There are three basic types of breast lifts (mastopexy surgeries) that most cosmetic surgeons use to raise breast tissue, reposition the nipple, and reshape the areola. The main criteria for selecting the correct approach for a specific patient is the degree of lifting desired. If you only want your nipples raised by less than an inch, you can choose a procedure that causes less scarring than one that raises the nipples a full two to three inches. The looseness of your skin and the amount of breast tissue (glandular and fatty tissue) inside the breast skin are factors that affect your degree of ptosis (drooping).
Periareolar/Circumareolar Breast Lifts
Both of these breast lifts are done solely through an incision around the areola (the darker pink or brown skin around the nipple). With a periareolar or crescent lift, the incision only goes partway around the upper edge of the areola and a small amount of skin is removed. This allows the nipple and areola to be repositioned slightly higher. It is the least invasive breast lift procedure but is not intended to produce dramatic lifting results. Some patients will return for a more extensive lift if they still want more lifting.
With a circumareolar, or “donut,” breast lift, the incision is made all the way around the areola. A donut-shaped area of skin is removed from the breast around the nipple. The edges are then drawn in toward the areola (like a purse string) and sutured in place. This technique allows the surgeon to provide a modest amount of lifting and also provides an opportunity to reshape or resize the entire areola if that is what the patient wants. A circumareolar incision permits the placement of a breast implant. Since the incision is not large, a malleable saline implant is typically used. A patient with smaller breasts might be a candidate for a breast implant with this type of breast lift since there may not be sufficient natural breast tissue to create her desired breast shape and size.
Vertical Breast Lifts
This “lollipop” breast lift combines a circumareolar incision with a vertical incision down the underside of the breast to the breast crease. Women who have larger breasts with some sagging from skin laxity are the usual candidates for this procedure. Unwanted skin is removed from both sides of the vertical incision. This technique reduces drooping by creating a tighter “pocket” of skin to hold the existing breast tissue. The result is a breast that appears more youthful with a rounded cone shape rather than an elongated shape. The circular incision is used to move the nipple complex upward so it is positioned properly on the newly-reshaped breast mound.
Traditional Breast Lifts
An anchor or inverted-T breast mastopexy combines the lollipop incision described in the vertical breast lift with a crescent-shaped incision along the width of the breast crease where the breast meets the ribcage. This is the most extensive mastopexy surgery and is usually reserved for patients with advanced ptosis. It may be performed in combination with a breast reduction for women with very large breasts. For women with small breasts that have very pronounced drooping, either a saline or silicone implant can be readily placed through the anchor incision. Because of the placement of the incisions, the surgeon can remove more excess skin and reshape the breast dramatically. There is more extensive scarring with this technique and healing may take longer.
Can I Choose a Breast Lift with a Scar in the Armpit?
Patients sometimes ask this question because of confusion about what’s involved in different types of breast lifts. Plastic surgeons do not perform breast lifts through the armpit since the “lift” is not achieved by raising the position of the pectoral muscle in any way. Instead, the lifting effect is created by removing excess skin and breast tissue and repositioning the nipple and areola. There is no way to do this without making excisions in the breast itself. It might be more accurate to call a mastopexy a breast reshaping procedure rather than breast lift. Patients who have lost volume that makes their breasts look deflated may see a slight lifting effect from receiving implants (which can be placed through the armpit). However, those that have actual breast drooping from skin laxity and excess tissue will still need a regular breast lift to bring the nipple into the desired position on the newly-augmented breast mound.