Breast Lift (Mastopexy)

Breast lift surgery, a mastopexy, is indicated for those women whose breasts have fallen and lost their shape with the nipple position being close to or at the bottom of the breast. The mastopexy procedure is often done in conjunction with breast augmentation. Most commonly, women seek consultation for a breast lift after child birth or weight loss.

WHAT ARE THE DIFFERENT TYPES OF BREAST LIFT PROCEDURES?

Breast lift procedures vary mainly in the pattern of scars left on the breast after the procedure. The breast lift procedure involves two goals:

1. Repositioning of the location of the nipple relative to the skin envelope
2. Reduction and reshaping of the skin which envelopes the breast
   

There is usually little to no tissue remove during a mastopexy. The nipple and areola remain attached to the breast tissue at all times and simply move with the breast volume as it is lifted by the reshaped skin.

The choice of procedure is dependent on several factors; however, one of the most important is how much the nipple has fallen relative to its original position. This is measured by a scale called the Baker scale. The three Baker measurements in woman who are seeking breast lift surgery are:

1. Baker II – The nipple is located between its original “ideal” position and the inframammary fold
2. Baker III – The nipple is located below the inframammary fold
3. Baker IV – The nipple is located at the very bottom of the breast
   

The other important factor is how much excess skin there is relative to the volume of breast tissue. For example, a patient who has lost much of their breast volume and is left with a great excess of skin after pregnancy, breast feeding, or weight loss may require a different procedure than that patient who has a mild excess of skin relative to her near normal breast volume and just requires a repositioning of her nipple.

Thus, the pattern of scars after a breast lift, or mastopexy, includes:

1. Periareolar only
2. Periareolar plus a vertical or vertico-lateral incision which extends from the bottom (6 o’clock) of the areola to the inframammary fold
3. Periareoalar plus an L-shaped scar extending from the bottom of the areola to the inframmary fold
4. Periareola plus a T-shaped scar resulting in the classic description of an anchor shaped scar
   

CAN A BREAST AUGMENTATION BE COMBINED WITH A BREAST LIFT PROCEDURE?

Not only can a breast augmentation be combined with the mastopexy procedure, but it often adds to the aesthetic result in many ways. Women who have an extreme reduction in the volume of their breast tissue cannot expect an ideal shape of the breasts after mastopexy. Complementing their procedure with an augmentation will allow the surgeon to achieve a more cosmetically pleasing shape. Increasing the volume of the breast will also often enable the surgeon to suggest a procedure where the final pattern of scarring is smaller. The reason for the latter is that by increasing the volume of the breast with an implant, the relative excess of skin volume is reduced, less skin has to be removed, and there is less scarring.

DOES BREAST LIFTING SURGERY REQUIRE A HOSPITALIZATION OR IS IT AN OUT-PATIENT PROCEDURE?

The procedure is done on an outpatient basis in our AAAHC (Accreditation Association for Ambulatory Health Care, Inc.) ACCREDITED OFFICE BASED SURGERY FACILITY. 

WHAT TYPE OF ANESTHESIA IS REQUIRED?

This procedure is most commonly done as an outpatient under a local anesthesia with intravenous sedation by a board certified anesthesiologist.

WHAT ARE THE COMPLICATIONS?

The complications of a mastopexy are very small in incidence and include the normal complications of surgery, such as scarring, infection, asymmetry, alteration in nipple sensation, etc. Patients will occasionally require a secondary procedure to correct any minor asymmetries or unsatisfactory scarring that may result.

WILL I LOSE SENSATION AFTER THE SURGERY? WILL I BE ABLE TO BREAST FEED?

As noted above, the nipple-areola complex is not separated from the underlying breast tissue during the mastopexy procedure. Try to envision the breast tissue and the attaché nipple and areola being repositioned by the surgeon beneath and within the overlying envelope of skin. The relationship of the nipple and breast to each other (and logically to the local sensory nerves and breast ducts) does not change. As a result, it is extremely rare for a patient to experience loss of nipple sensation or to lose the ability to breast feed after this procedure.

HOW MUCH DISCOMFORT WILL I HAVE? WHAT ARE MY POST-OPERATIVE INSTRUCTIONS- shower, exercise, work, etc?

The patient goes home in a gentle compression dressing of gauze and ace bandages. She is able to remove the dressing after 48 hours, shower, and change into a sports bra. Initial discomfort is controlled with oral medication. Patients are generally seen the first and second weeks after the procedure. Light activities can be resumed as tolerated. Most patients return to work or school sometime at the end of the first week after the procedure. Aerobic activities can be resumed in about 3 weeks.

WHAT ARE THE COSTS OF A MASTOPEXY

The range of total cost for a mastopexy ranges from $5,000 to $10,000. This includes $1,500 to $1,800 for the anesthesiologist and $1,800 - $2,500 for the facility fee. The remainder is the surgical fee. Patients undergoing a simultaneous breast augmentation may have additional fees, such as the cost of the breast implants.

ARE MASTOPEXY PROCEDURES COVERED BY INSURANCE?

Insurance carriers will generally not cover mastopexy procedures performed for changes due to age, pregnancy or breast feeding, or mild to moderate weight loss. Patients who have undergone surgery for massive weight loss and require extensive reshaping of their breast may find some coverage depending on their policy and carrier. A mastopexy that is performed at the time of breast reconstruction in order to achieve symmetry with the reconstructed breast is often covered by insurance.

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation and the completion of any required testing. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.