Breast Lift Washington DC
A breast lift, also known as a mastopexy, provides the look of a bra without wearing one. Some women’s breasts start to sag as part of the natural aging process, while others may have lost volume and elasticity from pregnancy and breast feeding or weight loss. The nipples are usually too low on the breast mound and need to be lifted to a more attractive position. A breast lift alone may make the breasts appear slightly smaller, as the skin envelope is tightened around the breast tissue. Women who would also like to be larger may benefit from a breast augmentation at the same time to improve the overall appearance of their breasts.
A crescent mastopexy is for women with only a very small degree of sagging (also known as ptosis) or for women who have slightly asymmetric nipple/areolas who want this corrected. A crescent of skin is removed from the upper half of the areola from 9:00 to 3:00 to give a slight lift.
A periareolar mastopexy is also known as a concentric or “doughnut” mastopexy. In this situation, a ring of skin is removed from around the areola, and the remaining skin is cinched in. While there may be some skin wrinkling around the areola initially, this contour irregularity improves after several months, and the final scar is limited to the edge of the areola. The only concern is that the scar may widen in some cases.
A vertical mastopexy allows the nipple to be lifted even further, with a scar around the areola and then extending from the 6:00 position down to the breast crease. Because the vertical dimension of the skin envelope is not shortened in this type of lift, there may be some contour irregularity in the fold which typically will smooth out over the next few months. Alternatively, a limited scar may be required in the fold.
Breast Lift Surgery
The procedure is performed on an outpatient basis with general anesthesia. The patient is first marked in an upright position prior to entering the operating room. The skin to be excised is marked as well as the new lifted location for the nipple/areola complex. If the breasts are asymmetric, breast tissue may be removed to attain symmetry. This breast tissue is routinely sent for pathologic evaluation.
Long-acting local anesthesia may be injected as intercostal nerve blocks to minimize postoperative discomfort, which should last at least 6-8 hours. At the end of the case, the patient is placed in a dressing consisting of gauze padding and ace bandages wrapped circumferentially like a tube top.
Recovery from Breast Lift Surgery
For the initial 24 hrs after surgery, it is normal for there to be drainage staining the dressing on the outside. The patient is seen in the next few days for dressing (+/- drain) removal. If non-dissolving sutures are used around the nipple/areola complex, these are removed at 4 and 8 days after surgery. All of the remaining sutures dissolve. The patient is asked to limit the use of her arms, keeping her elbows by her side for a period of 2 weeks from the day of the surgery. At that time, she will gradually start resuming her normal level of activity with the expectation that she will be back to normal at approximately 3-4 weeks. It is recommended that a mammogram not be performed until approximately 9-12 months after surgery to allow the scar tissue to settle and remodel.
Breast Lift Risks and Complications
Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, unfavorable scarring, delayed wound healing, sensory changes of the overlying skin and nipple (increased, decreased, lost), loss of the actual nipple (very rare), persistent asymmetry, and need for revision in the future. If a breast augmentation is performed with the breast lift, there is also a risk of capsular contracture and implant deflation.
Capsular contracture is our primary concern after breast augmentation. The capsule is the scar tissue which normally forms around the implants. If this scar tissue tightens around the implants, it may cause distortion and/or discomfort. This may be treated initially with more aggressive massage exercises. Accolate, a medication typically used for asthma, may also be added, as it can lessen capsular contracture in some patients. If these measures are unsuccessful, surgery is needed to remove the scar tissue and reopen the pocket. Implant massage exercises are then restarted a few days later to maintain the larger pocket and prevent recurrence.