Breast Lift Surgery (Mastopexy)

What’s inside the breast?
A mature female breast consists of a skin envelope containing glandular tissue and fatty tissue. In most women, the majority of the breast tissue is fatty. Within this fatty tissue, there is delicate connective tissue that attaches the breast to the chest wall.

What determines the firmness of the breast?
The firmness of the breast is primarily determined by the density of the fatty tissue and the tension of the skin, which are genetically determined.

Why do breasts sag?
The connective tissue that anchors the breast to the chest wall is very delicate and thus unable to support the breast tissue over time. In addition to this, several factors contribute to breast sagging: pregnancy, breastfeeding, weight gain, and weight loss. In each of these cases, the breasts enlarge, and the skin and supporting connective tissue stretch. In the second stage (after pregnancy, breastfeeding, or weight loss), the volume of the breast decreases, the glandular and fatty tissues shrink, and excess skin forms that cannot contract. The result is breast sagging.

Is there a correlation between breast size and sagging?
Yes. The larger the breast, the more likely it is to sag earlier. However, even relatively small breasts can sag, especially after multiple pregnancies or significant weight loss.

What does a sagging breast look like?
A sagging breast resembles a deflated balloon—it’s empty and certainly not as full as an upright breast. Another characteristic is the formation of a deep fold beneath the breast, and the nipple often points downward. The more the breast sags, the lower the nipple appears. Plastic surgeons classify sagging into several degrees, based on the relationship between the nipple height and the inframammary fold (the crease under the breast).

Sometimes, however, the breast tissue sags but the nipple “rises” upward. In such cases, the fold beneath the breast forms, but the nipple appears to point upward. This condition is referred to as “pseudo-sagging.” In both cases, surgery is necessary to restore the breast to its former appearance. In regular sagging, the nipple height must be adjusted, while in pseudo-sagging, this is not necessary. Both surgeries mainly involve the lower part of the breast tissue.

To sag or not to sag?
Usually, a quick glance in the mirror can determine whether your breasts have sagged. However, if you want to be very precise, you can check the relationship between the nipple and the inframammary fold. If the nipple is above the fold, your breasts are not considered sagging. Another simple test is whether your breasts touch your upper abdominal skin—if they don’t, you’re in the clear.

Breast Lift Surgery: What Can Be Achieved?
In breasts that are small to medium-sized, a breast lift can temporarily restore the firmness and fullness that the breasts had before sagging. However, as skin elasticity decreases with age (a factor that surgery cannot reverse), the level of support the skin can provide to the lifted breast is reduced. The surgery aims to correct the position of the nipple, remove excess skin, and restore fullness to the upper part of the breast.

What Can’t the Surgery Fix or Improve?
The surgery cannot eliminate stretch marks (striae) on the breast. These marks, caused by skin stretching due to pregnancy, weight gain, and weight loss, typically appear on the upper part of the breast. The surgery, however, is performed on the lower part of the breast tissue to hide the incision marks.

At What Age Can You Start?
You can consider a breast lift at any age when the breast appears saggy and you wish to lift it.

What’s Important to Know Before Surgery?
The solutions vary based on the degree of breast sagging. For mild sagging, a silicone implant may be enough (described later in breast augmentation). This allows for the filling and reshaping of the breast with minimal scarring. In cases of moderate to severe sagging, a silicone implant alone will not suffice; while it will increase the breast volume, it won’t lift it. In such cases, excess skin must be removed to achieve the desired lift.

Note: Removing excess skin results in scars, which will fade over time but will always be visible. The length and location of the scars depend on the degree of sagging: more sagging requires the removal of more skin, resulting in longer incisions and therefore longer scars.

What to Do Before Surgery?

• Wash the area thoroughly with soap and water.
• Avoid taking medications containing aspirin.
• Fast for 7 hours before surgery (no food or drink).

How Does the Surgeon Know Where and How Much to Cut?
The surgeon marks the breast before surgery, drawing a plan for the procedure. It’s crucial that this marking be done while standing, as the position of the breast changes when you lie down on the operating table.

Where Are the Incisions Made?
The incisions are typically made around the nipple, and sometimes extending beyond it, depending on the degree of sagging and the surgeon’s technique. There are two types of incision patterns: one that leaves an anchor-shaped scar (a straight line from the nipple to the inframammary fold, plus a curved line beneath the fold) and another that only leaves scars around the nipple, or a combination of a circular scar and a vertical line between the nipple and the inframammary fold.

What Happens During Surgery?
The procedure varies based on the degree of sagging. For mild sagging, a Benelli lift may be performed, where the skin is collected and stretched toward the nipple, and the excess skin is removed. The nipple is then repositioned.
For moderate sagging, the surgeon makes an incision around the nipple and vertically between the nipple and the inframammary fold. The breast tissue is reshaped, and the nipple is lifted to a higher position.
For severe sagging, a full lift is performed with an anchor-shaped incision, during which both breast tissue and skin are reshaped to provide support and lift. The nipple is positioned higher. The disadvantage of this method is the longer scars.

Anesthesia Used:
Breast lift surgery is usually performed under general anesthesia. For mild cases, local anesthesia can be used, where the surgeon injects a numbing agent directly into the breast tissue.

How Long Does the Surgery Take?
The surgery typically lasts between 1.5 to 4.5 hours, depending on the degree of sagging.

Possible Complications:

• Scarring: While most incisions heal well and fade over time, some women may develop keloid or hypertrophic scars, which are raised, red, and sometimes itchy.
• Asymmetry: The surgeon strives for symmetry, but complete symmetry may not be achieved due to pre-existing differences in the breasts, uneven healing, or surgical challenges.
• Nipple sensation loss or necrosis: Moving the nipple can affect sensation. In rare cases, there may be a loss of blood supply to the nipple, leading to partial or full necrosis.
• Delayed healing: Because breast tissue is rich in fat and poor in blood supply, the skin edges might not heal properly, causing an open wound or infection.

Recovery After Surgery:

• Pain: Most patients experience minimal pain as the surgery affects the skin and subcutaneous fat, not the muscles.
• Drains: Drains are usually left in place for 24-48 hours to prevent fluid buildup.
• Sports Bra: A sports bra is worn continuously for about a month after surgery to support the breasts as they heal.
• Recovery Timeline:
  • No heavy lifting or strenuous activity for 4-6 weeks.
  • You can return to work after 1-2 weeks if it doesn’t involve physical labor.
  • Full recovery takes about 6 weeks before returning to sports.

Can You Breastfeed After Surgery?
Whether you can breastfeed depends on the surgical technique and whether milk ducts are cut. If the ducts are intact, breastfeeding is possible after a breast lift, usually within a year of surgery.

How Long Will the Results Last?
A breast lift significantly improves the appearance of the breasts. However, aging and future life events (e.g., pregnancy, weight fluctuations) may cause the breasts to sag again. Larger breasts are more prone to sagging, and wearing a supportive bra can help maintain results longer.