Mastopexy or Breast Lift procedures are indicated for sagging / drooping breasts. There are varying degrees of sag (called breast ptosis) and a multitude of mastopexy options designed to correct these, spanning the full spectrum of aesthetic breast surgery. A mastopexy is done when there has been failure of the breast skin to maintain the parenchyma (content) in an aesthetic form, and hence the breast droops, and appears elongated. This may follow weight loss, pregnancy and breast feeding. The breast sags when the content descends, and the nipple complex is sited at or below the level of the breast crease. More often than not, to re-elevate the nipple complex, incisions are placed on the breast mound, which are not dissimilar to those used in a breast reduction (usually the vertical pattern, but occasionally the Wise pattern). Hence scarring on the breast mound itself is a necessary “evil” in mastopexy to accomplish the “lift” and better shape the breast content.
In the mildest form of droop (so-called psuedo-ptosis or false droop) there is deflation of the breast content, along with descent of the bulk of the breast content, but the nipple complex is well sited on the breast mound, above the breast crease. In these cases, one can sometimes simply place a breast implant (in the same way as an augmentation) in the appropriate position and this may be sufficient to give the impression of a breast lift, without resorting to a formal lift. In those with more significant droop, a formal lift is indicated. This may broadly consist of one of the 3 following options:
In those with an absolute deficiency of breast volume / content, and with sag, one can offer an augmentation mastopexy – adding an implant for the volume (usually beneath the chest muscle – dual plane placement) and doing a breast lift of the remaining tissue. The surgery can be done in one (combined lift + augment)or two stages (either lift or augment first, followed several months later by the other option), the combination of both augmentation and lift in one procedure being notoriously complex and having a fairly high revision rate, but still relatively common in practice.
In the somewhat large breast that has drooped, a small (vertical) breast reduction may be done with good effect. This reduces the volume, unweights the breast and better shapes the breast content around an elevated nipple complex. This is a simple mastopexy. (small breast reduction)
MAINTAINING BREAST SIZE
In those who want to retain their breast volume (i.e. happy with size in a bra – but not happy with form out of a bra!) we can sometimes offer a mastopexy (breast lift) with an auto-augmentation. This is a somewhat more complex version of the above procedure.
In that the tissue of the lower pole is not resected, but rather “recycled”, fashioned in to a pedicled flap (tissue with its own blood supply), and then used to tuck up high on the chest wall towards the cleavage area and sutured in to place. The rest of the procedure is then done as per the usual vertical mastopexy, closing the 2 pillars over the elevated flap. I find this a useful technique in selected patients who want to retain volume, and have sufficient lower pole breast volume to augment the upper pole.