Breast Lift (Mastopexy)
San Francisco Breast - Breast Lift Pages
The Breast Lift, like the breasts themselves, come in many shapes and sizes. A breast lift is also called a Mastopexy. Masto means pertaining to the breast, while pexy refers to fixing or securing, and in this case, lifting.
The most important step in any cosmetic plastic surgery is the planning. Preparation for a Breast Lift includes defining the goals of the procedure, and understanding why a specific type of Mastopexy is selected. The goal of your preoperative consultation should be to learn your options. Is a Breast Lift needed? Are there any alternatives?
If a Breast Lift is the best plan of action, the key to a good result is to find the optimal compromise between the amount of lifting required to achieve the ideal breast shape, and the type of lift. In other words, plastic surgeons strive to use the "smallest" possible procedure, that still provides sufficient correction and reshaping of the breasts. This normally translates to a Breast Lift that will do the job with the shortest and most hidden scars. There are two distinct aspects to lifting a breast: correcting a low Nipple Position and tightening up saggy Breast Tissue (Breast Parenchyma).
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 Lift Before and After Photos (Mastopexy)
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 Videos (Mastopexy Videos)
The Common Types of Breast Lifts
No matter which is selected, Breast Lifts share some common techniques. The nipple and areola remain attached to the breast tissue. This preserves the nipple's sensation and blood supply. Large areolae are reduced and elevated on the breast mound by sliding the them under the breast skin to the correct level. Excess skin on the lower breast is removed to form a new skin brassiere that lifts the breast tissue higher on the chest wall. The location of the scars depends on where the skin is removed. The amount of elevation required, the starting position of the nipple/areola complex and the amount of excess skin all determine the best breast lift in each case.
Below is a list of the most common breast lifts. They are listed in ascending order of complexity, from a crescent breast lift, which provides the smallest amount of lift, to the work-horse inverted-T, anchor or keyhole lifts, which can correct 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. The crescent of skin is removed or deepithelialized (when just the outer epithelium of the skin is removed), and the area is closed, lifting the nipple and areola. 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 the limitation, the Crescent Lift is used for small adjustments to the nipple/areola position, and cannot be used to correct significant ptosis (sagging).
PeriAreolar Lift (PeriAreolar Mastopexy): The periareolar breast lift is named after the location of its scar, because the incision is made around the areola. The shape of the skin excised gives this lift its nickname - the doughnut lift. Since the lower aspect of the areola is closed downward, it tethers the areolae inferiorly and limits the amount of vertical lift to one or two centimeters. This type of purse-string lift is often performed in combination with breast augmentation in cases where there is borderline ptosis. It is also helpful for decreasing the overly full or puffy 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 like the top of a lollipop, while the vertical scar runs straight down forming the stick. It is a variation on the inverted-t technique that eliminates the IMF scar. Since the lower aspect of the incision is closed side-to-side, there is no downward pull on the areolae as there is in the pure periareolar approach. The side-to-side closure pinches the lower pole of the breast and helps push the nipple-areolar complex higher up on the breast.
Horizontal Lift (Horizontal Mastopexy): The horizontal breast lift gets its name because it has a horizontal IMF scar in addition to the separate periareolar scar. The horizontal breast lift may be the least commonly used mastopexy technique. It requires a long narrow breast and significant nipple ptosis. It is a variation on the inverted-t technique that eliminates the vertical scar. To remove the vertical scar, the nipple needs to be raised more than 7 centimeters. The horizontal breast lift works best when the breast is long and narrow, and when there is no advantage to reducing the skin horizontally on the lower pole of the breast. The IMF scar is low and is 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 at 6 o'clock on the periareolar scar. The anchor lift names arise because the overall shape of the scar looks a bit like an anchor. The keyhole nickname comes from the shape of the upper portion of the resection. It looks like a keyhole before is it closed. This is by far the most versatile breast lift as it can reshape even severely overstretched and deflated breasts.
Breast Lift Presentation
Click or touch to view a video presentation.
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 San Francisco Breast Areola Reduction page.
Breast Lift Follow-up and Recovery
Breast Lift Recovery usually takes a few days to weeks. During the first few days, you will need to take it easy and just recover. Ice, elevation, rest and a comfortable bra will all help. An instruction sheet will be supplied for your post-operative care. Dr. Mele will see you back in the office periodically, beginning the week after your Breast Lift to be certain that you are healing well. Drains are not usually used, but in the rare cases when required, they are removed at the first follow-up visit. Walking is encouraged right after surgery. Desk work may resume as soon as you feel fit, often in a few days. Vigorous activities, that require repetitive overhead motion or that cause bouncing should be avoided for at least six weeks. Excess pain, swelling or other problems should be reported as soon as possible to keep everything on track. As you continue to heal, specific instructions for scar care will be detailed.
Schedule Your Breast Lift Consultation Today
If you are considering a Breast Lift, give us a call at (925) 943-6353 and schedule your personal Breast Lift Consultation. Dr. Mele is a Board Certified Plastic Surgeon who specializes in cosmetic plastic surgery. His San Francisco Bay Area office in Walnut Creek, CA, can also be reached with the contact form on this page. While we strive to provide the best possible information on our San Francisco Breast web site, medical advice can only be given after a careful history and examination. Dr. Mele will review your options and help you pick the best Breast Lift, tailored to your specific needs.