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 If
you are considering a breast lift...
Some women have unshapely, hanging breasts that are
not overly large. These can be raised by methods
similar to those used in breast reduction, but with
resection only of the superficial portion of the
excess skin. This procedure is termed "mastopexy."
For those with "empty" hanging breasts (often after
pregnancy, breast-feeding, or weight loss),
augmentation with an implant may be considered at
the time of the uplift. Over the years, factors such as pregnancy, nursing,
and the force of gravity take their toll on a woman's
breasts. As the skin loses its elasticity, the breasts
often lose their shape and firmness and begin to sag. Breast lift, or mastopexy, is a surgical procedure to
raise and reshape sagging breasts--at least, for a
time. (No surgery can permanently delay the effects of
gravity.) Mastopexy can also reduce the size of the
areola, the darker skin surrounding the nipple. If
your breasts are small or have lost volume--for
example, after pregnancy--breast implants inserted in
conjunction with mastopexy can increase both their
firmness and their size. If you are considering a
breast lift, this discussion will give you a basic
understanding of the procedure--when it can help, how
it's performed, and what results you can expect. It
can't answer all of your questions, since a lot
depends on your individual circumstances. Please be
sure to ask Dr. Gutstein if there is anything about the
procedure you don't understand.
THE BEST CANDIDATES FOR BREAST LIFT
A
breast lift can enhance your appearance and your
self-confidence, but it won't necessarily change your
looks to match your ideal, or cause other people to
treat you differently. Before you decide to have
surgery, think carefully about your expectations and
discuss them with Dr. Gutstein.
The best candidates for mastopexy are healthy,
emotionally-stable women who are realistic about what
the surgery can accomplish. The best results are
usually achieved in women with small, sagging breasts.
Breasts of any size can be lifted, but the results may
not last as long in heavy breasts.
Many women seek mastopexy because pregnancy and
nursing have left them with stretched skin and less
volume in their breasts. However, if you are planning
to have more children, it may be a good idea to
postpone your breast lift. While there are no special
risks that affect future pregnancies (for example,
mastopexy usually doesn't interfere with
breast-feeding), pregnancy is likely to stretch your
breasts again and may offset the results of the procedure,
but retightening can be done.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK
A
breast lift is not a simple operation, but it's
normally safe when performed by a qualified plastic
surgeon. Nevertheless, as with any surgery, there is
always a possibility of complications or a reaction to
the anesthesia. Bleeding and infection following a
breast lift are uncommon, but they can cause scars to
widen. You can reduce your risks by closely following
your physician's advice both before and after surgery.
Mastopexy does leave noticeable, permanent scars,
although they'll be covered by your bra or bathing
suit. (Poor healing and wider scars are more common in
smokers.) The procedure can also leave you with
unevenly positioned nipples, or some loss of
feeling in your nipples or breasts.
PLANNING YOUR SURGERY
In
your initial consultation, it's important to discuss
your expectations frankly with Dr. Gutstein. Every patient--and every
physician, as well--has a different view of what is a
desirable size and shape for breasts.
Dr. Gutstein will examine your breasts and measure them
while you are sitting or standing. He will
discuss the variables that may affect the
procedure--such as your age, the size and shape of
your breasts, and the condition of your skin--and
whether an implant is advisable. You should also
discuss where the nipple and areola will be
positioned; they'll be moved higher during the
procedure, and should be approximately even with the
crease beneath your breast.
Dr. Gutstein should describe the procedure in detail,
explaining its risks and limitations and making sure
you understand the scarring that will result. He should also explain the anesthesia to be used, the
type of facility where the surgery will be performed,
and the costs involved.
Don't hesitate to ask the doctor any questions you
may have, especially those regarding your expectations
and concerns about the results.
PREPARING FOR YOUR SURGERY
Depending on your age and family history, Dr. Gutstein
may require you to have a mammogram (breast x-ray)
before surgery. You'll also get specific instructions
on how to prepare for surgery, including guidelines on
eating and drinking, smoking, and taking or avoiding
certain vitamins and medications.
While you are making preparations, be sure to arrange
for someone to drive you home after your surgery and
to help you out for a few days if needed.
WHERE YOUR SURGERY WILL BE PERFORMED
Your
breast lift may be performed in a hospital, an
outpatient surgery center, or a surgeon's office-based
facility. It's usually done on an outpatient basis,
for cost containment and convenience. If you are
admitted to the hospital as an inpatient, you can
expect to stay one or two days.
TYPES OF ANESTHESIA
Breast lifts are usually performed under general
anesthesia, which means you'll sleep through the
operation. In selected patients--particularly when a
smaller incision is being made--Dr. Gutstein may use
local anesthesia, combined with a sedative to make you
drowsy. You'll be awake but relaxed, and will feel
minimal discomfort.
THE SURGERY
Mastopexy usually takes one and a half to three and a
half hours. Techniques vary, but the most common
procedure involves an anchor-shaped incision following
the natural contour of the breast. The vertical
or "lollypop" lift may be appropriate and avoids the
horizontal scar under the breast.
The incision outlines the area from which breast skin
will be removed and defines the new location for the
nipple. When the excess skin has been removed, the
nipple and areola are moved to the higher position.
The skin surrounding the areola is then brought down
and together to reshape the breast. Stitches are
usually located around the areola, in a vertical line
extending downwards from the nipple area, and along
the lower crease of the breast.
Some patients, especially those with relatively small
breasts and minimal sagging, may be candidates for
modified procedures requiring less extensive
incisions. One such procedure is the "doughnut (or
concentric) mastopexy," in which circular incisions
are made around the areola, and a doughnut-shaped area
of skin is removed.
If you are having an implant inserted along with your
breast lift, it will be placed in a pocket directly
under the breast tissue, or deeper, under the muscle
of the chest wall.
AFTER YOUR SURGERY
After surgery, you'll wear an elastic bandage or a
surgical bra over gauze dressings. Your breasts will
be bruised, swollen, and uncomfortable for a day or
two, but the pain shouldn't be severe. Any discomfort
you do feel can be relieved with medications
prescribed by Dr. Gutstein.
Within a few days, the bandages or surgical bra will
be replaced by a soft support bra. You'll need to wear
this bra around the clock for three to four weeks,
over a layer of gauze. The stitches will be removed
after two to three weeks or may be of the dissolvable
type.
If your breast skin is very dry following surgery, you
can apply a moisturizer several times a day. Be
careful not to tug at your skin in the process, and
keep the moisturizer away from the suture areas.
You can expect some loss of feeling in your nipples
and breast skin, caused by the swelling after surgery.
This numbness usually fades as the swelling subsides
over the next six weeks or so. In some patients,
however, it may last a year or more, and occasionally
it may be permanent.
GETTING BACK TO NORMAL
Healing is a gradual process. Although you may be up
and about in a day or two, don't plan on returning to
work for a week or more, depending on how you feel.
And avoid lifting anything over your head for three to
four weeks. If you have any unusual symptoms, don't
hesitate to call Dr. Gutstein.
Dr. Gutstein will give you detailed instructions for
resuming your normal activities. You may be instructed
to avoid sex for a week or more, and to avoid
strenuous sports for about a month. After that, you
can resume these activities slowly. If you become
pregnant, the operation should not affect your ability
to breast-feed, if you were able to before surgery, since your milk ducts and nipples will
be left intact.
YOUR NEW LOOK
Dr. Gutstein will make every effort to make your scars as
inconspicuous as possible. Still, it's important to
remember that mastopexy scars are extensive and
permanent. They often remain lumpy and red for months,
then gradually become less obvious, sometimes
eventually fading to thin white lines. Fortunately,
the scars can usually be placed so that you can wear
even low-cut tops.
You should also keep in mind that a breast lift won't
keep you firm forever--the effects of gravity,
pregnancy, aging, and weight fluctuations will
eventually take their toll again. Women who have
implants along with their breast lift may find the
results last longer.
Your satisfaction with a breast lift is likely to be
greater if you understand the procedure thoroughly and
if your expectations are realistic.
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