Breast lift (Mastopexy)

Generally speaking, this procedure involves reshaping the breast by means of the removal of excess skin without altering the breast size. Breasts can lose shape and firmness due to loss of skin elasticity, gravity, pregnancy, breastfeeding or weight loss. For women who are happy with the size of their breasts, the breasts can be lifted and a more youthful shape restored by a breast lift. Some women, however, might also want to increase the size of their breasts, in which case a lift can be combined with breast augmentation to create the desired size and shape of the breast (augmentation mastopexy).

There are various causes for the loss of elasticity and drooping of breasts (mastoptosis) and may be partly hereditary.
In some cases, the breasts have developed asymmetrically, so that one breast is firm and has a normal shape while the other sags and is malformed (breast asymmetry). The cause may be a malformation of the breast during development, resulting in tubular-shaped breasts (tuberous breast).
Many women who previously had normal breasts suffer from a loss of volume (involution atrophy) and elasticity after pregnancy and breastfeeding and would like to regain firmer breasts or recover their former breast size and shape. The natural aging process, or weight loss can lead to similar changes in the breast.
While sagging breasts do not usually lead to physical discomfort, they can however, cause significant psychological problems and reduced self-esteem and thus adversely affect the personal and professional lives and sexuality. In such cases a feeling wellbeing and self-esteem can be improved by a breast lift.
A breast lift can be performed at any age, but it is recommended to wait until breast growth is complete. Pregnancy and breastfeeding can have an unpredictable effect on breast size and shape, thus it is advisable to wait until after childbirth and breastfeeding before surgery is performed. It is important to note that in many cases breast surgery does not hinder the ability to breastfeed your baby. A further lift can also be performed if your breasts need lifting and tightening after pregnancy and childbirth.

Considerations

When to consider Mastopexy:

  • Your breasts sag, but are the correct size.
  • Your breasts have lost volume or firmness, e.g. after pregnancy.
  • Your breasts have shrunken and lost elasticity after weight loss.
  • If your breasts droop and you have lost a substantial amount of volume, then in addition to reshaping the breasts, an enlargement can also be performed (augmentation mastopexy) to achieve an optimum result.

Consultation

A prerequisite to a successful operation is careful planning. This starts with a personal consultation at the AARE KLINIK.

  • Communication of wishes and expectations ascertain what you would like to improve.
  • Explanation of the possibilities and scope of the operation.

 

Examination:

  • Medical history is taken.
  • Physical examination is performed.
  • Digital photos are taken.
  • Desired breast size and shape are discussed, as well as the position and size of the nipples.
  • Pre-existing asymmetry in the breasts or chest, skin quality and existing scars are examined.
  • Individual factors and personal wishes help in jointly deciding the right breast size and choice of appropriate surgical technique, the position of incisions and resulting scars.
  • Based on this, an individual treatment plan is drawn up and goals of the operation are discussed and defined.
  • Risks and possible complications are discussed and documented.

 

To plan the operation and to make a risk assessment we require:

  • Full medical history (pre-existing conditions and previous surgery).
  • Current diseases (high blood pressure, diabetes, thyroid dysfunction).
  • Allergies or aversion to medications.
  • Any important medical reports.
  • Please bring any important medical information (in particular anything relating to your breasts, e.g. mammography) along to the consultation and inform the surgeon if you have a history of breast cancer in your family.
  • If you are planning to lose a significant amount of weight or to get pregnant, this should be considered when planning a breast lift as the size of your breasts can alter unpredictably through weight fluctuation, pregnancy or breastfeeding.
  • It may be advisable to wait for the stabilisation of your weight or until after pregnancy/breast feeding before surgery is undertaken.
  • Depending on your age, personal and familial risk factors, it may be advisable to have a breast ultrasound (sonography), mammography or MRI (magnetic resonance imaging) before having a breast lift.

Procedure

Every breast lift involves removing varying amounts of skin, fat and glandular tissue from the lower areas of the breast. The nipple is raised and the areola is reduced in proportion to the new breast size. The nipple remains connected with the glandular tissue and both are lifted upward. The remaining connection to the glandular tissue allows the preservation of the blood circulation and feeling in the nipple. Excess skin is removed to improve the breast shape. In many cases the ability to breastfeed is retained after a breast lift, but in individual cases can’t be guaranteed.

Although there are a variety of different surgical techniques for reducing the size of a woman’s breasts, they cannot all be listed here. The most visible distinguishing difference for the patient is the position of the incisions and the shape of the resulting scars. Breast lifting surgery can be divided into 4 groups:

 

Breast lift with T-shaped scar

  • The most common form of breast lift.
  • Involves three incisions: a circular incision around the areola, a perpendicular one running from the underside of the areola to the fold under the breast (inframammary fold), and one that follows the fold to the inner and outer aspect of the breast.
  • This technique is particularly suitable for larger breasts or for those with a great amount of excess skin.

 

Breast lift with L or J-shaped scar

  • The incision is similar to the T-shaped scar.
  • However, the vertical incision is extended in one direction of the inframammary fold only, mostly extended outwardly.
  • Less skin can be removed, which is why the technique is mainly used in medium and smaller-sized breasts with a moderate excess of skin.

 

Breast lift with I-shaped (vertical) scar

  • This technique has no incision in the inframammary fold.
  • There remains an excess of skin above the fold on the lower aspect of the breast, which has to regress spontaneously.
  • This technique is only used in women with elastic skin and predominantly for medium-sized breasts with a moderate excess of skin.

 

Breast lift with O-shaped (periareolar) scar

  • The incision is limited to the outer circumference of the areola.
  • This technique does not have a vertical incision between the areola and submammary fold nor a transverse incision in the fold and is the shortest scar possible in breast reduction.
  • Because only limited skin can be removed through this technique, it is mainly used in breast lifts where only a small amount of tightening is necessary.
  • If breasts are not only reshaped, but also increased in size, then the insertion of breast implants or the injection of fat is required. Further information on these topic are found under the headings “breast augmentation with implants” and “breast augmentation with fat”.

Breast reductions are mostly performed under general anaesthesia as an outpatient procedures or with an over-night stay at the AARE KLINIK or as part of a short hospital stay. The surgery usually takes 2-3 hours. Drains are frequently inserted to evacuate blood and fluid from the wounds after surgery. These are removed after a few days.

Risks

Breast lifts are among the most common surgeries performed by plastic surgeons. Complications, such as infection, healing problems or circulation disorders of the breast tissue (e.g. loss of nipple) are rare when the procedure is conducted with the proper technique and care. However, in individual cases a longer treatment or another operation may be required. Every patient should be informed of all the benefits, risks and possible complications involved.

The lighter complications that usually heal without consequences include bruising (hematoma), wound fluid accumulation (seroma) and swelling. Severe bruising can make surgical removal necessary. Numbness of the breast skin and nipples are uncommon, but are usually only temporary if they do occur.

General risks

  • Haematoma (bruising), bleeding and swelling
  • Seroma (accumulation of wound fluid)
  • Healing problems or infection
  • Wound breakdown/dehiscence (separation of wound edges)
  • Injury of nerves or vessels
  • Numbness in area of operation (temporary or permanent)
  • Circulatory problem of breast skin or nipple (skin slough)
  • Scars
  • Slight asymmetry
  • Unsatisfactory aesthetic result
  • Secondary surgery
  • Thrombosis or embolism

Overall a breast lift is a safe procedure when undertaken by an experienced plastic surgeon and patients are mostly satisfied with the results. You can help to minimise the risks by following the advice of your surgeon.

Preparation

Our aim is to make the time before and after your surgery as comfortable as possible. By following a few recommendations you can support our care:

  • To aid the healing process, avoid smoking for two weeks before and after the operation.
  • Avoid medication that increases the risk of bleeding, like aspirin, non-steroidal anti-inflammatory drugs, as well as vitamins and homeopathic remedies for two weeks prior to the operation.
  • Depending on your age and additional risk factors, a mammography (breast x-ray), sonography (ultrasound) or MRI (magnetic resonance imaging) is sometimes recommended before a breast lift and possibly a few months after the procedure.
  • This can be helpful to detect abnormal breast tissue before (that can be removed during the operation) and after the operation.
  • A breast lift will not increase the risk of developing breast cancer.
  • Even after a breast lift, mammography, sonography or MRI can be undertaken.
  • Breast lifts are mostly performed as an outpatient procedure under general anaesthesia.
  • Make sure that you can be collected and cared for by someone for 24 hours after the procedure.
  • In some cases it may be recommended to stay overnight as an inpatient in hospital.

Day of surgery

In most cases, breast lift surgery is performed under general anaesthesia as an outpatient procedure or with an over-night stay at the AARE KLINIK. In individual cases, when necessary, the procedure can be undertaken in an affiliated private hospital.

  • During surgery you will receive various medications for your wellbeing.
  • Usually breast lifts are performed under general anaesthesia.
  • For your safety, your heart rate, blood pressure, oxygen supply etc. are monitored during the operation.
  • At the end of surgery, drains are usually inserted to prevent the accumulation of blood and serous fluid in the wound.
  • After surgery, the wound is dressed and a special compression bra is applied
  • You will be taken to the recovery room, where you will have continued monitoring until you awaken and are able to get up.
  • You will be allowed to return home after a few hours.
  • If you are an inpatient, you will remain in the recovery ward under surveillance until the following day.
  • Already on the day of the surgery you should get up regularly for a few minutes in order to minimise the risk of thrombosis.
  • The level of pain after a breast lift is not severe and can be compared with muscular pain.
  • You are advised to take mild pain relief that reduces swelling and should be continued for several days after surgery.
  • In case of an ambulatory procedure, you should have someone to care for you continuously for 24 hours postoperative.
  • We also provide the option of an over-night inpatient stay at the AARE KLINIK in a single room with a personal nurse care, if needed.

After surgery

  • It is important to realise that recovery from an operation varies for every individual.
  • In the first days after the breast lift, you should rest. Do not raise your arms above shoulder height, and do not lift heavy objects.
  • As a rule, you need to sleep on your back for a few days.
  • Only take the prescribed painkillers and avoid any medication that contains aspirin or other blood-thinning substances.
  • Wear the special compression bra and adjust it continuously over a total period of 4–6 weeks as per our recommendations.
  • Physically demanding and sporting activities should be avoided for several weeks.
  • In the first 2–5 days after the procedure, a feeling of tension and light pain will be felt in the region of the surgery.
  • Breast skin and nipples may feel numb or hypersensitive in the beginning. This is usually temporary.
  • However, it may take weeks or months, in some cases even longer until sensation returns to normal.
  • Slight swelling and bruising in the area of the breast usually subsides within 2–3 weeks.
  • Typically you will be back on your feet a couple of days after surgery and be able to resume your daily activities.
  • Drains are removed in the first days after the operation, after which you can take showers again.
  • Full baths and excessive heat (e.g. sauna), however should be avoided for several weeks until swelling has receded.
  • Most stitches will dissolve by themselves and do not need to be removed.
  • Non-dissolvable stitches are removed after one week.
  • You will probably be able to start work again one week after surgery depending on the kind of breast reduction and the kind of activities required in your job.
  • After removal of the sutures, we recommend the start of an intensive skin and scar care with rehydrating creams and light massage.
  • In individual cases it may be useful to have special treatment with silicone gel or silicone pads over a period of 2–3 months.
  • The fresh scars should be protected from UV radiation for at least six months, in order to prevent increased pigmentation.
  • After surgery you will be examined at the AARE KLINIK at regular intervals, so that the healing process can be assessed until the final result is achieved.

Outcome

  • Your breasts may be swollen for some time after surgery. It may take several weeks until they have assumed their normal shape.
  • The healing process is gradual and it takes several months before the operation result can be conclusively determined.
  • Scars might be a bit red for several months or appear pigmented, but this will fade with time until the scars and are barely visible.
  • Scars are easy to conceal, even when wearing revealing clothing.
  • A breast lift raises and firms the breasts and gives them an improved shape.
  • The position of the nipples is improved through surgery and is adapted to the shape and size of the breast.
  • The result of a breast lift is usually long lasting. However, gravity and the aging process continue to affect the breasts of every woman, gradually changing their shape and size over time.
  • Weight fluctuations, pregnancy and lifestyle can also affect the outcome.
  • If you are unhappy with the shape of your breasts after a few years, another breast lift can be performed.

Costs

A breast lift is generally a purely aesthetic procedure and therefore the patient, herself, has to carry the costs.

The costs of an aesthetically motivated breast lift are variable and mainly depend on the complexity of the operation and the facility in which the surgery is performed (hospital or AARE KLINIK). A more accurate cost estimate can therefore be made only after a personal consultation.

The costs are composed of:

  • Surgical fee (including consultation and post-operative care)
  • Anaesthesia fee
  • Technical infrastructure costs (AARE KLINIK/hospital)
  • Inpatient hospital costs
  • Compression bra
  • Medication
  • Diagnostics (laboratory, ECG, scans, etc.)

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