DESCRIPTION
A mastopexy, commonly referred to
as a breast lift, serves the purpose of “lifting”
the entire breast tissue along with the nipple/areola
and tightening the breast. The breast “falls”
downward, or becomes ptotic (pronounced totic) as a
result of gravity, aging tissues that lend decreasing
support to the breast gland and following pregnancy
and breast-feeding. The degree to which the breast falls
will be unique to each patient. The nipple to inframammary
fold ratio and relationship serves as a point of reference
when assessing whether or not a breast is “saggy”
and just how much it has sagged. When the patient is
viewed from the side, the nipple should lie above the
inframammary fold. As the breast “sags”
this relationship changes and so does the degree of
ptosis (pronounced tosis) or sagginess. Plastic surgeons
will frequently refer to the degree of ptosis in terms
of numerals I-IV depending on the distance or centimeters
that exist in the discrepancy between the nipple and
inframammary fold. Various procedures or breast lifts
have been arrived at to address the different degrees
of ptosis. Because a woman undergoing a breast lift
will frequently have an atrophied (shrunken) breast
gland, insertion of a breast implant is frequently suggested.
PROCEDURE
A mastopexy can be performed under
local anesthesia with intravenous sedation or general
anesthesia. We have found that our patients are most
comfortable undergoing general anesthesia. The procedure
is performed as an outpatient allowing you to go home
afterwards. Depending on your exact procedure, the incisions
will vary. However, most patient will undergo their
mastopexy through what is commonly term as an “anchor”
or “inverted T incision” This means that
the incision will be around the nipple/areolar complex
then extend straight down from the six o’clock
position until it meets the inframammary fold (the normal
breast fold, inferiorly). The incision then extends
within the limits of the inframammary
fold, from the center of the chest to out laterally.
Every attempt will be made to make the scars less conspicuous.
However, you need to understand that every patient will
be different. Another method used for select situations
is an incision made just around the circumference of
the areola (donut
mastopexy). Not all patients are candidates for
this operation and therefore, it cannot be used all
the time.
Because the basic problem
is that there is too much skin for the amount of gland
existing, the incisions described above allow your surgeon
to remove the necessary skin and be able to tuck the
breast tissue, redistribute the glandular mass and reshape
the breast. If not enough of your own breast tissue
is present, then a breast implant will be utilized to
re-establish or enhance the volume of the breast. The
breast implant will be placed in a sub-muscular position.
The incisions are closed, a surgical bra is placed and
you are taken to the recovery room. After allowing time
for recuperation, you will be discharged to go home.
POST-OP RECOVERY
You will be allowed to go home
after your surgery. You will need to wear the surgical
bra for the first few days. We then suggest that you
wear a sports bra. Some custom surgical bras are available
from different manufacturers and our office will be
happy to assist you in this purchase.
You will experience pain in the first 24-48 hours and
a feeling of tightness. This is normal. Pain medication
will be provided for you and we suggest that all your
post-operative medications be purchased prior to surgery.
You should not be the person controlling the meds to
avoid self-medication. At home, it is suggested that
you rest. You will be asked to come to the office the
next day. At this point some bandages may be removed.
You will have “steri-strips” or small tapes
around all incisions that will come off by themselves
within the first 10-14 days post-op. If they need to
be changed, it will be done in the office.
We will need to see you within another week for possible
suture removal. Frequently, the sutures used are absorbable
and will not require suture removal. Check with us in
your particular case. Most patients require 7 days recovery
before returning to work and/or driving their car unless
your work requires strenuous activity in which case
you may need 3 weeks. Exercise may be continued after
6 weeks. Always check with us. Household chores may
be started within the second post-operative week. Every
patient is unique and will recuperate differently. If
you feel great, don't over do it.
Please note that all implants, but particularly if they
are placed in a subpectoral position, will tend to ride
high on the chest wall during the first 10-12 weeks
following your surgery. This is normal and occurs as
result of the implants being placed in a tight space
comprised of skin and muscle. As each week goes by,
the muscle and skin start to adjust and stretch allowing
the implants to assume a more natural position. Occasionally
this process is not completed and the implants remain
high on the chest wall requiring further surgical correction.
COMPLICATIONS OF MASTOPEXY
Although complications are not frequent and percentages
will vary, you need to be aware that the following
complications may occur:
PROMINENT VISIBLE SCARS, POSSIBLE LOSS OF TISSUE &/OR
NIPPLE, ALTERED NIPPLE/SKIN SENSATION (EITHER INCREASED
OR DECREASED), CONTOUR IRREGULARITIES, ASSYMETRY,
POSSIBLITY OF LACTATION, INFECTION, HEMATOMA.
NOTE: If breast implants are being utilized along
with your breast lift, you will be asked to sign the
"INFORMATION FOR WOMEN UNDERGOING SALINE BREAST
IMPLANTS" or the Gel Breast Implant information
sheet
Some of these complications if severe enough, may
delay recovery time, require further surgery for correction
at additional costs and may involve other specialists
within the medical field. Please be aware that smokers,
diabetics and overweight individuals have a higher
incidence of complications when compared to those
who don’t smoke, have diabetes and/or are overweight.
You should also note that patients undergoing combined
procedures (i.e. breast augmentation and tummy tuck)
also have a higher complication rate than those undergoing
a single procedure.
WHAT & WHAT NOT TO EXPECT
These procedures are considered body contouring and
enhancing in nature. They are not meant as a substitute
for normal breast tissue. We have found that one of
the key factors in achieving patient satisfaction
is patient expectation. No guarantee implied or in
writing is given regarding the eventual bra cup size
that you will wear. A suggestion is made by Dr. Perez-Gurri
based on his professional experience as to the size
of implant. Remember that many things are taken into
consideration but the one limiting factor is the skin
and availability of good tissue coverage for the implant.
There seems to be an inverse relationship with expectation
and satisfaction. That is, the higher the expectation,
the lower the satisfaction. Body image is unique and
what the patient frequently sees may not be what is
seen by the surgeon. Therefore, it is important that
you become keenly aware of your expectations for the
procedure, know its limitations and fully discuss
any concerns that you may have regarding the procedure
with Dr. Perez-Gurri. We encourage questions and have
allowed ample time to answer them personally or with
our literature and videotapes. Please realize that
the results obtained through a mastopexy are not permanent.
Gravity continues to have an effect on the tissues
and the aging process and laxity of tissues continue
at the same rate as before. Every patient is different
and will have a unique experience.
OTHER QUESTIONS
What if I get pregnant?
Your breasts will grow under hormonal influence just
as they would without implants. Following your pregnancy
there is involution or "shrinking" of your
breast tissue but this will not affect the implant.
However, if you are left with excess skin, the breast
may sag once again.
Can I breast feed?
Probably not. You need to fully understand that some
women cannot breast feed regardless of implants. However,
after undergoing a mastopexy many of the milk duct
connections are interrupted, therefore preventing
the normal flow of milk to the nipple. If you are
able to breast feed there is no scientific data that
implants are harmful to the baby.
Will I be able to feel the implants?
More than likely. Saline implants seem to have a higher
incidence of implant wrinkling or rippling which makes
the implants more palpable underneath the skin and
in some cases the patient may see the ripples on the
skin. This happens more frequently in thin patients
and with the use of bigger implants.
Can breast implants cause cancer?
Scientific studies have not proven a relationship
between breast implants and breast cancer.
Will I need to change my implants?
Manufacturers suggest that breast implants should
be changed after ten years. However, every case is
different and patients need to be evaluated on an
individual basis. You should know that further surgery
would be required in the future either because of
complications or normal wear and tear. This means
that you will undergo added expenses in the future.
Are my results permanent?
No. The normal processes of aging & gravity that
cause continued laxity of the tissues eventually lead
the breast to sag again. There is no sure way of predicting
how long this process takes in any particular individual.
Will my stretch marks go away?
No. There are no permanent cures for stretch marks.
Different creams and remedies exist that temporarily
hydrate the skin making the stretch marks less visible
but they do not remove stretch marks. Lasers have
been utilized to treat stretch marks but are only
effective in reducing the color intensity of red/bluish
ones. By stretching the skin as a result of the implants,
the stretch marks may become less visible.
What happens if my implants "leak"?
If you have saline implants, the salt water will be
absorbed by the body, processed and eliminated in
the urine. Your breast will go flat within hours and
you will require further surgery to replace your old,
deflated implant. Do not worry; it is not an emergency.
If you have silicone gel implants, a leak is not readily
apparent from loss of breast volume and other diagnostic
tests will be required.
The above information has been compiled as a benefit
to you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
It is our sincerest wish that your surgical experience
at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a
pleasant and informative one. We recognize that all
patients will experience pre-operative anxiety and
fear of elective surgical procedures is normal. Our
trained professional staff and doctors are here to
serve your needs and answer your questions.
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