What is a Mastopexy/Breast Lift?
As women age and their breasts "mature", there is a natural tendency for the breast mass to descend. The skin of the upper breast loses its elasticity and the skin stretches. In addition, the breast tissue itself becomes less firm and decreases in mass or atrophies. This results in a breasts that have "shrunk" and "dropped" or in "saggy breasts". Plastic surgeons will generically refer to these characteristics in a breast as "ptosis" and will grade a breast by its "degree of ptosis". Mature breasts are graded on their degree of ptosis by the position of the nipple. Grade 1 is the nipple at the level of the inframammary fold (IMF), grade 2 is when the nipple lies below the IMF, and grade 3 is where the nipple is at the most inferior portion of the breast. Breast ptosis may become apparent to a woman while she is still relatively young after she has had children, or it may appear in middle age. Variables which will affect the degree of ptosis are the elastic qualities of the skin, the number of pregnancies, the age at the time of pregnancy, the size of the breast, and the characteristics of the breast tissue itself. Having ptotic breasts is normal just as getting wrinkles as you age is normal. A breast lift is strictly an elective cosmetic procedure The breast mound is lifted to a more youthful position and if there is excess skin, it is removed. The nipple areola complex (NAC) is repositioned to a more youthful position as well. It is the position of the NAC and the amount that it needs to be raised that will determine the procedure that needs to be performed. A mature but aesthetically pleasing breast has a NAC positioned at approximately the same level as the fold beneath the breast (inframammary fold). A youthful breast has the NAC above the inframammary fold (IMF). The surgeons goal should be to raise the NAC to or above the IMF depending on the patient's age, desires, and characteristics of their breasts. This procedure may be very similar to a breast reduction if the NAC has to be moved a considerable amount. The difference is that only skin is removed, leaving most or all of the breast tissue behind. This will allow the patient to keep her breast size but position the mound and NAC to a more youthful position. If a patient would like her breast to be slightly smaller, it is very easy to remove only a small amount of breast tissue and attain the same goals. A mastopexy where a large amount of breast tissue is removed and a breast reduction where a relatively small amount of breast tissue is removed are essentially the same procedure. Breasts with only mild ptosis can be lifted and made larger simultaneously by simply placing a breast implant, i.e. breast augmentation.

Who is a candidate for a breast lift?
A patient with grade 1, 2, or 3 ptosis who wishes to reposition her NAC and breast tissue to a more youthful position may be a candidate for the procedure.

Are there women who should not have a breast lift?
Women who smoke, have a high risk of breast cancer (scars may make reading mammograms difficult), or are unwilling to accept scars on their breast, a potential decrease in nipple sensation, or the ability to breast feed should not have this procedure. Also, women with very large breasts who only want a lift will ultimately be disappointed because of a high rate of recurrence unless a breast reduction is performed.

What are the potential risks with breast lifts?
The risks include unattractive scars, loss of nipple sensation, numbness on breast skin, asymmetry, inability to breast feed, loss of nipple, and most commonly, recurrence of ptosis. Obviously, the factors which caused the problem initially, (aging skin, heavy mound, pregnancy,etc,) may be present after surgery so that recurrence of ptosis is very possible if not likely.

What are the different techniques used for breast lifts?
The options for a breast lift are dependent on the position of the nipple and the goals of the patient and surgeon. With significant ptosis, many incisions will have to be made which will leave a scar around the nipple, from the nipple to the breast fold, and along the breast fold. In a patient with less ptosis, the size of the scars can be reduced because less skin is removed. An additional option is to place a breast implant below the pectoralis (chest wall) muscle which simultaneously enlarges and lifts the breast. This may be done at the same time as the lift or 6 to 12 months later depending on the particular circumstances.

What type of anesthesia is used?
Most surgeons, including Dr Wigoda, will use general anesthesia.

Will the scars be noticeable?
The scars are usually visible but may heal so that they are not very noticeable. The scars may extend around the areola, down to the breast crease, and under the breast. The scars will typically lighten over a one year period.

What size will I be after surgery?
This is an important point to discuss with Dr Wigoda. You can be made larger with an implant, left the same size, or made smaller.

How much bruising, swelling, and pain is there?
After surgery, it is expected that the breasts will have a moderate amount of swelling. This swelling will resolve over 2 to 4 weeks. The swelling and pain may worsen for a short period of time during the first menstrual period after surgery. The breasts will appear slightly larger than they will ultimately be because of this swelling. The scars will also appear darker initially. Both breasts will have some bruising although it is generally mild and resolves over 1 to 2 weeks. The vast majority of patients report the pain as very tolerable. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.

Will this surgery affect future mammograms?
Yes. There will be some scar formation on the inside of your breast. A mammogram done after surgery will very likely look different than one before surgery. You should obtain a mammogram approximately 1 year after surgery for a new baseline. Afterwards, the frequency of mammograms will depend on your age.

Will I be able to breast feed after a breast lift?
Because for the most part, the connections between your breast tissue, breast ducts and nipple are not interfered with a lift, your ability to breast feed should not be affected

Is a breast lift permanent?
Unfortunately, as you age, your skin ages and loses its elasticity. Because of this, the weight of your breasts will cause the breast ptosis to recur to some extent. The exact amount the breast will "drop" and the amount of time it will take for this to occur is very patient dependent. It will vary with age, skin quality, and size of breasts.

Are drains placed?
Dr Wigoda may place one drain in each breast, depending on the technique used. The fluid will drain into a collection device that can easily be emptied. The drains will usually be removed 1 to 3 days after surgery. Drains are placed and removed at the discretion of the surgeon. Removal of the drains is not painful.

What happens before I have the surgery?
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram done by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.

What happens on the day of surgery?
You will arrive at the office surgery center. You will not have eaten or drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr Wigoda will mark your breasts with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.

What happens after surgery?
Bandages will be placed and your chest will be wrapped in an ace bandage. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. As the pain and swelling decreases you will be able to resume normal activities. Dr Wigoda will allow you to resume strenuous exercise with your arms after 4 to 6 weeks. You may be able to resume exercise with your legs (walking, jogging, bicycling, etc) slightly sooner.

How much bruising, swelling, and pain is there?
After surgery, it is expected that the breasts will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. The breasts will appear slightly larger than they will ultimately be because of this swelling. Both breasts may have some bruising although it is generally mild and resolves over 1 to 2 weeks. The amount of pain post-operatively is very patient dependent. Some patients will experience mild discomfort, particularly with raising the arms and with increased activity. It is unusual to have significant pain. The vast majority of patients report the pain as tolerable. Some patients have reported difficulty getting comfortable when going to sleep for the first 1 to 2 weeks. Patients may also experience hypersensitivity of their nipples. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.

When can I get back to work? When can I drive a car?
For sedentary work with minimal physical activity you can expect to go back after 3 days. For moderate activity, it will take about 7-10 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 2 to 3 weeks. It will take 3 to 7 days to be able to drive safely, depending on your pain tolerance, how much pain medication you are taking (if any), and whether you drive an automatic or manual transmission automobile.

Will there be stitches that have to come out?
Dr Wigoda will remove the sutures after approximately 7 days.

When can I resume sexual relations?
You may want to wait at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.

When will I see the final results?
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all if it to resolve. After this you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts feel very soft and natural.

Please take a moment to contact Dr. Wigoda with any question you may have