A breast lift surgery, or mastopexy, corrects the droopy breast by tightening not just the skin but the deeper soft tissue as well. To further create a balanced result, it also involves repositioning the nipple area higher on the chest wall.
The procedure uses incisions around the border of the nipple-areolar complex, inside the inframammary fold, and vertically between these areas, leading to a scar that resembles an inverted T or nautical anchor. For this reason, it can only reshape the lower half of the breast.
Because women with saggy breasts may also have empty-looking upper cleavage, it is not uncommon to combine breast lift and implants in one surgical setting. This approach is also suitable for patients who are not satisfied with their current “cup” size.
Nevertheless, breast lift without implants can still provide impressive results for patients who have the “right” anatomies and realistic motives and expectations. Of course, the final outcome will also depend on the surgeon’s qualifications, specifically his training, skills, board certifications and plastic surgery affiliations, reputation, and experience.
Breast lift without implants is suitable for patients who are happy with their cup size, although they could choose to have the prostheses in the future should they develop deflated upper poles and want to correct this appearance.
Whether or not implants are used at the time of surgery, it is important to reshape the breast tissue and possibly use internal sutures to hold the new contour in place. A skin-only lift, meanwhile, must be avoided because of its short-lived results, poor healing, and wide scars.
By tightening the deeper structures of the breast mound, a surgeon is also able to restore projection. According to a 2014 study published in Plastic and Reconstructive Surgery medical journal, the upper pole to lower pole ratio of 45:55 is the ideal breast shape.
Dr. Tarick Smaili, a leading breast lift Los Angeles expert, says the 45:55 ratio has always been his basis for design in any type of breast enhancement surgery.
While the standard breast lift today uses an anchor-shaped incision pattern, modified techniques have been introduced that suits women who require less “correction” and/or with smaller breasts, explains Dr. Smaili.
One example is the vertical lift, also referred to as lollipop lift due to the shape of the resulting scars (it eliminates the horizontal incision within the inframammary fold). This technique favors women with moderately sized breasts that require lifting and narrowing at the same time, says Dr. Smaili.
Mastopexy, or more commonly referred to as breast lift surgery, is reserved for women with breast ptosis (sagging) wherein their nipple-areola complex falls within or far below their inframammary fold.
The inframammary fold is where the breast meets the chest and is most apparent in women with larger and/or saggy breasts.
Using strategically placed incisions, this type of surgery can tighten the loose tissue and skin and at the same time reposition the low-lying nipple area near the center of breast mound.
To help you better understand the surgery’s effects and determine whether your aesthetic goals are achievable, the list below describes the breast appearance after mastopexy:
* The original position of your inframammary fold will remain the same.
While mastopexy can raise the drooping nipple-areola complex to further create a “perkier” appearance, take note that it does reposition your inframammary crease. Simply put, the surgery cannot change your breast height.
* It can only reshape the mid to lower half of the breast.
Breast lift uses incisions within the lower half of the breast mound (e.g., around the nipple area, vertically from the areola down to the crease, and/or inside the inframammary fold), so it has no effect on the shape and appearance of the upper cleavage. Thus, if you have a deflated-looking upper breast pole, it will remain the same after surgery unless you will ask for small implants to achieve some fullness in the area.
* Scar is always a tradeoff.
Any time the skin is cut or injured, scar will always develop. However, it is supposed to heal and fade drastically within a year and is hidden even if you are wearing a low-cut top.
To encourage the scars to fade and heal well—and prevent them from becoming thick and noticeable—it is important to minimize the tension on the skin and work deeper into the layers of the breast to support to the new contour rather than use skin-only lift techniques.
With proper surgical techniques and post-op care that may include the use of scar treatments, for the vast majority of patients breast lift scars are barely noticeable.
* The nipple is repositioned higher.
In a youthful breast, the nipple lies in the center of the “mound.” However, it should not be too high lest it will lead to a very unnatural result that could appear worse as the soft tissue continues to age and respond to gravity.
* Your breast size will remain the same.
If you have overlarge, droopy breasts, the best approach is to combine mastopexy with reduction mammaplasty—or more commonly referred to as breast reduction surgery—to prevent or at least postpone re-drooping. And for most patients, the “combo” procedure also results in a more balanced appearance.
In “standard” breast augmentation surgery saline or silicone implants are used to increase the bust size and/or create more fullness especially in the upper poles or “cleavage.” But to achieve the ideal proportions, some patients need additional procedures such as breast lift.
Breast lift or mastopexy uses incisions around the nipple area to tighten the loose skin, in addition to a vertical scar between the areola and inframammary fold. In severe cases of ptosis or sagging, a horizontal incision within the natural breast crease is also needed for an additional lifting effect.
If the nipple area has sagged below the natural crease, implants alone will not provide a sufficient amount of lift and may in fact aggravate the saggy appearance and lead to more cosmetic-related problems, Los Angeles breast augmentation expert Dr. Tarick Smaili explains.
Dr. Smaili says that breast augmentation and lift are usually performed simultaneously, although some patients may benefit more with a staged procedure, especially if they need “more correction.”
Breast augmentation with lift is primarily performed to simulate the “ideal” breast proportions, which according to a recent study published in the Plastic and Reconstructive Surgery journal is having a ratio of 45:55 in which the nipple area serves as the demarcating line between the upper and lower poles.
Aside from delivering the ideal breast proportions, the Los Angeles breast augmentation surgeon says the “combo” procedure is particularly suitable for small-breasted “older” patients—i.e., 45 years and above—who are prone to tissue laxity.
Tissue laxity also “afflicts” massive weight loss patients who may also complain about the deflated-looking upper breast poles, which can be corrected by implants.
Using implants without correcting the “existing” tissue laxity often leads to a condition called double bubble in which a pair of visible line or indention appears above the breast crease, says Dr. Smaili.
In some severe cases, Dr. Smaili says the nipple area may appear herniated on top of the base of the breast if implants are used without correcting the saggy appearance.
While it is not uncommon to combine breast augmentation and mastopexy in one surgical setting, the renowned plastic surgeon says that sometimes a staged procedure in which breast lift is performed first followed by implant surgery after several months is a better approach.
With staged procedure, the skin has enough time to shrink and the swelling from breast lift to dissipate completely before implants are placed in the “pocket,” explains Dr. Smaili
Breast lift surgery or mastopexy uses incisions starting from the nipple level down to the inframammary fold to tighten the loose tissue and skin. As with any body contouring procedure, it can only deliver predictable results if the patient is near her ideal weight.
Leading plastic surgeon Dr. Tarick Smaili says that a well-executed surgery creates a “perkier” breast that will not droop for decades, adding that if ever it occurs, rarely does the nipple area lies too low to the point that it warrants a revision surgery.
Nevertheless, the list below shows the factors that can affect the long-term results of breast lift, as explained by the renowned plastic surgeon:
As with any body contouring surgery, breast lift’s results are also dependent on the patient’s ability to maintain a healthy weight, which is only possible through more active lifestyle and balanced diet.
If the patient is experiencing significant weight fluctuations, any form of breast surgery is not ideal because the cosmetic results could be highly unpredictable.
* Skin quality
During breast lift surgery, a small amount of excess skin is typically removed to create a more pleasing shape and proportion. However, it does not change or improve the overall skin quality.
* Lifestyle factors
While skin quality is partly affected by genetic factors, maintaining a healthy lifestyle—such as using sunscreen, avoiding tobacco products, and keeping a stable weight—is one effective way to prolong the results of breast lift or any type of body contouring surgery.
* Surgical maneuvers
A skin-only breast lift used to be a popular technique until the surgeons realized that it often led to short-lived results—i.e., bottoming out was a real concern because of the lack of support for the new contour.
Nowadays, plastic surgeons also go deeper into the breast tissue layers to reshape them, possibly with the use of internal sutures and/or biological mesh, to create a strong support that holds the new contour in place.
If the breast is large and heavy, it might be helpful to perform breast reduction at the time of breast lift. The two procedures share the same incision sites, so combining them does not result in more scars.
* Future pregnancy
Pregnancy leads to breast involution, which leads to changes in its size to pave way for lactation. As a result, it can affect the breast lift result, especially if the patient gains an excessive amount of weight while pregnant.
In standard breast lift surgery, also referred to as mastopexy, the saggy appearance is corrected by reshaping the skin and deeper tissue. At the same time, the nipple is repositioned near the center of the breast mound to achieve a more balanced, youthful appearance.
Today’s plastic surgeons go deeper into the breast structure because a skin-only lift leads to a short-lived result, in addition to higher risk of poor or wide scarring because of the significant tension on the skin.
Aside from going into the deeper layers of the breast, some doctors also believe that using an internal bra at the time of surgery can give a longer-lasting, stronger support for women.
The term internal bra may have different meaning from each doctor. Some use it to describe a technique wherein the deeper layers of the breast are hold in place by sutures, preventing the recurrence of sagging or bottomed-out appearance in which the lower breast pole looks excessively full, while the upper cleavage looks deflated or “empty.”
On the other hand, some surgeons use the term internal bra to specifically refer to a technique in which a thin silicone sheet is inserted between the patient’s skin and tissue. The device is then supported by biocompatible silk threads that have titanium anchors attached to the rib cage.
Proponents of the new technology, called Orbix Breast Supporting System, say it provides a strong lifting effect the same way as a push-up bra holding up the breast mound.
Despite the use of silicone sheet, the new technology does not increase the bust size the same way as the breast implant.
As of this writing, Orbix is still under clinical trial in the US. However, the device has been already approved for commercial use in Europe, with studies suggesting that it provides high patient satisfaction.
Nevertheless, some doctors are skeptical, saying that the currently available biological materials such as strattice, which is derived from swine skin, can provide the same lifting effect.
Strattice is particularly popular in cosmetic and reconstructive breast surgery because it does not cause allergic reaction. The cells in the pig’s skin is removed, leaving only the main structure to allow the patient’s own cells and blood supply to grow inside the material.
With so many technologies and techniques claiming to deliver longer breast lift results, leading Los Angeles plastic surgeon Dr. Tarick Smaili says the skills of a doctor still remains the most important factor that delivers good cosmetic outcome.