Breast lift (mastopexy) explained

Breast lift (Mastopexy) explained:

Many factors including: aging; pregnancy;  weight loss or gain, contribute to the skin’s loss of elasticity or ability to retain shape, and loss of breast firmness.

Major correction involves a surgical procedure. 

Nonsurgical stem cell bioregenerative breast lift option is available for selected conditions.

Where there is adequate underlying breast tissue, breast lift alone may be considered. If there is significant volume loss, a combined lift-augmentation is considered.

The goal of mastopexy or breast lift is elevation of a ptotic nipple-areolar complex (NAC).  Surgical NAC elevation is combined with breast augmentation in cases of volume loss with ptosis to restore breast shape and firmness.

Indications for a lift alone include a desire to avoid an implant where adequate breast tissue is present.  Women with small and deflated breasts who refuse combined augmentation-mastopexy are not good candidates for the procedure.

 Breast ptosis:

Breast ptosis was classified by Regnault as : minor (1st degree) – nipple areolar complex (NAC) above the inframammary fold (IMF) ; moderate ( 2nd degree) – NAC below the IMF and above the lowest contour of the breast ; severe ( 3rd degree) where the NAC is below the lowest contours of the breast.  (1) Glandular ptosis refers to a breast in which the NAC is above the IMF and the contours of the breast lay below the IMF.

 

The major difference between the mastopexy procedures and reduction procedures is removal of breast tissue with reduction.  With mastopexy, the major manipulation is of the skin overlying the breast resulting in an elevated NAC.  Reduction procedures have the secondary benefit of lifting a ptotic NAC.

 

Surgically, mastopexy procedures involve removal of skin surrounding the NAC resulting in elevation.  They vary in extent, depending on the degree of ptosis and surgical plans for augmentation with volume replacement.  Volume replacement lessens the amount of NAC elevation needed.  Often with minor ptosis, augmentation alone provides the mastopexy result. 

Breast Ptosis Classification: I (mild) ; II ( moderate) ; III ( severe)

 

 

Figure 1.  Decision tree: breast ptosis.

Decision tree used during evaluation of breast ptosis.  With less tissue support, larger degree of ptosis, and volume loss, a more extensive mastopexy procedure is required.

 

Actual patients of Dr.Burke desiring a mastopexy :

27 years old mother.  She has had 2 normal pregnancies and vaginal deliveries.  She breast fed each child for 6 months each.  Her youngest child was 2 years old.  She states that she is planning on no more children.  There is no history of breast problems.  There is no family history of breast or ovarian cancer.

Figure 2. Preoperative frontal view.  Assymetric NAC’s ; Breast Assymetry ; Hypomastia ; Grade II Ptosis left ; Glandular Ptosis Right.

 

Pre operatively considerable breast asymmetry is noted.  Both NAC’s are enlarged.  The left breast demonstrates second degree ptosis.

Figure 3. Preoperative breast marking including proposed elevation and NAC reduction.  Implant sizes marked on upper abdomen below each breast.

 

The patient’s breasts and chest have been marked for surgery.  The orientation lines are drawn from sternal notch to nipple and from the clavicle to the nipple (along the natural breast axis).  The NAC’s have been marked with the inner outline the proposed new diameter and the outer line representing the outer extent of surgical excision of the existing enlarged NAC.  The incision for subpectoral implant placement is made in the lower ½ of the NAC.  The implant sizes are marked on the upper abdomen below each breast.

Figure 4. Retractor in subpectoral space.

The dissection has been completed and the subpectoral space is opened in preparation for implant insertion.

Figure 5. Smooth high profile silicone gel implant inserted into subpectoral space. Using a Keller funnel “no touch “ implant insertion technique.

A Mentor® cohesive gel smooth high profile implant inserted subpectorally using careful bimanual digital finger pressure.  Blunt retractors are held by the assistant.

Figure 6. Implant in position prior to closure.

The implant has been placed in the subpectoral pocket. 

 

Figure 7. Wound closure to subcutaneous level.

Wound closure is made with 4-0 monacryl absorbable sutures to the subcutaneous level. 

Figure 8. Areolar cutter to create new NAC of desired diameter and shape.

A serrated, sharp areolar cutter of the desired final NAC diameter is used  to create the new NAC.

 

Figure 9. Prior to final wound closure.

Breast incision prior to final closure.  A small vertical incision extends from inferior margin of new NAC.

Figure 10. Preop oblique view.

Pre op.  Oblique profile view.

Figure 11. Postop oblique view.

 

Postop. Oblique profile view.  Smooth high profile round Mentor® silicone cohesive gel implants were used

 ( 275 cc right ; 250 cc left).

The following woman in her 30’s  complained of breast droop and small size. She requested larger, “more perky” breasts.  Her history was unremarkable except for normal pregnancies and deliveries.  There was no family history of breast or ovarian cancer.  She chose 400cc smooth high profile cohesive gel implants to be placed by periareolar incisions in the dual plane subpectoral position and simultaneous uplift.

 

Preoperatively she demonstrates volume loss in the upper breast poles, enlarged Nac’s, and grade I-II ptosis. 

Figure 12. Pre/Postop combined augmentation-mastopexy.  Periareolar incisions, dual plane, subpectoral implant placement.  Smooth high profile silicone cohesive gel implants used.