to reach 70% strength.
During this time, in breast augmentation, the capsule that surrounds the implant develops and strengthens and all the inflammation, which is essential for healing subsides. However there is probably much individual variation as to the exact timing in this process as well.
Therefore, as a compromise, I would not recommend extreme or severe exercise until at least six to eight weeks has passed. Remember it is possible to keep fit and have a sense of well-being by sensible graded return back to full on exercise, and to do this one should always be in touch with how you feel and of course discuss this with your surgeon or the clinical nurse specialist at any stage.