Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance Chen Offers Practical Tips About Breast Lifts

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Mastopexy: What to Know About Breast Lifts

Dr. Constance Chen

Surgical techniques are continually evolving to improve the safety and reliability of procedures used to reconstruct or restore the body for women who want to look and feel more comfortable in their skin.

A woman's breasts are often changed by age and gravity. As she grows older, it is natural for skin to lose elasticity and for her breasts to drop. The most significant contributing factor is breastfeeding, but even women who have never lactated will often find their skin stretching and their breasts drooping. With menopause, dense glandular breast tissue is replaced by fat, and fatty tissue is more prone to sagging. “If a woman is bothered by dropping breasts, there is only so much she can do without surgery,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen. “A properly fitted bra can provide support in clothes. Exercises that firm up the underlying chest muscles don’t really affect the breast tissue itself, which is on top of the chest. Ultimately, a woman who wants perkier breasts may end up visiting a plastic surgeon to discuss her options for a breast lift.”

A breast lift (or “mastopexy”) removes excess skin to tighten the breast envelope and repositions the breast tissue and the nipple-areola complex higher on the chest wall. A mastopexy should not significantly change the size of the breasts even though it may make breasts appear fuller and rounder. Women who want their breasts larger or smaller may opt for augmentation or reduction in conjunction with a breast lift. “The best way to determine if breast surgery is right for you is to consult with a plastic surgeon,” says Dr. Chen.

Women who seek a mastopexy often have nipples that point downward, particularly if they sit lower than the crease below the breasts. The tissue may have fallen to the bottom of the breast while the top of the breast appears flat and empty. There are several different mastopexy procedures depending on the degree of lift needed:

A “crescent lift,” the least invasive procedure, removes a crescent of skin at the top of the nipple-areola complex to improve the position of the nipple. It is performed when the breasts are basically perky but the woman wants her nipple-areola complex adjusted upwards slightly. For women who also want bigger breasts, this can also be performed in conjunction with breast augmentation.

A “Benelli lift” is used to provide a very mild lift on barely drooping breasts. A doughnut-shaped incision is made around the nipple-areola complex, and the skin is tightened. This lift is less invasive than a full lift but tends to flatten the breast. An implant can be used to improve breast projection.

A “lollipop lift” or a vertical mastopexy refers to the resulting scars around the nipple-areola complex and then vertically to the fold below the breast when more breast skin is resected and the underlying breast tissue is repositioned to significantly change the breast shape and lift it up. It is used when the breast tissue itself needs to be positioned higher on the chest wall.

An “anchor lift” or the traditional Wise-pattern mastopexy adds a horizontal scar along the crease below the breast to the same scars of the vertical mastopexy to allow for reshaping and repositioning the tissue. It is used when there is significant sagging.

Both the vertical and the Wise-pattern mastopexies are considered full breast lifts. The vertical mastopexy is also called the “short-scar mastopexy” because it eliminates the horizontal scar in the inframammary fold, and it was developed as an improvement on the anchor lift that is still widely used, especially among older surgeons. Full mastopexies are the most commonly performed lifts and the most effective in creating a more youthful contour.

Breast lifts are typically performed on an out-patient basis. Patients should start walking as soon as possible after surgery, and may have drains for 1-2 weeks. Most women can return to work after a couple of weeks, and feel relatively normal four to six weeks later. Heavy lifting should be avoided, but unrestricted activity can usually be resumed after six to eight weeks. Final results take months or even years to evolve. In order to minimize the risk of wound healing problems and infection, candidates should be in good physical health, non-smokers, and have a BMI less than 30.

Every year, many thousands of women undergo surgery to change the size and/or shape of their breasts. “Surgical techniques are continually evolving to improve the safety and reliability of procedures used to reconstruct or restore the body for women who want to look and feel more comfortable in their skin,” says Dr. Chen. “In a perpetually changing world, women may seek to improve both their physical and emotional well-being so they can feel more in control of their lives.”

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and aesthetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

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