Breast Uplift

What is a breast uplift or mastopexy?

A breast uplift or mastopexy is a surgical procedure to lift sagging (ptotic) breasts by removing excess skin and repositioning the nipple so that it is higher and on the front of the breast. A small amount of breast tissue may be removed at the same time if desired. The operation is similar to a breast reduction although there is usually less scarring as it is normally possible to use short scar techniques (e.g. periareolar or vertical scar techniques – see below).

Who might consider having a breast uplift?

A breast uplift is for droopy breasts where the overall size is about right. Many women’s breasts naturally have a shape where both the nipple and the volume of the breast are low. However, following pregnancy or weight loss, the breasts are often particularly droopy. A breast uplift lifts the breasts and gives them a more pleasing shape. An uplift is often helpful where the breasts are a different shape (breast asymmetry) either because that is the way they developed or following surgery.

What should I expect when having a breast uplift?

You are admitted to hospital on the day of your operation. The time you come in varies on when your operation is scheduled. The operation is carried out under a general anaesthetic (asleep). The operation usually takes between one to two and half hours. The stitches are usually absorbable (‘dissolving’) and are placed under the skin, so that you can not see them. A dressing is placed over the wounds at the end of the operation. Drain tubes may be placed into the wound to reduce the build up of blood and tissue fluid under the wound (these are often not required). You will be prescribed regular painkillers while you are in hospital and to take home. Usually the drains (if you have them) are removed the next day or on the second day after the operation and you are discharged home. You are advised to where a supportive (not wired) sports-type bra for 4-6 weeks following surgery. You are offered a dressing check one week after surgery and you have a follow up consultation with your surgeon four weeks after the operation. If you are worried at any time after you have gone home you can phone the ward, phone the cosmetic nurse advisor or the consultant’s secretary for advice. If necessary you can return to the ward at any time for a check (please phone first).

How is the operation done?

There are many different techniques for doing a breast uplift. They vary in which pieces of skin are removed, which parts of the breast tissue are removed and how the nipple is kept alive. As far as the end result is concerned the main difference is the position and extent of scarring.

Peri-areola breast reduction (sometimes called the Bennelli technique or circum-areola):

The peri- areolar technique reduces the breast with a scar place around the areola only. This technique is limited to breast requiring a small uplift. For very small uplifts the scar can be limited to the edge of the upper half of the areola (the areola is the brown area around the nipple).

Vertical scar breast uplift (also called Lejour or SPAIR uplifts):

The vertical scar techniques are widely used. The scar runs around the areola and then from the bottom of the areola down to the fold under the breast. Sometimes a short horizontal scar is placed at or above this fold. The projection (how the breast protrudes form the chest) of the breast is often better with these techniques.

Wise pattern breast uplift

The Wise pattern approach has been widely used and for the longest time. It enables the greater amount of skin to be removed compared with other techniques. The scar runs around the areola and then from the bottom of the areola down to the fold under the breast. The scar also passes the whole length of the fold under the breast. The final shape of the scar is that of an anchor.

What about my nipples?

The majority of breast uplifts involve lifting the nipple, but it is not normally removed form the breast. The nipple is kept alive on a strip or segment of tissue called a pedicle. The pedicle can originate from below the nipple (inferior), above (superior), the inside (medial), the outside (lateral) or behind the nipple (central). Surgeons vary in which technique or techniques they favor and certain techniques may be better for particular breast shapes. It is possible to remove the nipple completely and replace it on the breast as a graft. This is called a free nipple graft breast uplift. Most surgeons would consider this an old fashioned technique. The nipple tends to lose its projection afterwards and may be slow to heal. It is still used under certain circumstances particularly if the blood supply to the nipple is failing with the other techniques.

What results can I expect?

The great majority of people who undergo a breast uplift are very pleased with the results of their surgery. Their breasts sit higher on the chest with the nipple on the front of the breast and higher on the breast. It is important that you understand what is involved, how much time you need to recover and the potential risks. There is swelling following the surgery and it is important to keep the breasts well supported. There is frequently some bruising and this tends to settle over the first 2 weeks. Sensation in the nipples may be reduced or even lost following an uplift. If feeling is lost it may return but this can not be guaranteed. It may not be possible to breast feed following a breast uplift.

What do the scars look like?

The scars depend on which technique is used (see above). The majority will be either a vertical scar technique with a scar around the nipple and down to the fold under the breast or a Wise pattern which has an additional scar running along the fold under the breast. Scars themselves vary from a thin line which rapidly becomes pale through to stretched or lumpy scars that take time (months sometimes years) to settle.

How long will I need to recover?

People vary a lot in the time they need to recover from surgery. The following gives some idea. Some people will require less time and others more. If you experienced complications then recovery may take longer.

When can I go home from hospital?

Most people go home from hospital either on the day of surgery or on the day after surgery.

When can I shower or have a bath?

There is usually no problem in having a shower after 48 hours. Soaking the wounds for long periods in the bath is best avoided until the wounds are fully healed, usually at least 2 weeks.

When can I start driving a car?

It is illegal to drive with in 48 hours of a general anaesthetic. Most people return to driving after 10-14 days. The most important consideration is that you feel comfortable and safe to drive. You have to be able to react appropriately in an emergency. If you are taking medication such as painkillers you need to check and consider whether these may affect your ability to drive.

When can I return to work?

Usually people return to office type work about two weeks after surgery. Some people are back sooner or work from home. More active work using the arms may require longer 2-4 weeks. Very active work will require 4 to 8 weeks off vigorous activity. You will need to be guided by your body, if you are causing pain and swelling you may be doing too much. A good supportive bra is essential.

When can I start picking things up?

Lifting small things around the house is not a problem. It is best to be guided by your body, so if it hurts stop. It is best to avoid lifting anything heavy for 2 weeks. You should not be straining to lift anything for 2-4 weeks.

When can I go back to exercise / the gym?

Walking only for 2 weeks after surgery. Light lower body exercise (e.g. exercise bike 2-4 weeks). Light upper body 4-6 weeks. Back to normal 6-8 weeks.

When can I start swimming?

You should avoid swimming until the wounds are fully healed. You should normally avoid swimming for 4-6 weeks following surgery.

When can I have sex again?

Sex should be avoided until you feel comfortable and ready. Sex will not do any actual harm as long the breasts are not squashed or squeezed. It would be sensible to keep a supportive bra on if having sex less then 6 week after surgery.

When will I be back to normal?

Most people feel they get back to normal between 4 and 6 weeks after surgery. Although the breasts may still be tender at this stage.

What are the risks?

The great majority of healthy people undergoing a breast uplift have an uneventful recovery and are very pleased with the outcome of their surgery. However, as with all surgery, there is the potential for complications. Complications include those of having a general anaesthetic, complications that may occur with any operation and those that are particular for a breast uplift.

General anaesthetic:

There are the risks of having a general anaesthetic such as allergic reactions, chest problems such as a chest infection and the possibility of clots in the legs (deep vein thrombosis). Underlying medical conditions e.g. asthma can be aggravated. In general, if you are healthy, modern general anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery to discuss your concerns.

Bleeding and haematoma:

During surgery great care is taken to stop bleeding. However after the end of the operation, particularly if the blood pressure is raised, a bleeding point may start bleeding again. This causes a build up of blood under the wound called a haematoma. Small haematomas usually are absorbed by the body over time. Larger haematomas may need to be removed with a further operation. Most people will then recover normally. It would be most exceptional to need a blood transfusion following a breast uplift.

Nipple loss:

During the operation the nipple has to be moved. Normally the nipple is not removed from the breast but kept alive on a block of tissue called a pedicle. It is possible for there to be an insufficient blood supply for the nipple in this block of tissue. If this is the case, the nipple can lose its blood supply and die. In healthy non-smoking women this is a very rare complication. Problems with the blood supply to the nipple are more likely with breast reductions of very large breasts rather than breast uplift operations. With very large breasts it may be advisable to use a free nipple graft technique where the nipples are removed and replaced as a graft. This technique would only be used for a mastopexy.

Infection and slow wound healing:

As breast uplift surgery is quite extensive there is a significant potential for wound infection. Most wound infections settle down with a short course of antibiotics. If a wound becomes badly infected the wound may open up and take time to heal up.

Asymmetry:

Most women have some difference in size or shape of their breasts. With a breast uplift the aim is to produce breasts which are as similar as possible. However, particularly where breasts are different before the operation, it is not uncommon for there to be some difference after the operation.

Fat necrosis:

Fat necrosis happens when areas of fat in the breast either lose their blood supply or are damaged. The fat dies and becomes a hard and frequently tender lump. These need to be diagnosed and distinguished from more serious causes of a lump in the breast. These lumps may resolve on their own but sometimes fat necrosis needs to be removed.

Seroma:

Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained, but usually resolves on its own. Draining a seroma is usually done with a needle and syringe as an outpatient.

Deep vein thrombosis (DVT):

A breast uplift is a long operation. This does increase the risk of a thrombosis (clot) in the deep veins of the legs, a DVT. A serious complication of a DVT is where a thrombus breaks off and travels to the lungs in what is called a pulmonary embolus or PE. A large pulmonary embolus can be life threatening. During your operation and time in hospital we will take measures to protect you from DVT formation although these can not guarantee complete protection. Once you go home the best protection is regular walking.

The combined oral contraceptive pill (the pill) increases the risk of DVT with surgery. If you are on one of these pills you should discuss this with your surgeon. If you stop the pill four to six weeks before your surgery then your risk returns to normal. If you stop the pill and are having intercourse then you must use alternative contraception otherwise you may become pregnant.

Scarring:

As the scars may be quite long it is important to understand that scarring varies from one person to another. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide or become lumpy, hypertrophic or keloid.

Drooping and ‘bottoming out’:

Over time breasts tend to droop because of the effect of gravity. The degree to which this happens varies with the weight of the breasts and the natural strength of the breast tissue. The breast tissue strength varies from one person to another. ‘Bottoming out’ is where the breast tissue droops but the nipple stays in an elevated position following a breast uplift. It is more likely where the nipples are placed higher with the surgery.

What else should I consider?

Mammography before surgery:

The national breast screening program recommends a mammogram every 3 years between the ages of 50 and 70 (this may change to 47 to 73). If you are in this age group you should consider ensuring you are up to date i.e. you have had a mammogram with in the last 3 years. If you have any additional risk factors or would like additional reassurance you can discuss having a mammogram anyway prior to surgery. If you are between 40 and 50 years consideration may be given to obtaining mammograms before surgery. Under the age of 40 it would be unusual to have mammograms with out a specific reason.

Mammography after surgery:

If recommended by a doctor there is no reason not to have a mammogram because you have had a breast reduction. It may be uncomfortable or painful for 3 to 6 months following surgery.

Weight loss

If you are planning to lose weight you should do so before your surgery. Losing weight after your surgery may affect the appearance of your breasts.

Finish family first

You should finish having your family before surgery as further pregnancies are likely to undo the benfit of surgery. (It is safe to have further pregnancies following an uplift).

What are the alternatives?

Well fitting bra:

Women with large breasts frequently find that a well fitting bra can help with managing their breasts.

Breast reduction

If you primarily would like smaller breasts then a breast reduction may be the procedure you should consider. A small amount of breast tissue may be removed with an uplift but this is not always the case and the change in breast volume is usually very small. Breast reduction and breast uplift are frequently carried out in the same way with the only difference being that with a reduction tissue is removed and the breasts are made smaller.

Breast implants

Where there is modest breast droop a reasonable result may be obtained with a breast augmentation. This involves placing a silicone implant behind the breast. Only a very limited uplift is achieved but the breasts are given a fuller appearance. Breast implants should not be considered a way of creating uplift as the extra weight of the implants tends to counteract the lifting effect. However the fuller appearance of the breasts may be the result you are looking for.

Breast implants and uplift combined

An uplift can be combined with breast augmentation using implants. Many surgeons would favour doing the surgery in 2 stages about 3-4months apart. When the operations are combined in single operation the risks are significantly higher. There is a greater likelihood of you needing revisional surgery. The increased swelling from 2 procedures and weight of the implants during healing from the uplift may increase the tendency for drooping and result in poor or stretched scars.