Breast lift (mastopexy) is a common procedure requested by my patients. Many times, a patient comes to my office and is happy with her breast size, but feels the nipple and the breast skin is saggy and “just want a breast lift”.
I wish it was that simple!
I have rarely seen a patient who will obtain a nice result with breast lift alone. What does a breast lift do? The only thing a breast lift does is to reposition the nipple to a higher position and remove excess skin. It does not redistribute the weight or shape of the breast tissue underneath. Many times a patient pinches the skin thus tightening the skin, and repositioning the nipple. They also see that this maneuver brings upper pole fullness to the breast. What the patient does not realize is that by squeezing the skin, one is also squeezing (redistributing) the breast tissue as well…this does not occur with a breast lift alone.
There are two types of patients who require a breast lift. The first group has a deflated breast, due to pregnancy or significant weight loss. These patients present with essentially a deflated balloon with loose skin with or without nipple malposition. A breast lift alone will only reposition the nipple and tighten skin without providing any three dimensional form to the breast. Typically a breast augmentation and a mastopexy are required for the best result.
The second group of patients has bottom heavy breasts. The breast may be significantly large (which then requires a major breast reduction) or not that large, but the weight distribution of the breast is the main reason breast ptosis has occurred. Again, a breast lift alone will not redistribute the weight of the breast and a mastopexy alone is doomed to fail in a few months. The patient has several options. A small breast reduction, just enough to remove some of the heaviness from the lower part, will result in better shaped, perkier breast but it will not provide significant upper pole fullness. If a patient desires an implant for upper pole fullness, two options are available. Luckily, if the patient’s breast is mainly fatty, aggressive liposuction will decrease the weight and size, while providing some degree of nipple elevation due to skin retraction. In a few months, the patient can be resized for a breast augmentation with or without a breast lift. If the patient has larger, denser breast tissue, a small breast reduction followed by breast augmentation is a reasonable option. Obviously, staging the surgery will allow patient to try on the implants and choosing the best size. Unfortunately, most patients want everything done in one session, which is reasonable, as long as the patient understands there will be some guess work as to what size implant should be used, since I cannot wake up the patient in middle of surgery for implant sizing!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 14 years of experience. His office is located in Orange County, California. To schedule a free consultation, please call (714) 834-0101
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