Breast Uplift (Mastopexy)

The Operation: What Happens during Surgery?

The operation is carried out usually under general anesthetic, but can be performed under local anesthetic and sedation.  It lasts between 1.5 – 3.5 hours, though possibly longer (up to five hours).  It requires a one- or possibly two-day stay in hospital depending on the extent of the operation.  It may be possible to return to your accommodation within the day if you had local anesthetic. 

There are various surgical techniques employed in breast uplift surgery and the route your operation takes depends on the degree of sagging (ptosis), and the nipple and areola position to be corrected.  It is possible that slight ptosis can be corrected by breast augmentation surgery instead.

In brief, mild ptosis involves only concentric incisions around the areola while more advanced ptosis requires vertical incisions in addition, and possibly another incision below the breast crease.  The most common procedure requires the so-called ‘anchor-shaped’ incision which starts around the areola, then goes down vertically to the breast crease and finally horizontally under the breast crease.  Here, we explain the two common surgical options open to you:

Concentric Mastopexy

This is commonly known as ‘doughnut’ mastopexy as it requires concentric circular incisions around the areola.  This technique is used on women with smaller breasts with less developed ptosis.  It requires fewer incisions and is a less complex procedure which can be carried out under local anesthesia.

During surgery, a circular piece of skin is removed from around the areola, the areola and nipple are then repositioned upwards and the outer skin sutured into place.  Sometimes, the surgeon may also remove a vertical strip of skin from the areola down to the breast crease if there excess skin which might lead to a puckering in the scar tissue.  Concentric mastopexy might then require a vertical incision, but this will be determined usually during the operation.  You are advised to be aware of this and to ask if it might be required in your case.  In any event, concentric mastopexy still results in less scarring than with anchor-shaped mastopexy.

Anchor-shaped Mastopexy

As its name suggests, this procedure requires incisions that form an anchor shape.  It is used to correct more severe ptosis and is more commonly carried out on women with larger breasts. 

The surgery requires a keyhole shape incision around the areola and nipple, then two vertical incisions to the breast crease.  A further incision is placed at the ‘bottom of the anchor’ running right to left under the breast crease. 

Excess skin and tissue are removed from the upper anchor area, and the nipple and areola repositioned towards the lower part of the anchor.  The keyhole, vertical and horizontal incisions are sutured. A new lower fold for the breast crease is formed at the lower anchor incision mark.  

Recovery / Convalescence

What to expect immediately

Your chest will feel some pain, though this should not be severe, as well as be swollen and bruised for up to two to three weeks.  Following surgery, you will have a light surgical bra or support over the gauze dressings.  This will be replaced within a few days, with a soft support bra, which you will need to wear 24/7 for up to three to four weeks.  Stitches, if permanent, are removed within a week or so, but in some instances you may have absorbable sutures that dissolve.  You will be prescribed painkillers to ease the immediate discomfort.

It is likely you will experience some loss of feeling, tingling or numbness in your nipples and breast skin.  This usually goes when the swelling reduces, but it can last longer.  Advise your doctor if you have any worries about it.

Your breast skin may be quite dry after surgery so, in time, you can gently apply moisturiser but keep well away from the healing areas.

You can help your recovery along by:

• Using ice packs on your chest in the day or so after surgery
• Sleeping and resting with your torso and head elevated, for up two
• Moisturising your breasts daily (do not apply lotion to any healing areas)
• Avoiding any straining – through lifting, exercise or bending

Long-term care

You will see the full benefits of your breast uplift within around two weeks once the swelling has subsided but it may take six months to realise the full benefits of your surgery.  Scars take up to a year to fade but will be permanent.   

You will need to take about a week off work, and to avoid doing anything strenuous (exercise, lifting, bending and so on) for around three to four weeks. 

Keep wearing your soft support bra – a sports bra is ideal – for several weeks, and do not wear under-wired garments during your convalescence. 

Safety

Breast uplift surgery is a highly successful procedure, but as with all cosmetic surgery, there are risks from the surgery itself and from any complications which might arise. 

You may also feel that the outcome is not what you intended.  It is a very personal decision to undergo breast uplift surgery and there are no guarantees in any cosmetic surgery about the results of surgery.  But rest assured that the majority of people find the benefits of breast uplift of lasting benefit, and they often feel psychologically better having opted for it.  

Most complications are temporary and relate to infection (in breast ducts or scar tissue) or are due to pain and swelling.  There are some long-term and permanent complications you need to be aware of and discuss at consultation stage. 

All cosmetic surgery carries the risk of:

• Infection
• Allergic reaction to anesthetics or analgesics
• Lack of wound healing (excessive bleeding – hematoma)
• Blood clot (possibly deep vein thrombosis, or cardiac or pulmonary risk)
• Fluid accumulation
• Ongoing, excessive pain
• The need for further, possibly corrective, surgery
• Absorbable sutures causing skin ruptures and uneven healing of the scar tissue
• Possibly revisionary surgery

What are the risks in Breast Reduction surgery?

Unfavorable scarring

Scars should fade within around six months to a year.  At first, scars will be pink and slightly raised.  If you notice they heal over the longer term in ridges (keloids), consult your surgeon as you may need minor corrective surgery.  You may also find that your breasts are red and hot and some leakage occurs from the scars.  Consult your surgeon should you see this sign as you may need antibiotics.

Nipple & breast sensitivity impaired

It is common to have a different sense of feeling in your nipples after the operation.  Various parts of your breast will feel either more or less sensitive than before.  If you experience numbness, this can be permanent due to the severing of nerve endings that may have occurred during surgery.  In rare cases, part of the breast underlying fat tissue may die, and you will lose sensation.  This is more likely to happen if you are a heavy smoker or have poor circulation, as the blood supply will not be sufficient to ‘feed’ the nipple area.

Skin discoloration

You might find that you have some permanent pigmentation changes after the swelling and bruising subside.

Fat necrosis

This occurs at trauma spots caused during surgery.  When the abdominal wall is stretched, the blood supply to the remaining fat and skin may get damaged.  While rare, this can lead to the death of fat cells, which causes raised hard lumps.  Occasionally, an internal infection can result in these areas.

Skin necrosis

This occurs when the skin is stretched and the underlying blood supply is damaged.  This is more likely to occur if the patient is a smoker or has diabetes. 
Excessive firmness of the breast: you may feel the whole breast is taut and uncomfortable.  This may need corrective surgery.

Uneven or lop-sided breast

You may find that you have asymmetric breasts after the operation.  Breasts may be differing shapes and sizes.  Nipples may not be aligned.  This may require further surgery to correct.  However, it does take time to see the results of your surgery and you will need to ensure swelling, pain and bruising has subsided before you form an opinion on the look of your breasts.  If in any doubt, ask your surgeon.

Other risks:

If you intend to become pregnant or breast feed, you are likely to get less benefit from having undergone breast uplift surgery.  It is best to postpone surgery if you are intending to have children or breast feed.

Any breast surgery can make diagnostic procedures more complicated in the future – ie. mammograms.