If you’re considering improving the appearance of sagging breasts, understanding what a breast uplift (mastopexy) entails is essential.
Philip Turton, a highly experienced oncoplastic surgeon in Leeds, specializes in this transformative procedure designed to enhance breast shape, lift the nipple position, remove loose skin and restore confidence in your appearance.
Below, we explore everything you need to know about breast uplift surgery, including its benefits, techniques, and considerations.
Mastopexy, commonly referred to as a breast lift, is a surgical procedure that addresses the common concerns associated with sagging breasts, such as stretched breast tissue, low nipple position, and often loss of fullness. These issues can lead to dissatisfaction with appearance and reduced confidence.
Breast uplift surgery involves removing excess skin, repositioning the nipple without detaching it, and reshaping the breast tissue to achieve a more lifted, more youthful contour.
Unlike breast implants, which primarily add volume, mastopexy directly addresses sagging by tightening the skin and restoring the breasts’ position on the chest.
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 childbirth and breastfeeding. 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 residual 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. In some patients the breasts elongate very unflatteringly and look like empty socks that hang from the chest.
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.
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The skin stretches with time. This is an ageing effect 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 and droop are the terms usually used to describe this somewhat empty, deflated hanging and lower appearance.
In summary therefore, Breast sagging, medically known as ptosis, occurs for several reasons:
Stretched Cooper’s ligaments (tiny internal ligaments) and skin contribute to a deflated look, especially in the lower breast region. The nipple and areola may also stretch and shift downward.
Breast lift surgery (Mastopexy) is an operation that is specifically and routinely performed by specialist breast surgeons. We have this expertise as 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.
Philip Turton will conduct a thorough evaluation, including measurements of nipple position, skin stretch, and breast volume, to determine the degree of sag and the best surgical approach.
Mastopexy is performed under general anesthesia and typically requires a few hours. Scars will fade over 12–18 months, and Philip Turton’s advanced suturing techniques ensure optimal results.
More information on this is in my FAQ page on Uplift.
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 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.
This is the commonest and best 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. A full deep plane uplift is possible with MKr Turton suing this technique.
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 heal with excellent results and find the scars are 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. The sutures under the skin only dissolve after 9-months. Have a look at typical outcomes in the breast uplift image gallery.
This is also called a Benelli mastopexy or circum-areola mastopexy. It produces a scar around the areola. It is generally suitable for very 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. I find 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 surgery can be repeated in the future.
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.
Next. the outer breast skin circle is 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 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.
This is a technique that combines the donut incision with removal of a vertical wedge of skin from between the 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.
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 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 to 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.
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 or more below the crease line.
Philip Turton uses these grades, along with detailed measurements, to determine the most effective surgical plan for you.
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 21-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.
Rare complications, like tissue necrosis, are exceedingly uncommon under expert care.
Your consultation is always with Mr Turton. This is a detailed meeting to assess your current situation, medical history, suitability for breast mastopexy, and to perform the biodimensional assessment. You will have a full breast examination, and comprehensive measurements made of your frame, existing breast size, glandular analysis, tissue characteristics, and anatomical variations in typical dimensions. The type of breast uplift and whether you might consider breast augmentation too (same time, or later) can be discussed. Mr Turton will want to let you know about your best options and if there are any alternatives and the potential complications. He will let you know about the limitations of surgery, short and long term breast changes, the need for future surgery, mammography and follow-up and cost estimates. Please look at his Breast Uplift Information sheet and read it completely prior to the consultation.
A breast uplift can be done without removing any breast tissue. A full breast uplift therefore makes use of all of your own tissue to reshape and bring the dropped breast back into its correct position. The skin envelope of a drooped breast is made smaller by cutting away the excess skin, and the contents (your breast tissue) is then more tightly packed into this reduced envelope giving you the nice shape. This more compact breast will probably be smaller size in your bra. The overall size after surgery depends on how much breast tissue you have to start with. Some women have too much breast tissue and actually need (and request) a degree of breast reduction with the uplift. For others, the breasts would be too small and subsequent (two stage) or simultaneous (one-stage) breast augmentation to supplement your volume with silicone implants is requested
You should avoid any medication, herbal preparations, and vitamins except those that Mr Turton has said it is OK to take (please ask specifically). For example- No NSAIDS such as neurofen the week before surgery. You will also be fasting, and cannot take any liquids, any sips of water, or any food (no sweets, or chewing gum even), from the time specified (usually 6-hours prior to surgery). Avoid moisturiser on the breast area please. Arrive in good time, and you will be checked in first by nursing staff. You will be admitted several hours in advance of your operation so that it is completely unhurried. You should relax in your room (bring a book and magazines, ask for the wifi code if you wish to work or just browse the internet ). Mr Turton will take your pre-op photo and mark-you up.
Mr Turton’s anaesthetist will evaluate you and confirm that you can proceed on the day (If you are unwell or have developed a chest infection since your pre-assessment check, your operation would obviously be cancelled and rescheduled). When Mr Turton is ready for you in the theatre, your nurse will accompany you from the ward to the operating theatre reception for your first check-in, and then on to the anaesthetic room where your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds when they are ready to do so and you will be told before hand! Your will be under full anaesthesia for the full duration of the operation. Mr Turton will additionally use the longer lasting type of local anaesthesia into your breast tissues to provides additional comfort on wakening for around 8-hrs. Every thing is geared around you, your 100% safety, and your well-being. You will be woken up in the recovery room, and supervised 1 to 1 with an experienced recovery nurse after the anaesthetist has reviewed you. You will then be taken back to your room where you may start your recovery within the comfortable surroundings provided.
Your operation will be conducted meticulously and unhurriedly. You are positioned on a padded operating table. There are additional gel supports that will be placed under your ankles and for your arms to rest on. Your head is on a soft pillow. Although you will be wearing special “TED” stockings already, once in theatre, we will also place anti-thrombotic boots around your lower legs which will gently squeeze your calf muscles on and off pneumatically throughout the operation- the flowtrons (Mr Turton has never had a cosmetic breast surgery patient develop a DVT using this precaution), and there will be a special sterile operative warm air blanket covering your lower body (this is called the “huggy-bear” and it is set at a temperature designed for your comfort).
An operation time of 1.5-2.5 hours is typical for primary breast mastopexy. Mr Turton uses various techniques to reduce operative risks such as haematoma and infection; consequently his reoperation rate is well below average. You are fully monitored throughout the operation and the consultant anaesthetist is solely with you (one-to-one consultant care).
The chest area often feels “tight” and tender for a few days. You will be able to move about with a little more restriction than normal, taking extra care not to knock yourself or do anything too physical. It is better to keep elbows in to the sides of your body at all times- if you reach up bringing your elbow away form your sides it stretches the breast tissue under the skin. If you also have implants placed , with sub-pectoral positioning of the implants you should avoid using your chest wall muscles forcibly, to avoid discomfort. This will be discussed. In particular though, when getting in and out of bed or out of a chair, it is quite hard not to use the pectoral muscles as you normally push your hands down to help support your weight! So, you have do this very slowly and very gently if you need to. It usually feels more sore for a few more weeks with sub-pectoral positioning of implants and mastopexy, but sometimes only a few weeks with mastopexy alone.
Individual advice varies: From 1-2-weeks. You should have come off the strong painkillers before driving (such as Tramadol, Codeine, Dihydrocodeine or Tylex). You should be comfortable that you could make an emergency stop or be able to swerve sharply if needed before driving. Please ask for advice if you are uncertain.
Usually after 2-weeks. Some patients return after less time, ie 7-days, but any jobs that involve strenuous lifting should be avoided for 2-weeks, and then discussed with Mr Turton to get a realistic time frame based on your particular circumstances.
If you have empty breasts but without significant droop (usually a hollowed flat appearance in the upper breast, but the nipple is still well above the level of the crease under the breast) you probably just need breast implants to fill out the shape again and don’t need a mastopexy. Ask for Mr Turton’s professional opinion.
If you have very marked droop and you want to get more fullness than a mastopexy can provide, it is better not to have implants at the time of the mastopexy, but wait for around 4-months and then have a second operation to have implants placed.
If you have minor droop you could have implants at the time of the mastopexy, although the risks are a little higher for all complications. If you have a lot of breast tissue, you may not feel the need to have implants at all (many don’t) and this is the better option for you in the long run.
Discuss this with Mr Turton at your consultation.
The costs of each operation need to be taken into account.
If you have surgery in the afternoon or evening you will normally stay overnight as this is Mr Turton’s preference. Expedited recovery surgery is part of Mr Turton’s practice, and will enable you to go home more quickly surgery. You will be reviewed by Mr Turton the morning after surgery and only released when ready. This is normally always by late afternoon.
For your comfort, Mr Turton advises waiting a minimum of three few weeks as the breasts will be too tender to touch during this time. After this gentle sexual activity, without pressure on the breasts, can resume as long as no pain is experienced. Generally, it takes 6-weeks before you are able to lie on your front at night, which is a useful guide as to how pressure will affect your comfort. Breast massage must be avoided for a minimum of 8-weeks and should be very gentle after this too. In the long term, it is preferable not to sleep on your front at all, and you should not routinely massage your breasts.
You can return to all of your normal sporty activities. The only impact is when you are having implants placed as well- if this is the case please restrict your physical activities for a minimum of 6-weeks and taper back over a 3-month period.
Yes. UK domestic flights can be taken within 7-days. International flights are best avoided for 6 weeks (please ask). This is more to do with Mr Turton being able to assess your recovery. Long-haul flights in general increase your risk of DVT, and you should wear anti-thrombotic stockings, stretch your legs, and perform leg and foot exercises during such flights. There is no altitude affect on your surgery or implants if placed!).
In general, “Yes”. Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom/hip area, you will also often find some of it goes onto the breast area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuation of 2-4 lbs, which has negligible consequences. Weight changes can make the breasts sag more, or for if you have implants, if makes them feel deflated and you may notice rippling. Losing excess weight makes your breasts more empty at the top of the breast, and if you haven’t had implants it might be something you desire to fill out the breast again.
You can’t. However careful choices can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have breast implants or not. This is because of biological changes that occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking related damage, effects of weight change on skin and breast tissue, effects of pregnancies and breast feeding on skin and breast tissue, hormonal changes, weight of breast tissue and any implant’s weight and size (if placed). Large breast implants also stretch the tissue, acting a little like tissue expanders.
The biodimensional assessment goes some way to reducing excessive implant sizes being chosen by patients. You should very much speak to Mr Turton about this. If you do have implants after mastopexy, the larger the implant the greater the long term detrimental effects. This is because of the additional weight, and the compressive force of the implant on the surrounding tissues, which become thinner, and more stretched. In general you are better to avoid very large augmentations (eg over 350cc) and implant sizes that exceed your natural dimensions. Sub muscular breast implant augmentation may provide additional coverage to the implant but there are some negative aspects of sub-muscular positioning too and you sometimes have to trade-off one thing for another.
Wearing a well-fitting bra after your recovery is important (usually from 6-weeks). An underwire bra is safe and recommended. Wearing a comfortable sports bra at night is also very useful. A shock-absorber type bra should be worn during sport. Keeping the skin over the breasts moisturised helps to maintain the elasticity (bio oil is possibly advantageous here). Avoid the use of sunbeds and do not smoke at all (both have a very detrimental effect on skin elasticity and quality, as well as micro-vessel blood flow). Maintain your weight in the healthy range for your body mass index. Don’t sleep on your front at night. If you have children/further children, after breast augmentation, you breasts will very likely develop some sag.
Acute problems after surgery are covered by your “fixed price package”. This includes typically having to go back to theatre to evacuate a haematoma, or having to come back to clinic to check wounds and wound healing.
Longer term problems after mastopexy are usually defined as those that occur after a 6-month period form your surgery and the hospital would not usually provide ongoing free consultations or treatment beyond this date. If you form a breast lump for example, it is very unlikely it would be related to your surgery. If you have private medical insurance you may be covered to attend Mr Turton’s private breast clinic. If you don’t have insurance you can self fund consultations and investigations, other wise you should go through your GP to get referred to the NHS breast clinic for review.
Complications from breast mastopexy surgery under Mr Turton are very rare (<2% occurrence). He will be unable to give you a categorical guarantee that they won’t occur, but he is an experienced surgeon and manages problems if they do occur. There are some types of problem that are more minor and typically occur in the first few hours after surgery if they are to manifest at all, such as a collection of blood, which is termed a haematoma. As this forms in the first 24-hours it needs evacuation so you go back under anaesthetic to have it washed out. In the first few weeks after surgery, the complication of infection can occur. This would likely result in needing antibiotics. If you have an implant when you have mastopexy the risk of complications is higher and if these complications do occur you will be covered by the fixed price package for further surgery. For example, if you need to have the implants removed because of an infection in the post-operative period, this is covered, as is the subsequent operation to replace new implants.
Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery related complications occur. They do not cover the more long term changes with like: rippling, palpability, breast sag, capsulation, rupture of implants, and malposition. They also do not cover dissatisfaction with the size, or shape.
Mr Turton will always strive to meet your expectations but if there are limitations as to what can be achieved (often related to your starting point) then these will be discussed. It is important to be realistic. If you are concerned about “body dysmorphia” please mention this, and similarly if Mr Turton feels you may have body dysmorphia he would suggest you do not have surgery as it doesn’t result in satisfaction for patients.
Your first post-operative follow-up is included in your surgical fees. Most patients are discharged at 3-months and Mr Turton doe not charge for your consultations during this time. Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £100; please check with Mr Turton’s secretary), which will be collected at the consultation on your card (please always bring this with you to avoid additional charges). You will not generally require further follow-up. Some patients desire check ups in the future and this is not covered by medical insurance if you are free of symptoms and have not been referred. It therefore costs £100 per consultation. Any investigations such as mammograms and ultrasound scans are considerably more and are levied by the hospital per test, eg mammogram and ultrasounds cost around £550, and biopsies cost over £1200).
Breast mastopexy may make you feel more confident within yourself but will not change things if you are dissatisfied with your lifestyle or your body in general. Surgery in itself will not change a life situation, but the confidence and self-assurance which result from it can indeed empower you to make the required changes, allowing you to live and enjoy your life, to the full. Some patients can rarely have a general problem with body image, and remain dissatisfied with their appearance even when the result has been within the expected and described range. This may be because of something called “dysmorphic body image syndrome”. Patients who have a general body image problem are unlikely to gain benefit from cosmetic breast surgery or any cosmetic surgery and should avoid it. Mr Turton would also want to avoid operating on someone who he suspected of having such a problem.
Due to possible changes in shape it may not be possible to wear the same styles.
Once you have recovered from surgery there is no reason why you shouldn’t go without a bra on occasions. As long as you feel comfortable it will not have a detrimental effect if it is not frequent. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.
The scars mature over a 1-2 year period. They tend to feel slightly thick and firm, slightly lumpy in places and look more obvious being quite red in the early period. But the scar will mature, and the suture material will be reabsorbed. Some sutures are designed not to being to break down for the first 3-months and so scar maturation takes longer, usually 18-months. We use the optimum techniques in designing and managing your scars but scars are permanently visible even after full maturation. A small proportion of people, around 5% get thicker raised scars (hypertrophic).
For women with sagging breasts over old implants, mastopexy can significantly improve breast shape. Implants should be removed during the lift, with the option to replace them 6-months after healing. For those patients who have had initial removal of implants with mastopexy, but do want to have Replacement Implant surgery, you must be aware that it is a separate operation that you are invoiced for; it is usually just slightly higher in cost to standard breast enlargement.
This approach enhances the breast contour while preserving or restoring volume if desired.
