Surgical Procedures - Breast Surgery

Breast LiFt (Mastopexy)

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Raising and reshaping breasts surgically to improve their appearance, sometimes using implants.

The youthful shape and firmness of a woman's breasts are adversely affected over the years by pregnancy, nursing, and simple gravity. As the skin loses its elasticity, the breasts often begin to sag. Breast lifts raise and reshape such breasts for a time - though surgery cannot permanently delay natural changes. Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple. If your breasts are small or have lost volume, after pregnancy, for example, implants inserted in conjunction with mastopexy can increase both their firmness and their size. What can and should be done in your case will depend on a Consultation with your surgeon. However the following introductory paragraphs will, we hope, be helpful.

RIGHT FOR YOU?

The process can make you look younger and more shapely and so may enhance your self-confidence. But remember it can't alter your appearance completely, or give you back your youth. Please discuss your expectations thoroughly with your surgeon before deciding. The most suitable mastopexy patients are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. Small, sagging breasts usually benefit most. Breasts of all sizes can be lifted, but the results may not last as long with heavy breasts. Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less breast volume. If you're planning to have more children, however, it may be a good idea to postpone your breast lift. Mastopexy does not normally interfere with breast-feeding but a further pregnancy is likely to stretch your breasts and reduce their size once more.

Some Risk

A breast lift is not a simple operation but, provided you choose a well-qualified plastic surgeon, any complications are likely to be minor. Because, however, individuals vary greatly in their reactions and in their ability to heal, outcomes are never completely predictable. Bleeding and infection are uncommon, but these can both cause scars to widen. The way to reduce your risks is to follow your surgeon's advice closely both before and after surgery - poor healing and wider scars are more common with smokers for example. Mastopexy does leave noticeable, permanent scars, although they will be covered by your bra or bathing suit. The procedure can also leave you with nipples unevenly positioned, or a permanent loss of feeling in your nipples or breasts.

PLANNING

Every patient and every physician will have a different view of what is a desirable size and shape for breasts. It is very important, therefore, to discuss your expectations fully and frankly with your surgeon. The surgeon will examine and measure your breasts. He will discuss the variables that may affect the procedure - your age, the size and shape of your breasts, the condition of your skin, and whether an implant is advisable. You must also agree where the nipple and areola will be positioned since the procedure raises them. Your surgeon should describe the procedure in detail, explaining its risks and limitations. Be sure you understand the scarring that will result. Your surgeon will ask you about any medical conditions that could cause problems during or after surgery, such as high blood pressure, blood clotting problems, or any tendency to form excessive scars. Be frank , particularly about smoking and any drugs or medications you are taking - aspirin for example can affect clotting. Your surgeon will explain fully the techniques and the anaesthesia he will use, where the surgery will be performed, and the risks and costs involved. Do ask any questions you may have about discomfort, healing time and so on.

PREPARATION

Your surgeon may require you to have a breast x-ray (mammogram) before he agrees to operate if your age and family history suggest this would be wise. You will also be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

WHERE?

Our surgeons perform breast lifts in an operating theatre in the Hurlingham Clinic or in one of the London private hospitals where they serve as a Consultant. Many patients are able to go home on the day of the surgery; some remain in the hospital for one or two days.

ANAESTHESIA

The Hurlingham Clinic and Spa offers a modern, patient-friendly approach to anaesthesia TIVA - Total Intravenous Anaesthesia. TIVA, is a newer anaesthetic technique which has risen in profile within the last 5-8 years. It has been made possible with the advent of a new generation of intravenous medications with unique properties. TIVA patients sleep soundly during the entire operation, feeling no pain and experiencing no anxiousness. They wake up quickly and comfortably with no memory of their procedure. Many patients prefer this type of anaesthetic to traditional general anaesthetics since they feel comfortable, wake quickly, have less nausea, experience none of the 'hang-over' effect of a full general anaesthetic, and therefore can be discharged earlier. TIVA is safe, effective, extremely well tolerated and is the anaesthetic of choice of Hurlingham Clinic surgeons and most of their patients.

Alternatively, for some patients, they and their surgeons may decide that a full general anaesthetic is still the best choice. Discuss your options for anaesthesia during your consultation with your cosmetic surgeon.

WHAT HAPPENS?

Mastopexy usually takes from one and a half to three hours for both breasts. Many techniques are available but the most common uses an anchor-shaped incision that follows the natural contour of the breast. The incision defines the area from which breast skin will be removed and determines the new location of the nipple. The surgeon removes the excess skin and moves nipple and areola up to the higher position. The skin around the areola is then brought down and drawn together to reshape the breast. Stitches go around the areola and in a line extending downwards from the nipple and towards the lower crease of the breast.

Less extensive incision patterns may be enough for some patients, especially those with relatively small breasts and minimal sagging. One such procedure is the 'doughnut' (or concentric) mastopexy where circular incisions are made around the areola, and a doughnut-shaped area of skin is removed. If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

AFTER SURGERY

Your breasts will be bruised, swollen, and uncomfortable for a day or two but the pain should not be severe and can be relieved by prescription medications. For protection you wear an elastic bandage or a surgical bra over gauze dressings. After a few days you will be able to switch to a soft support bra. You will have to wear this around the clock for three to four weeks. All your stitches will slowly dissolve on their own but moisturiser may need to be applied several times a day if your breast skin is very dry. You can expect some loss of feeling in your nipples and breast skin which should subside after about six weeks. In some patients, however, the numbness may last a year or more, and rarely it may be permanent.

RECOVERY

You will be up and about in a day or two, but do not plan on returning to work for a week or more. Healing takes time. Avoid lifting anything over your head for three to four weeks and, if you have any unusual symptoms, call your surgeon immediately. Detailed instructions for resuming your normal activities may include no sex for a week or more, and no strenuous sports for about a month. After that, you can gradually resume these activities. If you become pregnant, the operation should not affect your ability to breast-feed because your milk ducts and nipples will be left intact.

HAPPY?

Your surgeon will make every effort to make your scars inconspicuous but you must remember that mastopexy scars can be extensive and are permanent. They often remain lumpy and red for months. Gradually, however, they become less obvious and should eventually fade to thin white lines. Fortunately, they can usually be placed so that you can wear even low-cut tops and bikinis. Remember, too, that a breast lift won't keep you firm forever. Gravity, pregnancy, ageing, and weight fluctuations will eventually have the inevitable effect again. Implants normally make breast lifts last longer. You are far more likely to be happy with your breast lift if you understand the procedure thoroughly and if you approach the surgery with realistic expectations.

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