7th January 2013 Breast lift – Mastopexy
A mastopexy is a common operation to remove excess skin from breasts which have lost some of their original shape usually following pregnancy or loss of weight. It can also be used to alter the shape of breasts which have developed pendulous.
The operation is also useful to correct breast asymmetry, so that the breasts can be equalised and lifted at the same time.
With large breasts, the nipple often lies quite low on the breast, and the areola around the nipple may be stretched. As long as the breasts are not too heavy, this can all be corrected as part of the mastopexy. The nipple usually does not need to be detached from the breast, but just moved upwards into position with its blood supply still connected. If the breasts are heavy, I recommend a small reduction because heavy breasts may over time distort the shape of a mastopexy.
It is important not to underestimate the magnitude of the operation. It takes up to three hours under general anaesthetic, and a stay in hospital of one night is usually recommended. After this, a good three weeks is needed to regain one’s energy, and up to two months for a full recovery to normal.
A mastopexy entails the same type and pattern of surgery as a breast reduction, but breast tissue is not removed or not to a significant extent because the main purpose is removing excess skin and a more youthful shape.
WHAT DOES A MASTOPEXY ENTAIL?
For a mastopexy as for any other operation, it is important to prepare yourself, so that everything runs smoothly. This means ensuring that you are fit and not anaemic, eat sensibly and stop smoking/vaping if you are a smoker.
Why stop smoking? Apart from the general increased risk of chest infection, the nicotine in cigarettes/vaping/nicotine patches causes a temporary narrowing or constriction of blood vessels, so that you carry less oxygen to the breast and you heal less quickly; furthermore you may be more likely to heal with an infection or more scar tissue.
You may need to lose weight, as overweight people have a higher risk of deep vein thrombosis, chest infection, and wound infection as well as possibly not getting as nice a cosmetic result. You need to check your list of supplements and medication with your general practitioner, and myself, in order to ensure that you are not more susceptible to bleeding or other complications.
The operation itself is performed under general anaesthetic. The anaesthetist will see you before your operation. Discuss any queries you have about the anaesthetic with your anaesthetist. If you have had any difficulties during a general anaesthetic in the past make sure that the anaesthetist and I know about it ahead of time. On the evening after your general anaesthetic you will feel rather tired and sleepy and should warn your visitors not to visit you for too long.
During the operation a large quantity of skin may be removed. It is not possible to do this without creating scars. Your scar will run around the nipple, and possibly also down the centre of the breast below the nipple and along the crease below the breast. I try to limit the scars as much as possible, so that they don’t show with revealing clothes. The scars will never completely disappear and may even stretch (widen) as the year goes by. The scars start off red and noticeable. Over a period of time they will fade – it will take about 12 to 18 months for this process to occur. Some people’s scars fade better and faster than others. If you scar “badly” there will be only slight fading and you will be left with red, thickened scars that remain noticeable and sometimes painful and itchy (keloid or hypertrophic scars) over a longer period of time as the scars take longer to mature. I do my best to advise how to reduce this.
Most if not all the sutures used are buried and dissolvable. The sutures can make their way out through the skin instead of dissolving or can cause small areas of inflammation or suture abscesses. This is a temporary nuisance but is not serious.
Moving the nipple upwards is usually part of the mastopexy and involves cutting tissue with its nerve and blood supply. This can result in an alteration in the nipple sensation which is usually temporary. Some ladies find a decrease in sensation with a degree of numbness and others an increase in sensation with a degree of tenderness. Most experience no change in sensation. Usually in consultation with you I will make the areola smaller in keeping with a more youthful look.
Interfering with the blood supply to the nipple may occasionally result in small areas of breakdown of the nipple or areola. These areas will be slow to heal but will heal leaving an area of scarring on the nipple or areola. It is possible to lose all or nearly all of the nipple and areola on one or both sides. This is a more serious complication and would require further surgery to reconstruct the nipple. Fortunately this more serious complication rarely occurs.
Moving the nipple may involve dividing the milk ducts of the breast. More often than not breast-feeding is no longer possible after a mastopexy. You must be satisfied in your own mind that you will not want to breast feed in the future. If you are unsure about this it is perhaps best to delay your surgical operation until you have completed your family.
Sometimes the fat tissue in the breast forms hard tender lumps after surgery. This is called fat necrosis. This is uncommon after a simple mastopexy. These lumps usually settle on their own over a period of time (which may be several months).
Any operation can result in infection or bleeding, and breast operations are no exception. Simple infections will settle with dressings or a course of antibiotics. Some infections will require further treatment.
If you notice increasing redness of your wound and it is painful make sure to get it checked as soon as possible – infections caught early are easier to cure. Bleeding after your operation can result in a collection of blood called a haematoma. Haematomas must be drained in theatre otherwise they can cause wound problems later on.
With a mastopexy, little or no breast tissue is removed. The aim is to remove excess skin and lift the breast. If there is asymmetry, I can reduce this asymmetry after discussion with you by reducing slightly the larger breast. After your operation it is inevitable that you will have some asymmetry. This is seldom noticeable to other people.
Sometimes the upper part of your breast is flat or empty. Traditionally this is corrected with the use of breast implants. It is however possible to use excess breast tissue from the lower part of the breast and move it to give fullness in the upper part by using internal flaps. This takes a little longer but allows you to avoid having implants and needing to change them over time.
Sometimes there are little folds at the ends of the scars. These are called ‘ dog ears ’. If they do not settle over a period of about 6 months they can be removed as a small operation under local anaesthetic. I will also discuss planned dog ears with you.
WHAT TO EXPECT WHEN YOU RETURN FROM THEATRE
- A drip –this stays in until you are eating and drinking normally– usually just overnight at most
- Drains – one to each breast. These stay in until they stop draining – usually about 24 hours,– sometimes you do not require drains. I do not send you home with drains.
- Dressings – a firm dressing will be applied to support the breasts after the operation. This usually stays on until after you go home and will be removed in due course at the first follow up appointment. I will provide you with comfortable soft (not underwired) but supportive bras once you are up and about.
- Heparin – lying in bed increases the chance of the veins in your legs clotting. To counteract this you will have tiny heparin type injections under your skin once a day until you are mobile. You will also be given firm TED stockings to wear until you go home.
- Home – once your drains are out and you are up and about and feeling well enough you will be able to go home.
WHAT TO EXPECT AFTER YOU GO HOME
At first you will feel rather tired and should spend the first week or so taking it very easy. Thereafter you will be able to build up slowly to doing your usual activities. A mastopexy is a big operation, which does take time to get over. Expect to feel more tired than usual for up to 2 months.
You will be able to start driving once you feel up to it. For most people this will take about two weeks. Do not drive if you are not well, alert and able to take emergency action safely. It is advisable to check with your insurance company before you start driving. You will, likewise, be able to start work again once you feel up to it. If your job involves a lot of lifting or heavy work this will take longer. Most people get back to work after three weeks to a month.
A mastopexy is an excellent operation when done under the right conditions for the right reasons. That means preparing for the operation and for the recovery time after the operation as well. It is possible to really rejuvenate the shape of your breasts by removing the excess skin and lifting them up.