Augmentation Lift


Mastopexy (Breast Lift)    

 

Throughout the centuries, women who were unhappy with the size and shape of their breasts had little choice but to try to disguise the problem. As with the rest of our bodies, gravity continues to exert its constant downward force on the breasts. This force when exerted on breast skin that has begun to loose its elasticity causes the breast to sag. The Mastopexy or breast lift operation is done to restore a youthful, uplifted appearance to the breasts.  With continued sagging the nipple may drop from its youthful placement to a position that is below the breast fold. The surgery to uplift the breast removes no breast tissue. Only excess skin is removed and the nipple repositioned to create an improved shape and contour. The volume of the breast will remain the same, thus this is the ideal operation for a woman who is satisfied with her breast volume, but dissatisfied with the shape and contour of the breast. In some cases it may be necessary to increase the size of the breast with an implant at the time of the breast lift.  Breast sagging can occur naturally or as the result of pregnancy and breast-feeding. The problem is one of loss of breast volume coupled with loss of skin elasticity. Breast sagging or Ptosis is classified into three categories.  Minor sagging occurs when the nipple is at the level of the fold beneath the breast but above the contour of the breast itself. Moderate ptosis means the nipple is below the crease but still above the contour of the breast. Severe ptosis occurs when the nipple is below the fold of the breast.

   Breast Cancer and Breast Lift

There is no evidence that indicates either an increased or decreased risk of a woman who has had a breast lift developing breast cancer. Regular mammograms and self-breast examinations are advocated for all women.  We feel strongly that all women should be aware of the risk of developing breast cancer and that they develop a routine and systematic system for early cancer detection. If you are over the age of 35 we recommend a repeat mammogram one-year following the breast lift. This will serve as your new baseline study.

 

Breast lift / augmentation video

  

The Surgical Technique of a Breast Lift

A breast lift procedure can be performed in either our office operating suite or in the outpatient area of the hospital. It is typically done under either twilight anesthesia (local anesthesia with sedation) or under general anesthesia. When the procedure is performed in the office, we have a board certified anesthesiologist   present to administer the anesthesia medications.  At Prima Center for Plastic Surgery our in office operating room is certified by AAAASF. 

The breast lift patients will commonly have a normal sized breast and in this case all that is required is a lifting of the sagging breast. The procedure is accomplished by changing the position of the nipple-areola complex. The nipple and the dark circle of skin around it are brought up to a more normal position on the chest wall. The incisions usually follow the natural curve of the breast and are usually located in the crease under the breast.  The incisions typically look like a keyhole and this is made in the area above the nipple to mark the new position for the nipple and areola.  Through a combination of vertical and horizontal incisions the excess’skin is removed from the lower section of the breast. Then the nipple, areola and breast tissues are move up to their higher and more normal position. After the nipples are relocated the upper skin flaps are brought down and wrapped around and brought together to reshape a new breast. If the sagging is only minimal or moderate a procedure with less incisions and scars may be possible. This can sometimes be done removing skin from around the areola and drawing it towards the center portion of the breast.  If there is a problem with breast volume we may recommend the insertion of an implant in addition to the breast lift. There will be scars as a result of the procedure. The incisions are placed in positions that are thought to be the least noticeable. Everyone heals differently and usually the scars will be quite inconspicuous. The scars will be expected to go from pink and firm to soft and faded over a six to twelve months period.  The operation can be performed in our in-office surgical suite or in the outpatient area of the hospital. The normal recovery time is very short.  Many women can have their breast lift done on a Friday and be back to work Monday. Some soreness is expected to last for the first week or so.

Strenuous physical activity such as jogging and aerobics will be restricted during the first four weeks. You will be allowed to take a shower on the day following the operation. Pain medication is usually needed only for the first couple of days following the surgery. This is discussed further in the section on Post-operative instructions.

The Initial Consultation

During your initial consultation with the plastic surgeon you will discuss the specific details of the procedure. We will review your past medical history and perform a physical examination. Your breasts and chest area will be examined and then specific recommendations will be made concerning the location of the incisions and the exact type of lift that should be done.

All of our fees will be discussed in a surgical cost analysis. The total cost includes the surgical procedure, the implants, the cost of the operating room, anesthesia, all supplies and medication and post-operative follow up examinations. It is our policy to apply the cost of your initial consultation to the cost of the surgery if scheduled within 90 days. The fees for aesthetic surgery are payable in advance. The specific details of our financial policies are available and will be included with your cost analysis. If you decide to proceed with the breast lift all arrangements will be made through the office. Our patient coordinator will arrange the time and location of the surgery with you. Once scheduled you will return for a pre-operative examination. At this time we will answer any questions. Pre-operative photographs will be taken to serve as a record. Routine laboratory studies such as a blood count will be done. You will be instructed not to drink or eat anything after midnight the evening prior to your surgery.  This ensures that your stomach is empty and increases the safety of administering your anesthesia. You should not take any aspirin or aspirin containing products for two weeks prior to the surgery. Common medications that contain aspirin include Alka Seltzer, Anacin, Ascriptin, BC, Bufferin, Coricidin, Darvon, Fiorninal, Dristan, Excederin, Percodan and Sine Off. Tylenol may be taken during this time. If you smoke then you should stop for a minimum of two weeks before surgery and for two weeks following the surgery. Nicotine has a direct negative effect on the healing process.

The Day of your Surgery

You should wear loose, comfortable clothing. Avoid shirts that have to be pulled on over your head. A loose fitting shirt or blouse or a jogging suit with a zipper in the front works well. We will supply you with a post-operative bra to be worn after the surgery. You may shower or bathe as normal the day before surgery.

The breast lift procedure is done under either twilight anesthesia or under general anesthesia. It is normal to feel anxious before surgery. The anesthesiologist or anesthetist will give you medications that will make the surgery as pleasant of an experience as possible. Most of the incisions are closed with sutures that are placed under the skin and will dissolve on their own. Following the surgery you will be observed in the recovery area. You will be under the effects of the medications for several hours and will remain drowsy. You will need some one to drive you home. Arrangements should be made for someone to stay with you for at least the first day after surgery.

Post-operative Instructions

You will be given prescriptions for pain medications and antibiotics several days prior to your surgery. It is usually best to fill these prescriptions before the surgery so that they are available when you get home. You should take the medications as instructed. It helps to take the medications with a small amount of food. If you become nauseated be very careful with food intake.  Begin with clear liquids like a soft drink or tea. You may also try saltine crackers or dry toast. When you arrive home try to make yourself as comfortable as possible by going to bed or sitting up in a chair. Take the pain medications every three to four hours as needed. Do not eat heavy foods the evening of surgery.  Slowly advance your diet until you are certain that you are not going to have a problem with nausea. If you develop nausea that is persistent then call your plastic surgeon and he will prescribe a medication for you.  You may change your dressings as needed. This is usually done by stuffing the gauze under the post-surgical bra. It may be necessary for you to wear the bra night and day for the first two weeks. If this is the case it will be discussed with you before surgery. There will be steri-strips over the actual incisions. Allow the steri-strips to remain intact. You may shower or bathe the day after surgery. It is not harmful to get the incisions wet after 24 hours. Over the next week you will slowly resume your normal activities. The initial discomfort usually subsides after the first 24 hours. At first when you begin to move about you will experience some discomfort related to muscle spasms. The more you move about the quicker your recovery will be. During this initial healing phase use your commonsense. If you think that you should not do it then don’t do it. You may continue to need the pain medication for the first few days. Then you will be able to get by using Ibuprofen (Advil).

 

Your post-operative office visit should be scheduled for 2-3 days following the surgery. At this visit we will check for any potential problems. Bruising generally appears in the area around the incisions and under and around the breasts by the first to fourth day.

 

You will be instructed to notify the doctor immediately if you experience any of the following problems.

§         An elevated temperature of 101 degrees or greater that is not relieved by two Tylenols

§         Excessive swelling or tenderness in the breast

§         One sided disproportionate swelling

§         Any significant and prolonged bleeding from the incisions

§         Any redness along with increase warmth of the breast

Risks and Complications

Risks and complications associated with a breast lift are rare. We do not mention these risks to frighten you, but rather to inform you and educate you so that you can make an intelligent choice.

Bleeding - The development of a post-operative hematoma or bleeding is unusual. This risk of this complication is less than 1. If the bleeding and subsequent blood collection is severe it may require a reoperation.  Infection - Antibiotics are prescribed to reduce the possibility of infection; however a risk of infection always exists with surgery. Infection is most commonly seen in-patients with poor blood supply to the area, such as a cigarette smoker. We ask that you stop smoking for two weeks before and for two weeks after the surgery.

Numbness - Loss of sensation to the nipple area is a rare problem. The nerve that supplies the nipple comes from just under the fourth rib and extends over the outer portion of the breast. These problems are usually temporary and will subside over the first few weeks. In very rare circumstances it can be permanent.

Nipple or skin loss - This is due to lack of circulation and is aggravated by smoking. If this is severe subsequent surgery may be needed.

Postoperative recovery

You should expect to be sore for the first week or so following the surgery.  There will also be some swelling and bruising. You may take a shower after 24 hours just be careful and gently pat the area dry. You will be placed in to a postoperative bra and you can change the dressings as needed by inserting gauze under the bra. For you comfort it is best to sleep with the bra on for the first week.

Most of your stitches will be placed under the skin. Any external stitches will be removed by the seventh day. The remaining deep sutures are the dissolvable type and do not need to be removed.  Your activity will be restricted during the first two weeks following the surgery. Good healing and wound care will play an important part in the final appearance of your scars. If you have a job that does not require strenuous activity or lifting then you can return to work after a week.  Heavy activity such as jogging or aerobics should be delayed for at least four weeks after surgery.

It is also a good idea to wear your bra for the first few months following the surgery. We recommend any type of soft bra or sports bra the will give you a good deal of support. This will help you maintain the improved shape of the breast.

Results

The results of a breast lift surgery are not expected to be permanent. This is a surgery that should be considered as a repair and maintenance operation.  Gravity will continue to pull the remaining breast tissue down and as the skin looses some of its elasticity the sagging will gradually recur. Other factors that can lead to a recurrence are fluctuations in your weight, weight gain, weight loss, and pregnancy.

Cost

At the time of your consultation we will give you a surgical cost analysis.  The cost of your surgery includes all professional fees, the operating room charges, all sterile supplies and medications, the breast implants, the operating room assistants, and anesthesia. Also included in the cost are all follow up examinations for one year. If you should require any additional procedures to repair complications you would only be charged for the cost of sterile supplies and medications. As with all cosmetic procedures, the cost of a breast lift is not covered by health insurance.