Breast Lift (Mastopexy)

Breast lifts, like breast themselves, come in many shapes and sizes. The goal is always to provide adequate lifting with the "smallest" possible procedure. This normally translates to a lift that will do the job with the shortest possible scar. A breast lift is also called a mastopexy. Masto means pertaining to the breast, while pexy refers to fixing or securing.

There are two distinct aspects to lifting a breast: Nipple Position and Breast Tissue (Breast Parenchyma) Location.

Nipple Position:

The ideal nipple position is on the front of the breast at the point of maximum projection. Whether congenital (when the nipple is low from birth) or acquired (when the nipple is low after weight loss, child birth or natural breast atrophy) the treatments are similar. The closer the nipple position is to "ideal" the less that needs to be done.

Breast Tissue Position:

Sometimes the nipple is in the correct position, but the breast tissue itself is low. This is most commonly seen after child birth or weight loss. In this situation the majority of the breast tissue is below the inframammary fold (IMF), while the nipple is still at the front of the breast.

Breast Ptosis Classification:

Ptosis means sagging. The amount of breast ptosis is graded depending on the location of the nipple with respect to the inframammary fold or IMF. The IMF is the fold under the breast where the breast skin meets the chest. Breast ptosis falls into one of three classes.

• Grade I Ptosis - The nipple is located above the IMF
• Grade II Ptosis - The nipple is located at or lower than the IMF but still points forward
• Grade III Ptosis - The nipple is located lower than the IMF and is pointing downward

Pseudoptosis - Literally fake sagging. The nipple is correctly positioned, but the breast tissue is below the IMF.

The higher the grade, the bigger the lift needed to restore a more ideal breast shape. Pseudoptosis will often respond to breast augmentation without a breast lift.

Breast Lift Before and After Photos (Mastopexy)

The Common Types of Breast Lifts

Below is a list of the most common breast lifts. They are listed in ascending order, from a crescent breast lift, which provides the smallest amount of lift, to the inverted-T, anchor or keyhole lift, which can lift even Grade III ptosis.

Crescent Lift (Crescent Mastopexy): The crescent breast lift is named for the shape of the skin that is removed. A crescent is drawn on the skin, over the top of the areola. When the skin is removed or de-epithelialized (when just the outer layer of the skin is removed) the nipple and areola are pulled up. Since the areola is still attached along its lower half, the amount of lift is limited. Moreover, pulling too hard will distort the shape of the areola. Because of these limitations, this lift is not often used for true ptosis.

PeriAreolar Lift (PeriAreolar Mastopexy): The periareolar breast lift is named after the location of its scar, because the incision is made around the areola. Since the lower aspect of the areola is closed radially, it does limit the amount of vertical lift to one or two centimeters. This type of lift is most often performed in combination with a breast augmentation in cases where there is borderline ptosis. It is also helpful for decreasing the overfull areola that is seen with the tubular breast deformity.

Vertical Lift (Vertical Mastopexy): The vertical breast lift is so named because is has a vertical scar added to a periareolar scar. The two shapes drawn together give the lift is nickname - the lollipop lift. The periareolar scar is a circle and the vertical scar runs straight down from the bottom of the circle forming the stick of the lollipop. It is a variation on the inverted-t technique that is absent the IMF scar. Since the lower aspect of the incision is closed side-to-side, there is not the downward drag associated with the pure periareolar approach. The side-to-side closure pinches the lower pole of the breast and helps push the nipple-areolar complex further up on the breast.

Horizontal Lift (Horizontal Mastopexy): The horizontal breast lift gets its name because is has a horizontal IMF scar that is added to the periareolar scar. The horizontal breast lift may be the least commonly used mastopexy technique. It requires a long narrow breast. It is a variation on the inverted-t technique that is absent the vertical scar. The lack of the vertical scar requires that the nipple be moved more than 7 centimeters. Since no skin is removed between the areola and the inframammary fold, this breast lift works best when the breast is narrow, and there is no advantage to reducing the skin on the lower pole of the breast. Since the IMF scar is low in the breast, it tends to be hidden in the curve at the base of the breast.

Inverted-T Lift, Anchor Lift, Keyhole Lift (Inverted-T Mastopexy, Anchor Mastopexy, Keyhole Mastopexy): The inverted-T breast lift gets its name from the inverted capital T shape of the scar that is added to the periareolar scar. The other names arise because the overall shape of the scar makes an anchor shape, and the shape of the upper portion of the resection looks like a keyhole before is it closed. This is by far the most versatile breast lift as it can reshape even severely overstretched or deflated breasts.

Areola Reduction

If the areola is too large an Areola Reduction may be seamlessly incorporated into all the lifts above (except the crescent lift). When the nipple and areola are in the correct location on the breast, an Areolar Reduction is most similar to a periareolar breast lift. More information from our San Francisco Bay Area, Walnut Creek Breast Lift specialist is available on the Specialty Breast Procedures page under Areola Reduction.