Due to the effects of aging, pregnancy, weight loss and gravity, it is common for breasts to sag and nipples to start to point downwards. A breast lift, or mastopexy, returns your breasts to their youthful shape and position. The breast can be divided into four quadrants or quarters. As your breasts change with age, there is a loss of fullness in the upper inner quadrant. Most women refer to this as a loss of cleavage and are disappointed when wearing V-necks and strapless dresses. An important goal of a breast lift is to reposition your breast tissue into the upper inner quadrant, recreating a stable, youthful cleavage line.
When you just need a lift
Breast ptosis is often perceived as not only a sign of aging but also a loss of femininity. Regnault defined breast ptosis as the descent of the breast gland, skin and nipple-areola complex on the chest wall. He explains that the degree of ptosis is based on your nipple position. Many women pursue mastopexy to help ameliorate this gradual process, seeking a more lifted, “perky” and youthful appearance. A lift will correct the position of the your nipple, lift your breast tissue and remove lax skin.
Depending on the distance that the breast needs to be lifted and the breast’s shape, the incision may be around the areola (the dark skin surrounding your nipple) or in the shape of a lollipop, or an anchor (see figure). For patients who have had a previous mastopexy or breast reduction, I will often perform a fish mastopexy (link to paper), a specialized procedure that I published in which the breast is lifted without altering the location of the nipple. The procedure can reduce enlarged areolas and can be combined with a breast augmentation to add volume and firmness. During your consultation, I will help guide you to determine which option will give you the most natural, youthful result.
A breast lift will not only reposition your nipple into a more youthful location but it will also tailor any loose or sagging skin, lifting your breast. There are three incisions used to perform a lift depending on the distance the nipple needs to be lifted and the shape of your breast. When the nipple has to move a minimal distance, it is possible to make the incision around the areola. Depending on the amount of reshaping necessary, you may have a scar shaped like a lollipop or an anchor. The anchor-shaped scar allows for maximum reshaping.
Is Bigger Always Better?
Not necessarily…but sometimes. Many women who are contemplating a breast lift also wonder if they should have breast implants placed. The decision depends on the shape, contour, and volume of your breasts. During the mastopexy, I will resculpt your breast, restoring its original location. But sometimes women have lost a significant amount of breast volume from pregnancy or weight loss. In these cases, adding a small implant creates a foundation upon which to place your breast, plumping your cleavage line. Some surgeons believe that breast ptosis is due to only a loss of breast volume, thus inserting a large implant will lead to a satisfied patient. But large breasts can lead to back and neck pain, difficulty in finding professional clothing and an overall heavy appearance. I believe that the best result occurs when the implant is scaled to your body and the breast skin envelope is tailored to fit it.
As the breasts start to sag, the nipple becomes lower and the breast appears ptotic. The key factors that influence the degree of ptosis over a women’s lifetime are the number of pregnancies, loss of skin elasticity, gravity, cigarette smoking, higher body mass index, a large bra cup size, and significant weight gain or loss. Contrary to common belief, pregnancy not breastfeeding leads to ptosis and wearing a supportive bra does not prevent sagging. During a mastopexy, the nipple is repositioned at the level of the breast fold. This is where the nipple is located during youth.
Tailoring the Areola
The areola is the colored area encircling your nipple. Often due to pregnancy or having large breasts, the areola becomes wide. During a breast lift, the areola can be resized or reshaped to be in better proportion to your breast.
In the Details
The procedure is performed as an outpatient in a surgery center or the outpatient area of a hospital. It requires two to three hours of surgical time depending on the extent of surgery. After the mastopexy, your breasts will be wrapped in gauze dressings and you will be placed in a soft supportive bra. You will wear this bra around the clock for your first month after surgery. You will likely find that your breasts feel swollen and sore for the first few days after surgery. Most patients require pain medication for the first few days and are able to return to work in a week. You can start light exercise the next day and strenuous exercise in four weeks. You may resume wearing a underwire bra in six weeks. The results should be long-term but weight change, pregnancy, and natural aging may alter your appearance.
A Picture is Worth a Million Words
A picture may be worth a million words but in the age of the internet, online photos can be viewed by billions of eyes. In respect of patient privacy, a before and after section was not created on our website. Several patients have agreed to allow their photos to be viewed by prospective patients in the office. You may request to view photos during your consultation. Some patients have also agreed to speak with prospective patients if you would like to learn more about the procedure from a patient’s perspective.
What is the first step?
If you are considering breast implants or a breast augmentation, please call our office at (212) 600.4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in for surgery as well as those who are local to Manhattan.