Mastopexy - Breast Lift

Mastopexy - breast lifting procedure - breast lift - characteristics

Due to the increasing popularity of plastic surgery procedures, treatments that improve the appearance of the bust are enjoying unflagging interest. Patients report not only for reconstructive purposes, e.g. after oncological procedures, but also for purely aesthetic reasons, which is not surprising - breasts are perceived as one of the main attributes of femininity.
The female breast gland is made of both adipose and glandular tissues in various proportions. These proportions change with age, and such reconstruction is one of the factors of the loss of firmness in the bust. The breasts lose their volume and firmness due to the loss of elasticity of the collagen fibres of the skin (we observe "excess" of the skin in relation to the volume of the gland) and become sagging. In the case of large breasts, it will be more visible in time than in those patients whose nature has not been so generous. Such an undesirable appearance is also caused by fast weight loss, where along with the loss of adipose tissue from the breast, there is no simultaneous shrinking of the skin over the gland. Breastfeeding is also unfavourable to the breast structure - it loses its fill and the skin tensions.
With the help of patients who are not satisfied with how their breasts have changed, a procedure called mastopexy comes, colloquially, a breast lift, or raising it. Simultaneously with the mastopexy procedure, a slight correction of the position and size of the nipples can be performed, as well as the reduction or enlargement of the breast with the help of the implant (augmentation).

Mastopexy - breast lift treatment - breast lift - benefits

The unquestionable benefit of breast lifting surgery should be considered:
• restoration of the natural, youthful appearance of the bust with immediate effect
• improvement of contour, elevation and shape of the breast gland
• improving the shape of nipples
• raising the patient's self-esteem
• possibility of simultaneous volume plasticity of the breast using an implant, with prior consultation regarding the final expectations
• quick return to normal life activity

Indications for the procedure

Indications for the procedure
Bust lifting is performed after consultation with the doctor conducting at the request of the patient who is not satisfied with the appearance of her breasts, loss of their volume and firmness due to:
• rapid weight reduction and associated excess skin on the chest
• breast flaccidity resulting from long breastfeeding
• the natural aging process of the body
Submission to such treatment significantly improves the patient's self-esteem and its functioning in society and partner relations.

Contraindications for the procedure

• unrealistic expectations of the patient regarding the effect of the procedure
• disorders of connective tissue production, keloid
• severe general condition of the patient
• active infection within the operated tissues
• active breast enlargement process
• poorly controlled diabetes (high blood glucose levels hinder wound healing)
• previous hypersensitivity events associated with the administration of general anaesthesia (narcosis)
• blood coagulation disorders
• pregnancy and breast-feeding

Before the surgery

Each time before the surgery a medical consultation takes place, at which the patient's expectations regarding the final effect are discussed, as well as any contraindications considered. A complete set of basic examinations should be provided for such a consultation, such as: leaf morphology, ECG, glycemia (or glycosylated haemoglobin level), coagulation system, HIV, Hbs, HCV, breast ultrasonography, and sometimes chest X-ray. Usually, the clinic of aesthetic surgery performing a breast lifting procedure ensures that such a set of examinations is also performed.
One should be prepared for the fact that after an independent breast lifting procedure (without the correction of breast size with an implant), the final size of the bra cup will be about one size smaller than before the procedure. However, it is possible to implant a gel implant in parallel to enlarge the breast.
The procedure should be done on an empty stomach, limiting one month before smoking cigarettes and alcohol consumption, as well as discontinuing anticoagulants (e.g. aspirin).

Type of anaesthetic

Anaesthesia for any surgical procedure obviously depends on the extent of the planned surgery, but may be:
• general - pain, reflexes and consciousness are eliminated during this type of anaesthesia
the patient. General premedication requires proper premedication - administration
substances that will reduce anxiety and fear of surgery, suppress secretion
saliva and bronchial content, cause retrograde amnesia, and also enable
reduction of doses required for proper anaesthesia.
• wired - anaesthesia is given to interrupt the conduction in the sensory nerves, the patient has abolished pain and reflexes but is aware of the course of the operation
• local - when an anaesthetic is used to justify the operated area
Breast lift treatment is performed under general anaesthesia. General anaesthesia is considered to be a safe procedure for the majority of patients and used for a wide range of surgical procedures, however there are certain risk groups that are more likely to have intraoperative complications - such as obese people with coagulation disorders, poorly controlled diabetes, breathing disorders, hypertension.
However, these are rarely complications related directly to anaesthesia (unless there have been no adverse reactions after administration of anaesthesia), but rather to the patient's own health condition. The risk of subjecting the patient to general anaesthesia, of course, is to be evaluated by the attending physician and anaesthesiologist.

How is the procedure performed?

Bust lifting procedure is carried out after the patient is under general anaesthesia - it should be remembered that under general anaesthesia the patient intubates, so please inform your doctor if you have a removable denture.
In general, the procedure consists of removing the excess flaccid skin and subsequent transposition of the nipple to the appropriate height, or the shape of the nipple can be changed (reduce it if it has also been excessively stretched). The skin can be cut in three ways: around the nipple, a vertical cut from the nipple down to the breast fold and the oblique incision, from the nipple to the outer lower breast quadrant. Then the breast is properly formed, and the wart is transferred as necessary to the right place.

Time and course of convalescence

Usually, patients undergo surgery at the plastic surgery clinic one day for observation. Patients start up so early because prolonged hospitalization increases the risk of thromboembolic complications. Sutures are sutured between 7 and 10 days after surgery in outpatient settings. For a few days after the procedure, a slight swelling may persist, gentle breast massage is recommended to reduce it. Bruises disappear after about two weeks of surgery. For about two months after the procedure, you should wear appropriate, cotton and seamless bras, preferably sports - without underwire. For unproductive daily activities, the patient may return after a few days, to light sports activities - not earlier than a month after the surgery.

Effects after surgery

The best results are observed in patients with initially small breasts. After this treatment the bust is lifted up, the nipples are at the right height and the breasts gain proper firmness. Due to the nature of the procedure and the removal of excess skin, patients after the procedure usually wear a bra with a bowl smaller than before the procedure. There remains a small scar after cutting, different shape, depending on the chosen surgical method.

Recommendations after the procedure

After breast lift surgery, the seams should be removed between 7 and 10 days after the procedure. Good hygiene of the wound should be maintained - do not be afraid of bathing, you just need to remember to properly dry your breasts and spray the wound with a topical decontamination type Octenisept, and then put on a sterile dressing. Do not use any ointment for an unhealed wound, after it has been healed but you can try to reduce the visibility of the scar using ointments stimulating the production of collagen - e.g. Contractubex or ointment from onions. If during the healing the patient observes redness, excessive warming or long-lasting swelling, immediately report this fact to the treating physician in order to avoid a widespread infection of the post-operative wound. You must also tell your doctor immediately if systemic symptoms appear - fever, chills, worsening of well-being. Underwear worn for a few months after the procedure should be thin, airy - preferably cotton, without seams and whalebone. Excessive motor activity should be limited to about a month after the procedure.

How long do the effects last after the treatment last?

The effect after lifting the bust, unfortunately, is not permanent. It is difficult to predict how long the desired shape and lifting of the breast will last, as each patient ages at an individual rate, and each subsequent approach to breastfeeding brings you closer to the initial situation before surgery. However, using appropriate habits, such as smoking cessation (smoking causes a loss of elasticity of collagen fibres), wearing properly suited to the weight and shape of underwear, or applying moisturizing and firming creams will allow you to enjoy the effect of treatment as long as possible.

How to avoid complications after the procedure?

Complications after having a breast lift are extremely rare, but as with any surgical intervention, they can of course occur. In order to avoid complications after breast lifting, it is worth giving up smoking and drinking alcohol at least a month before the surgery, as this makes it difficult to heal the post-operative wound. Gently massage the bust swollen shortly after the procedure, as well as maintain the hygiene of the wound and adhere to all medical recommendations regarding the time of return to specific activities. In order for the bust to not become distorted, you need to wear a properly selected sports bra. Individual recommendations are always agreed with the attending physician at the discharge from the clinic.
Please inform your doctor beforehand about possible allergic reactions to medicines used during general anaesthesia.

Possible complications after the procedure

After mastopexy - admittedly rarely, there may be various types of side effects, such as:
• nipple asymmetry
• necrosis of the skin and fatty tissue of the breast gland
• slight or permanent sensation in the nipple due to partial or complete denervation
• creation of visible, haughty scar after cutting
• the formation of microcalcification in the breast, which in later mammography may be confused with calcification seen in breast cancer and raise anxiety oncology
• complications directly related to the conduct of a medical procedure under general anesthesia

Recommended additional treatments after the procedure

If the patient so wishes, can simultaneously with mastopexy perform breast enlargement with an implant or reduce breast volume. Breast augmentation involves the implantation of a simple implant with a silicone gel for the larger pectoralis muscle - a procedure commonly used in plastic surgery. However, if the patient does not want to decide on such a large and expensive procedure, one may consider additional breast lift with PDO threads, creating a kind of net inside the gland and helping to maintain firmness. If the scar after surgery is long visible and extensive, laser removal of such a scar can be considered.

Author: Wiktoria Feret, MD
Literature:
Peter C. Neligan, Six Volume Plastic Surgery, vol. 2 Aesthetic, Elsevier, ed. III, 2012
Grabb & Smith Plastic Surgery, Charles H. Thorne, ed. Lippincott Williams and Wilkins 2013
Mastopexy for breast ptosis: Utility outcomes of population preferences, Ibrahim AM, Sinno HH, Plast Surg (Oakv). 2015 Summer; 23 (2): 103-7.

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