Removing excess skin
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A breast lift, or mastopexy, corrects sagging breasts by removing excess skin and repositioning the nipple higher. The diameter of the areola is reduced at the same time if overly large to begin with. This operation is a trade-off of improved shape for permanent scars. There actually is little change in the appearance of the breasts when clothed and supported by a bra. However, wearing a bra is more comfortable after a lift because the bra is not working hard to lift the breasts but rather just holds them in place.
In mastopexy the skin is removed from the lower part of the breast in order to conceal the scars as much as possible. There is no way to lift the breasts from above without leaving profound and very objectionable scars. This is simply not done. The typical scar pattern today is the same as that for a breast reduction: the final scar will encircle the areola and then extend as a vertical line down to the crease underneath the breast. The most traditional type of mastopexy also includes a scar in the crease of the breast.
A mastopexy accomplishes more than just raising the breast. It simultaneously elevates the nipple position on the breast so that it will point forward instead of downward. A mastopexy also makes wide breasts narrower so that there is less fullness on the side to rub against the arms. The breasts can also be made slightly smaller if desired by removing some of breast tissue from the bottom of the breasts as an integral part of the lift procedure.
There are some things a mastopexy cannot do. A mastopexy will not be helpful to women who have long torsos with breasts that are naturally positioned low on the chest but otherwise have good shape and do not really sag. The breasts cannot be raised to a higher position on the chest in these individuals. Mastopexy is also limited in that it cannot by itself restore missing volume to the upper breast that commonly develops as a consequence of multiple pregnancies nor can it remove stretch marks of the breasts. The upper breasts may be somewhat concave in shape following mastopexy in women who have either lost a lot of breast volume due to postpartum atrophy, have severely stretched breast skin, or both. Breast implant placement together with mastopexy exists as an option to restore upper breast fullness in these cases.
Mastopexy removes excess skin without really disturbing the underlying gland which contains the small sensory nerves that supply feeling to the nipple. Nipple sensation may nevertheless be permanently diminished following mastopexy but this is a rare occurrence. More often any changes that occur are mild and transient. Mastopexy with augmentation is more likely to affect sensation because of the need to make a pocket for the implant, a maneuver that can stretch the nerves. Nipples sometimes can become unpleasantly hypersensitive after surgery. This is an indication that the sensory nerves have been stretched slightly. This condition is a benign process that eventually resolves.
The ability to breast-feed normally after a breast lift is similar to the sensation issue: more aggressive procedures that disturb the gland tissue are more likely to impair function. A mastopexy that just removes skin is safest in this respect. This is not a major issue for most women because they typically do not become candidates for a mastopexy until multiple pregnancies have adversely affected the breasts.
Breast lifts are performed under general anesthesia. A surgical bra is placed at the time of surgery and is worn continuously (except for bathing) for six weeks after surgery.
The aftercare following breast lift surgery is minimal. Stitches dissolve and do not need to be removed. Most daily activities can be resumed at that time although heavy lifting should be avoided for six weeks. Limited exercise involving primarily the lower body may begin two weeks after surgery. Jogging or intense exercise involving the chest and arms is not recommended for six weeks.
Poor skin elasticity, large breast size, pregnancy, and weight gain can cause the breasts to sag years after a breast lift. If this happens it is possible to tighten the skin again using the original scar pattern. This is usually less involved than the original procedure. However, most women have a long-lasting improvement after a mastopexy and do not require a second procedure.
Problems such as bleeding, infection, loss of nipple or skin tissue, decreased nipple sensation, delayed healing and excessive scarring can occur following a breast lift. Fortunately, these problems are rare.
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