Breast Lift

After time and breast feeding, breasts can become saggy, the nipples low, and the skin loose. This droop is called ptosis. The level of droop is important in determining a course of action for your breast lift. Plastic surgeons rate the severity as mild, moderate, and severe:

• Mild: the breast has lost some fullness on top and the nipple sags a little
• Moderate: the nipple has descended to or beyond the level of the inframmamary crease
• Severe: the nipple is at the bottom of the breast and points directly downward

The levels of ptosis and treatments are discussed below, as well as nipple sensation, the importance of mammograms, and the risks involved with breast lift surgery.

Plastic surgeons have typically used the skin to tighten up the breast. Unfortunately, with this technique, the skin will stretch and sag again within a few years. Newer techniques allow us to give the breast new shape by using the deep layers of the extra skin to create a new breast mound. This is called the "internal dermal bra" and yields much greater longevity, as well as superior breast shape with fullness at the top of the breast. Instead of removing extra skin, it is "de-epithelialized," which means to remove the outer layer of the skin. The still-intact, deep layer of skin, or dermis, is then attached to the outer edges of the breast, more deeply than the existing breast skin. The skin is then just draped to fit the new firm, round breast. The incisions usually heal very nicely, because there is no tension on the skin closure, only on the firm, underlying new breast.

• Mild Ptosis
  The easiest way to lift a breast with mild ptosis is to use breast implants. This gives the breast a little lift and fills out the top of the breast without a lot of work. For this reason, most plastic surgeons will recommend implants for any patient who needs a lift. I have found that many patients are not open to this idea, however. They just want to look youthful without the volume or feel of implants.
  
  For women who need only a little lift, the scar can be limited to "periareolar" only - meaning just around the border of the darker skin that surrounds the nipple. Often this is referred to as a "Bennelli lift." The more skin that needs to be removed, however, the more there is likely to be ridging, albeit usually temporary, around the nipple.
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• Moderate Ptosis
  With a moderate ptosis, the surgeon needs to create a vertical scar from the nipple to the bottom of the breast (the "inframammary fold") in order to help take up the extra slack and to keep the breast from looking too flattened.
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• Severe Ptosis
  With a severe ptosis, it is more likely that a horizontal scar along the inframmammary fold will be needed as well.
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Nipple Sensation
With all degrees of ptosis, the nipple is never detached from the breast tissue but is simply shifted upward. This optimizes the chances for normal sensation in the nipple after breast surgery and allows for the possibility of breast feeding after the surgery.

Mammograms
For any woman over age 35 or any woman with a close family history of breast cancer, a mammogram should be performed before the surgery. It is imperative that your surgeon know if you have any abnormalities before your mastopexy procedure; it is important for comparison to any post-operative mammograms, and if any concerns arise, they can be dealt with in the same procedure.

Risks
The risks of the procedure are low and include bruising, hematoma (blood collection), and infection. There is a small chance of decreased nipple sensation. If the mastopexy is done with an implant, see the implant section for the additional risks.

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