1. What is a breast lift?
A breast lift (mastopexy) is a surgical procedure where the entire breast or the nipple/areola complex or both are elevated to a higher, more youthful position on the chest. It is done for patients who have sagging (ptosis) of their breasts, particularly after nursing or weight loss.
2. Are all breast lifts the same?
No. There are a variety of different breast lifts; which one is right for you depends on how much sagging you have and how much of a lift you want. In a standard breast lift, a considerable amount of skin is removed from the lower portion of the breasts while the areola around the nipple is made smaller. The nipple and areola are then moved to a higher position on the breast. Skin from the upper breast is then moved to the lower pole of the breast to provide support. The final scars run around the areola, in a line straight down from the areola to the crease under the breast, and along the crease. Although it appears that the nipple and areola have been completely removed, they have actually been left attached to the breast tissue underneath.
3. Are there breast lifts that create less scarring?
Yes. For patients that need less of a lift, a smaller procedure can be done that eliminates some of the scarring. A minimal lift can be done where a small crescent of skin is removed from just above the areola. This elevates just the nipple and areola two centimeters or less. I call this a “superior areolar mastopexy.”
A somewhat larger lift is done by removing a doughnut of skin from around the areola. This leaves a scar around the edge of the areola only and provides some elevation of the breast as well. This is known as a “doughnut, periareolar or Binelli mastopexy.”
The next larger lift incorporates the doughnut mastopexy with removing some skin from below the areola in cases where there is too much skin for just a doughnut lift. This leaves a scar around the edge of the areola and one extending from the bottom of the areola towards the crease. This is known as a “VOQ mastopexy.”
4. Can a breast lift be done at the same time as putting in breast implants?
Yes. Breast implants are commonly put in at the same time as performing a breast lift. However, combining the two procedures may limit the size of implant that can be put in. Some of the risks are also higher, such as asymmetry, implant malposition and implant infection or extrusion.
5. Do breast implants alone lift the breast?
For the most part, breast implants provide very little, if any, elevation of the breast. Breast implants make the breasts larger. The larger a breast is, by nature, the more it tends to sag. So, implants tend to make the sagging that is present more appropriate for the size of the breast. Unfortunately, surgeons have been taught for years that placing a breast implant on top of the muscle will help to correct sagging. A breast implant placed on top of the muscle not only makes the breast larger, but also makes it heavier. Over time, this will only result in more sagging of the breast, worsening the condition. There are many advantages of placing breast implants under the pectoralis muscle, with very few disadvantages. For this reason, I feel that breast implants should only be placed under the muscle. Sagging of the breasts is not an indication for putting implants on top of the pectoralis muscle. If you need a lift, get a lift.
6. Is there a risk of losing sensation to the nipple with a breast lift?
There is very little risk of losing sensation to the nipple area with a breast lift. It is more common with breast augmentation. Although much of the skin on the lower aspect of the breast may lose sensation for a few months, it generally comes back to normal.
7. Is there much pain with a breast lift?
No. There is generally very little pain with a breast lift. Most patients take the pain medication just a few times and some take only over the counter medications such as acetaminophen.
8. Does my breast size change much with a breast lift?
Since only a thin layer of skin is generally removed with a breast lift, the size of the breast changes very little, if at all, with a breast lift.
9. My breasts are different in size. Can that be corrected with a breast lift?
Some breast tissue can be removed from the larger breast at the time of a lift in an effort to improve symmetry.
10. How soon after pregnancy can I have a breast lift?
You should wait until your breasts have recovered from pregnancy and breast feeding before having a breast lift. For most women, that time period is at least two to three months.
11. Will having a breast lift make it more difficult to detect breast cancer on a mammogram?
Although the image of the breast on a mammogram will change after having a breast lift, it does not make it more difficult to detect breast cancer.
12. Should I have a mammogram prior to having a breast lift?
If you are at or near the age where yearly mammograms are recommended, you should have one done prior to having breast surgery. If you have no family history of breast cancer, you should start having yearly mammograms at about age 40. Those with a family history should begin by the age of 35.
13. Can I have another procedure done at the same time as having a breast lift?
It is very common to combine breast lift surgery with other procedures such as breast augmentation, liposuction, a tummy tuck or cosmetic facial surgery. By combining procedures, there is usually a significant cost savings.
14. I had a breast lift done previously but now I have lost a lot of weight and I am sagging again, is it possible to have another breast lift?
Yes, it is entirely possible to have more than one breast lift.
15. I have had breast implants for a long time and I want to have them removed and get a lift, can this be done at the same time and is it risky?
It can be difficult to determine how much of a lift needs to be done when implants are being removed at the same time. Therefore, for patients who have saline implants, I prefer to deflate them in my office several weeks prior to the lift. This gives the skin a chance to retract without the weight of the implants and gives me a better idea how much of a lift needs to be done.
For patients who have had their implants placed on top of the muscle, a significant amount of the blood supply to the nipple and areola has been removed. More of the blood supply is removed at the time of doing a breast lift. If too much blood supply is lost, this can result in death of and complete loss of the nipple and areola. In this situation, I generally recommend removing the implants first, let the breasts recover and perform the lift at a separate time. In many patients, the implants can be removed in my office under local anesthesia.
16. Who is qualified to perform a breast lift?
True plastic surgeons are the only physicians who learn cosmetic surgery as part of their required surgical training. There are many untrained surgeons and actually many physicians who aren’t even surgeons trying to perform plastic surgical procedures. This can be very dangerous! Most of them only do the procedures in their office or their own surgical suite because they are not trained to perform the procedure and, therefore, cannot be credentialed to perform the operation at a hospital or legitimate surgical center. In these offices is where most of the serious complications occur. Neither the internet nor the telephone book care about your safety, the truth, adequate training or credentials. If you’re going to spend money on plastic surgery, don’t take unnecessary chances. At least make sure that your surgeon is trained and experienced in plastic surgery and is not just dabbling in something in which they have no expertise. Dermatologists are medical doctors, not surgeons! They are not trained to perform plastic surgery and have no business doing so.
When selecting a surgeon, at least make sure that he or she has had adequate training. Your surgeon should be certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. You can contact the American Board of Plastic Surgery at (215) 587-9322. Another way to find out if your surgeon is trained is to see if your surgeon is a member of the American Society of Plastic Surgeons, Inc. (ASPS). Visit their website at www.plasticsurgery.org or call 1-888-4PLASTIC. All members of the ASPS are certified by the American Board of Plastic Surgery.
I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. Their web site is www.surgery.org and phone number is 1-888-ASAPS11.
Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about letting an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office. And forget the consultation fee. They don’t deserve to be paid for trying to deceive you.
Do you have a question that hasn’t been answered? Please email me at [email protected] and I will respond as soon as I can and may add it to my list of FAQ’s.
The answers to the above questions are my personal opinions based on years of legitimate general surgery and plastic surgery training and extensive experience in plastic surgery private practice. They are intended to give you, the patient, as much knowledge as possible in making your decision about plastic surgery and who performs that surgery. They are not intended to be derogatory or demeaning towards any individual physician or group of physicians. I firmly believe that physicians should only practice within their field of training and expertise, except in life-saving, emergency situations.
James D. McMahan, M.D., F.A.C.S.