Gravity is not a friend to the breasts
Over time there will inevitably be a loss of support of tissues and the resultant droopiness of the breast tissue. There are a number of factors that will influence this including breast size, prior pregnancy and breast feeding, hormonal changes, poor support over years, and hereditary factors.
The degree of breast ptosis (droopiness) is determined by the relationship of the nipple to the inframammary fold (the fold defining the bottom of the breast). In general the "normal" position is about 2 cm above the fold with only a moderate amount of tissue fullness below this. Mild ptosis would be when the nipple is at fold level. Moderate is with the nipple 1-2 cm below the fold and severe would be beyond this with the nipple often pointing down.
The appearance is also significantly impacted by breast tissue that may be adding heaviness of the lower pole. In some cases this may be enough of a problem that it creates "pseudo-ptosis" or the appearance of droopiness even when the nipple position is in fact normal. Often this will be associated with a loss of upper pole volume and may benefit from volume replenishment with augmentation.
It is also possible to correct for the size of the areola for those in whom it may be excessive.
The choice of procedure is directly related to the degree of ptosis that exists as well as the breast volume and desired outcome.
If there is mild ptosis or pseudo ptosis and a smaller breast volume or in particular a loss of the upper pole fullness, breast augmentation alone may offer an ideal solution by simply re-expanding the skin envelope of the breast.
Mild ptosis where the nipple is less than 2cm from ideal may be corrected with a "crescent" lift technique which involves removing a crescent moon-like portion of skin above the nipple to allow it's repositioning. This can often result in a nice repositioning with very minimal scarring.
For more moderate ptosis the correction will require adding a vertical incision under the nipple to allow for movement without distortion of the structure. This also allows for tightening of the skin "brassier" to provide the needed lift and support. This procedure may be accompanied by augmentation to provide added volume resulting in added upper pole fullness . This corrects for the common loss of fullness and flattening that may occur. The incision is generally quite favorable in the majority of individuals and allows for close to ideal repositioning of the nipple.
Anchor Incision Mastopexy (inverted T incision)
For more significant ptosis and when there is a significant amount of excess breast tissue an inverted T type of approach will be needed. This allows the removal and tightening of the excess lower pole breast tissue and skin as well as the repositioning of the nipple. The incision design places the lower part of the incision in the natural fold of the breast and is well hidden. We are then able to minimize any "bunching" or "dog-ear" problems with the skin.
As with the other lift options this may be combined with augmentation to restore or add to volume.
Breast lift and reduction is an outpatient procedure almost always performed with general anesthesia. The surgery time varies considerably depending on the specific problem but may take as much as several hours. You will be awake and quite alert within minutes of finishing the procedure and we will have you stay in the recovery room untill we are satisfied you are ready to go home. This is generally 30 min to 1 hour following the surgery. Of course you will need to have a driver and a responsible adult to be with you afterwards.
A good option is for you and a companion to spend the night across from our Kirkland facility at the Woodmark Hotel. We would then see you for a check the following morning.
There is usually quite minimal discomfort and many not require much medication use. Although there is inevitably some swelling and possible bruising-this tends to be fairly minor and resolves fairly quickly. Some degree of swelling does continue to resolve for a longer period of time so that there is ongoing refinement and reshaping that occurs for some months.
We ask you to wear the specialized support garment that we provide at essentially all times for the first 2-3 weeks. Subsequent to this we will advise you as to the best choice of brassiere.
There may be some strips or tape over the incision lines and we will remove this after several days.
We will ask that initially some ointment be applied to the incision areas to assist in healing and in order to improve the long term scar appearance we will generally have you start using a special silicone sheet material to place over the incisions.
Who is the right candidate?
The ideal candidate for a lift or reduction is one who is past child bearing options as pregnancy may result in recurrence of ptosis and other tissue changes. Of course a younger individual with significant concerns may certainly consider the procedure even given future potential pregnancy, but should be aware of the risk that recurrence of droopiness or other changes might well arise.
A current smoker is not a candidate for breast surgery due to the very high complication rate particularly to the risk of tissue loss. Dr. Allegra will not consider the procedure for you if you actively smoke.
If you do not want any visible scar it is not possible to achieve significant improvement of the ptosis. However; if the degree of droopiness is modest we can review the option of augmentation alone that may reduce the appearance of droopiness.
Expectations and risks
Dr. Allegra will extensively review the procedure, expected outcome and risks with you-the following is a brief but not inclusive summary.
No one has absolute symmetry in all areas of the body; this is particularly true of the breasts. It is best to think of them as fraternal, not identical twins. We make all efforts to achieve the best symmetry possible. We are generally able to restore the nipple position to close to ideal, but again minor variations are normal and affected by many factors during healing.
Cleavage is dependent on several factors that are mostly due to basic anatomy. With a lift it may be possible to improve the position of the nipple on a horizontal plane as well which could narrow wide spaced breasts and perhaps allow for better cleavage. Dr. Allegra can review the possibilities dependant on your anatomy.
Overly large nipple size can be fairly easily addressed with a lift.
If there is an element of volume loss particularly in the upper pole then the addition of a breast implant at the time of the lift is often an ideal option.
The major risk of breast lift and reduction is related to the blood and nerve supply to the tissues. This procedure is performed very gently with all attempts to avoid compromising the tissues; however, there is a risk of poor healing with possible tissue loss of skin areas that might require further corrective surgery. This is particularly true in smokers and we will not offer this procedure to you if you are smoking or haven't stopped for at least 3 weeks.
Visible scars are unavoidable with the majority of lifts and will be highly dependent on your individual healing tendency. In most cases the results are truly excellent but some individuals may be highly prone to widening or thickening of a scar that might then warrant further treatment. Pigmentation problems, particularly darkening of the incision is occasionally seen-particularly if you are darker complected or of Mediterranean or Asian descent. This generally will improve or resolve with minor treatment.
Some asymmetry as noted above is normal and unavoidable; however, more significant asymmetry would rarely occur requiring correction.
Infection is a very rare but potentially serious complication that often requires further surgery and drainage. I f there is an implant this would have to be removed and later replaced.
Bleeding (hematoma) is also rare but might require another surgery for drainage.
Loss or decrease of nipple sensation may occur. Usually this will return over time; however, a permanent loss is a rare possibility.