Breast Uplift (Mastopexy)

What Does Breast Uplift (Mastopexy) Mean?

Mastopexy means breast uplift. Sometimes this is just referred to as a breast lift. One of the commonest reasons for women to be disappointed with their breasts is due to breast tissue stretch, a low nipple position and loss of fullness. The low nipple position and loss of shape of the breasts does cause loss of confidence in one’s appearance. When there has been excessive stretch to the skin of the breast with descent of the nipple position, breast implants no longer provide the solution to improve shape. This is because they do not ‘undo’ the excess skin that is present, nor will they make the nipples sit centrally on the front of the breasts facing forwards, as opposed to downwards. This can only be achieved by cutting away the excess skin and repositoning the nipple (we do not need to cut the nipple off to do this, but rather we keep it attached internally and cut around it) on the breast mound.

Breast tissue tends to sag with increasing age- Why?

Some women are unfortunate with the way their breasts develop in their late teenage years, probably due to genetic, developmental and hormonal differences. In others the changes occur commonly and naturally with time. The degree to which these changes occur is what separates individuals and it can have a profound impact on breast appearance and affect a woman’s confidence.

• More common after child birth and breast feeding. This is because as the breast volume increases the ligaments inside the breast stretch and the outer envelope of skin is stretched too. Hormonal changes associated with pregnancy contribute to the relaxation of tissue. After pregnancy and discontinuing any breast feeding the glandular tissue inside the breast shrinks (atrophy), usually to a lesser amount than before and the volume of the thicker glandular structures in your breasts therefore decreases. The ‘bag’ of skin that surrounds the breast tissue is now more flaccid and relatively under-filled. Under the influence of gravity the breast and the nipple position assume a lower position. The degree to which this occurs is different in each individual. The consequences on your cosmetic appearance are therefore also different.
• Hormonal influences occur throughout your life, from a monthly menstrual cycle, to changes from the pill, and subsequent hormonal decline with the menopause, or the effect of surgery or some prescribed medication.
• Gravity has a constant effect. When running or exercising the forces on the breast tissue are magnified and you should always well a high impact bra. If you have large breasts you should also wear support at night.
• The internal breast ligaments (Cooper’s ligaments) stretch. These tiny ligaments are not visible to the naked eye but they run through the breast tissue. They stretch when your breasts enlarge and do not return to normal afterwards.
• The skin stretches with time. This is an ageing effect and due to hormones and volume changes in your breasts. The stretched skin causes the breast tissue to be less well distributed within the breast skin envelope. When it falls more into the lower part of the breast, the bottom of the breast becomes more redundant and sinks further below the level of the infra-mammary crease (this is the skin line directly under the edge of your breast where the underwire of your bra rests). Because the nipple and areola are on the skin surface, they may become stretched and get broader. They may descend further down the front of your chest as the breast descends such that they point more towards your feet and come to lie below the level of the infra-mammary crease.
• The medical term for breast sag is “ptosis” and we refer to breasts as ‘having become ptotic’ or ‘looking ptotic’. Ptosis, sag usually and droop are used to describe this somewhat empty, deflated and lower appearance.

What does a Breast Uplift – Mastopexy – Involve?

Breast lift surgery (Mastopexy) is an operation that is routinely performed by specialist breast surgeons. We use the technique commonly in different areas of breast surgery such as to improve symmetry between two breasts that have developed differently, to even out breasts after the reconstruction of one side due to breast cancer, and also purely for the correction of cosmetic deterioration due to sagging breasts. It is carried out under general anaesthetic. Incisions are first made on the breast skin in a cosmetic manner, designed to enable optimal scar position afterwards. Incisions are then made internally in the breast tissue and around the nipple areola structure. The deep soft tissue is brought up to a better position, reshaping it into the central breast again. Depending on the type of mastopexy, surgery may be more or less extensive but it generally takes a few hours.

• Reshaping and lifting the breasts looks much better than a sagging breast. It may also produce a fuller and firmer bust as long as there is sufficient breast tissue to enable this.
• If you have relatively little breast tissue, the mastopexy will be predominantly removing loose skin only (dermo-cutaneous mastopexy) and will elevate the nipple position but there will not be a full breast mound if there is insufficient tissue to create one- this is where some patients desire breast implants to be placed too.
• Reduction in the areola size if needed. Sometimes the areola, the pigmented skin that surrounds the nipple, can be very wide and look unflattering. It is very normal to reduce the diameter of the areola during the breast lift procedure.
• Raising the height of the nipple so that it is optimized on the breast. When the nipple points downwards it is particular unattractive and one of the key benefits to a breast lift is to elevate the nipple position to that it is facing forwards rather than downwards.

Mastopexy Options

Depending on the severity of breast sag, three different techniques are often used, with the commonest being the wise pattern mastopexy as described below:

Wise pattern mastopexy breast lift

This is the commonest type of breast lift procedure that is performed for women with breast sag. It works extremely well for all grades of breast sag. A carefully planned anchor shaped scar (similar to the conventional breast reduction scar pattern) is produced that goes neatly around the areola, and then vertically down from the bottom of the areola in the lower half of the breast to the crease line, and fully across the breast crease under the breast. This gives the surgeon maximal control of symmetry, removing excess skin, adjustment to shape and overall internal reshaping. It is optimal for patients with any significant sag. It is natural to worry about the scars from breast uplift, but the vast majority of women and the scars far better than they imagined. The main aspect is to understand that scars mature, usually taking 12-18-months to fade and that the suturing technique used is designed to optimise the long term cosmetic appearance of the scars. Have a look at typical outcomes in the breast uplift image gallery.

• Uplift with implants
  • One needs to be more cautious about combining an uplift with breast implant placement at the same time. You need very careful assessment by Mr Turton. This is because if the degree of sag is excessive, it is better to do an uplift first, wait 3-6 months for good tissue healing and then to present your self again for the placement of breast implants. These implants can be used to better fill a deflated breast, to restore the shape to the upper breast which is commonly relatively empty despite a breast lift, and if patients generally want to have a bit of breast enlargement. Mr Turton finds he can produce a much better uplift if the surgery is staged as two procedures in this way. If there really is just minor sag then this can be treated with uplift and implant surgery being combined at the same time. However, you must be aware that the risks of complications are higher and careful judgement is required from your specialist as to whether this is a suitable approach.
  • More information on this is in my FAQ page on Uplift.
• Implants alone- Sometimes the breast does not have excessive droop, but it has an empty shape often with a concave appearance in the upper breast. The nipple might be a little low on the breast but not TOO low. If this is the case, Mr Turton can assess your suitability for an implant only technique. It depends on a quite a few factors as to whether this is appropriate. It is only suitable for filling out very minor sag. In all cases the nipples must be above the level of the infra-mammary crease otherwise the outcome of the breast appearance is not good. If this option is chosen and you wish for an uplift after the surgery has been done as you do not like the breast shape enough, you need to remember that an uplift can then be done, but you need to wait at least 3-months, and the full cost of an uplift will still apply.
  • When implants are used, and the tissue characteristics are just right, a nipple lift of 1-1.5cm might be achieved with full projecting implants. However, if your skin is too lax, the weight of the implants can pull the breast lower. Lighter weight Blite implants might reduce this effect but they can’t stop the need for a mastopexy if that is still required. Implants alone won’t prevent recurrent sag and will sometimes make the areola look bigger.

Donut breast lift

This is also called a Benelli mastopexy or cirum-areola mastopexy. It produces a scar around the areola. It is generally suitable for quite minor sag only as it allows for only a little adjustment. I sometimes do this with breast augmentation where just a small elevation in nipple height on the breast is required. If ind this to be a low risk procedure even when implants are being placed simultaneously, which is something that I feel should otherwise be cautioned against. The scar around the areola is usually fairly prominent for about 6-12-months after surgery. Sometimes the areola can stretch again and become broader but that is not common. The excess skin around the areola is removed which creates a wide circle. The areola diameter is also reduced. There is a big mismatch at this point between the outer circle from the excised breast skin and inner circle from the smaller areola. The outer breast skin circle is therefore reduced in size by placing a continuous suture under the skin, all the way around the edge, that is then drawn tighter like a purse string until the diameter matches the areola size. You will sometimes feel a slight ridge from the suture material that is under the edge of the areola. Finally fine cosmetic stitching is performed to to unite the breast skin and areola neatly. The reason this technique works best for small amounts of droop is that the final scars are better. If it were used to try to correct very drooped breasts, the gathering of the purse string closure would create lots of lines radiating out from the edges of the areola. This is like the rouging on dresses or curtains, and we therefore try to avoid that occurring.

Vertical scar mastopexy key hole breast lift

This is a technique that combines the donut incision with removal of a vertical wedge of skin from between nipple and the fold under the breast. This is a reasonable option for minor sag but does not allow the full uplift that is achievable with the wise-pattern mastopexy technique.

How is Breast Sag measured?

Mr Turton carries out a very detailed assessment of your breasts including specific reference measurements from your collar bones to the nipple, the top of the breast bone to the nipple, and from the nipple to the crease under the breast. We evaluate the global shape, tissue stretch and volume of the breast and take assess this in relation to your frame. We measure across the breasts and take account of the position and orientation of the nipples. The level of the nipples in relation the crease under the breast are determined. The distribution of the breast tissue is assessed and the descent of the lower edge of the breast (the inferior pole) in relation to the crease is measured. The degree of skin stretch and emptiness is evaluated. Using these measurements we produce a grading of the breast sag, which is explained further below.

Grading Breast Sag

Broadly speaking, the lower the nipple the worse the sag. Mr Turton finds the grade one and two assessments to be useful numbers. However, the Grade 3 number incorporates a wide variety of degrees of more minor excess sag to extreme amounts of excess sag. For example, Mr Turton has dealt with many women where the nipple is 10cm of more below the crease line.

Grade 1 breast sag: The Nipple is level with the crease

Grade 2 breast sag: The nipple is under 3cm below the crease line

Grade 3 breast sag: The nipple is more than 3cm below the crease

Is it Safe to Have a Breast Lift (Mastopexy)?

Breast Mastopexy should only be performed by a specialist who is experienced in the technique. Mr Turton has a very low complication rate as he has extensive experience and this operation has been part of his normal cosmetic and reconstructive breast surgery repertoire for over 15-years. But you must be careful, particularly if you have had multiple operations on your breasts before such as previous implant surgery, or even previous uplift surgery as the blood supply to the skin will not be as good. Poor blood supply can increase the risk of an infection or even nipple necrosis.

• Complications are not common but as for breast reduction may include:
  • Minor delays in healing, hypertrophic scars, minor infections needing antibiotics
  • Very rare: <1 in 500: the nipple or skin blood supply can be compromised causing tissue loss
  • Please review the FAQ page on mastopexy for a more comprehensive discussion

Should I Combine my Uplift with Breast Implants?

If you already have old breast implants and your breast tissue has now sagged over them it can leave the breast shape looking poor. Simply exchanging implants will not correct that sag. If you want to improve the cosmetic appearance and you need new implants you will usually need to have the implants out and have an uplift, but without any Implants going back in initially. Great care is still required as the blood supply to the skin is often reduced. The uplift will never reshape or fill the upper breast in this scenario but it will tighten the looseness to the breast, remove the redundancy of the breasts beyond the crease line and elevate the nipple so that the breast looks better, even though it is smaller. When women then want the implants back again we ask them to wait 3-6 months before doing this. If you don’t want to have implants back in and you have got used to the smaller but better shaped breasts that is a good cost saving too.

For women who have never had breast implants, and have sagging breasts, the big question is whether to have the uplift first then implants, or to have the uplift and implants at the same time. Mr Turton’s advise is that you allow him to make that decision as it based on the degree of sag that you have, combined with your desires, and balancing risks against benefit.

See the FAQ page on mastopexy for a more comprehensive discussion

• If it is done in stages, it is preferable to wait 3-6 months before having implants placed
• If you are a smoker it is essential to completely abstain from any smoking or nicotine products for at least 6-weeks pre-op until at least 6-weeks post-op.