BREAST LIFT (Mastopexy)

 Patient Groups
 Patient Concerns and Planning
 Classification of Ptosis
 Preparing for Surgery
 The Operation
 At Home
 Office Visits and Follow-up
 Outcome and Complicationsn
 Case Histories (Before and After)

Patient Concerns and Planning
1. All patients wish their breasts to look ideal, having them uplifted and of a good size to balance the hips, and be able to wear more appealing apparel. They prefer not to wear tight restrictive brassieres to give this look. Patients don't wish their breasts to be smaller after a mastopexy, and this tradeoff can occur when the skin is reduced and the gland is tightened internally. During the preoperative visit, skin taping is performed to gather the skin and gland into a more pleasing shape and size. If size is not sufficient, then breast implants are offered at the same time. Bras are placed and breast prosthetic sizers are introduced to yield a cup size and uplift pleasing to both patient and surgeon. When a patient requests a large increase in cup size, it is preferable to counsel carefully on this point, and when adamant, the use of postoperatively adjustable implants is recommended when preformed jointly with a lifting procedure. Adjustable implants have a small fill port seated under the skin where the surgeon can introduce small amounts of saline at subsequent office visits to slowly expand the gland size without fear of compromising the circulation to the lifted tissues. The ideal breast shape and size while always sought may not be possible in patients with the most challenging breast shapes.

2. Women may become fearful of the scars discussed when offering various options to mastopexy. It is for this special reason that minimal scar methods have been developed and popularized for breast problems of increasing difficulty. It is now possible to obtain similar results in patients with mild to severe forms of breast ptosis using reduced scar closure methods.

3. Regarding implants, many women would prefer not to have implants placed at the time of mastopexy and are hoping the mastopexy alone will solve their dilemma. When an augmentation is planned at the time of mastopexy special attention is given to the forces imposed by expansion of the gland by an implant, and reduction of excess skin by a mastopexy. This collision of opposing tensions must be explained and can add some risk. Some surgeons believe augmentation and mastopexy should be performed in stages to ensure optimal safety. While this is an acceptable standard of care, a staged approach is ordinarily reserved for much older patients, those with medical risk, some smokers, and those who have severe ptosis as a result of massive weight loss.

4. Permanence and complete symmetry of lifted breasts is desired but cannot be perfectly assured, since general changes will occur in the patient's body and breasts as a matter of fact. The best symmetry is underscored in the planning and markings of the breasts before operation. Fixed landmarks or cardinal points are measured which will then take into account any differences in shape, size, configuration, skin excess, and breast slant, so that a more uniform outcome is obtained.