Mastopexy is an operation in which extra skin is removed and the breast tissue is re-positioned to a higher location on the chest wall. There are many ways to do this operation and over the years I have tried inferior pedicle, central mound, superior pedicle and lateral pedicle techniques using circular, lollipop and inverted T incisions/scars. I have found that the inverted T incision yields the most consistently good results. Other approaches have unacceptably long down times or poorer scars in spite of the claims their proponents make. If a woman is unhappy with the volume of the breast, then an augmentation with an implant can be done at the same time. If a woman has had a breast lift without an implant and subsequently desires an augmentation, it may be dangerous to attempt it because of changes to the blood supply of the breast and nipple that occur after an inferior pedicle lift. I recommend that both be done at the same time if there is any worry about the adequacy of the existing volume.
If a patient chooses to do a breast lift alone, then I do an operation similar to a breast reduction. I start by drawing a keyhole pattern on the breasts with my patient sitting up in the pre-anesthesia area. This pattern is centered on the new, higher location for the nipple. During surgery I remove the skin between and below the flaps on the side, leaving a smaller nipple and areola attached. The skin and fatty of the flaps are now lifted off the breast tissue. No breast tissue is removed. The breast tissue and areola are now lifted to be in a higher position on the chest and the skin flaps are brought around and under it to keep it in place. All incisions are then closed. A bulky cotton dressing with ace wraps around the chest is used as a dressing. The dressing is changed after about five days but the breasts are supported in their new position for six weeks using special bras. Sutures are removed after about two weeks. In all but the most strenuous jobs, patients return to work in two to three weeks. If lifting and vigorous chest/arm activity is required, return to work might be delayed for as long as six weeks.
Breast Augmentation with Lift
If the choice is to combine a lift with an augmentation, I first put in the implant through an incision under the breast. I then sit the patient up, while asleep, and re-shape the breasts by folding and stapling the skin into place. I mark the created edges and then remove the staples. This indicates the skin that requires removal. After removing the marked, redundant skin, the wounds are closed and a bulky, cotton dressing is placed. Sutures come out after two weeks but support of the new breasts continues for six weeks with a special bra. All but the most strenuous jobs can be returned to in two to three weeks. Most patients are very happy with the results of this operation. My most common patient is a mother in her thirties or forties who breast fed and lost substantial volume after she stopped producing milk.