A Mastopexy or Breast Lift involves reshaping the breast to give a more elevated and youthful shape to the breast. This can be combined either with a simultaneous reduction or augmentation of the breast volume. A mastopexy primarily involves removing and tightening the excess skin and correcting the nipple and areola position to a higher and more centralized position on the breast. There are many variations of the mastopexy procedure that may be recommended for you depending on your goals and preferences.
In a breast reduction, we decrease the weight and volume of the breast to improve the proportion of the breast size with respect to the rest of your body. A mastopexy is similar but the weight of tissue removed is much less than a standard breast reduction. The goal with a mastopexy is typically more about an improved and lifted shape with a minor reduction in the volume and weight of the breast. [See Breast Reduction for more details.]
An implant is the most reliable and powerful way to increase the overall breast volume, especially the upper breast fullness and cleavage area. The implant position will settle in the early period after surgery but should then remain in a stable position long term. The size of implant used depends very much on a patient’s preferences and the look she desires. When combined with a mastopexy, the breast shape can change dramatically, from a deflated and droopy breast to a full, rounder, and lifted appearance. A temporary implant (implant sizer) is used first and then the overlying skin and breast tissue is tailored to fit the shape and give the best combination of skin tightening and lifting. The nipple and areola are then repositioned to the appropriate location.
Any of the incision patterns can be combined with the Implant Augmentation Mastopexy. However, for certain patients, breast augmentation with the appropriate size and positioning of the implants can provide enough of a lift by itself to avoid the need for a Mastopexy.
For women that want to maintain the size of their breasts but improve the position and upper pole fullness (think perky, youthful shape), Dr. Davison uses a technique which repositions the descended lower breast tissue to the upper chest and secures this behind the NAC, which can give a more full and rounded look similar in some ways to an implant, but using only your natural tissue.
There are essentially 3 different patterns of incisions used for a Mastopexy. All patterns require an incision around the areola, where the final scar will be at the junction of the pigmented areola skin and the lighter breast skin. This incision is needed to reposition and elevate the nipple & areola. The vertical and horizontal breast fold incisions are needed depending on the patient and the required skin tightening.
For larger breasts with a starting nipple position that is well-below the breast fold (IMF), this is typically best with the full anchor or inverted T-shape. This is the classic incision and provides the ability to dramatically reshape the breast. The excess skin and tissue can be removed as needed and the horizontal scar is kept hidden in the breast fold. Dr. Davison avoids placing the scar in the visible midline area of the breast and would only extend it laterally to the side of the chest for patients with extensive skin excess, such as post-bariatric surgery or massive weight loss.
For smaller breasts, a circumareolar (donut-style incision), or vertical only (lollipop-style) may be sufficient for tightening and lifting the breast.
Fat grafting involves removing unwanted fat from another location in your body, typically the abdomen, flanks (love-handle area), or inner thighs and transferring it to the breasts.. This is done by tiny 3-4 mm incisions using a liposuction cannula. The fat is kept sterile and processed to isolate only the high quality young fat cells and associated stem cells. This processed fat graft can then be distributed as needed to augment and shape the breast. This is a good natural alternative to implants for those interested in a small augmentation at the same time as the Mastopexy (breast lift). The limitation of fat grafting is that the maximum amount that can be reliably augmented at one time is between 100-300 mL per session (but this can vary widely by patient, depending on their original breast size and shape). Also, only 60-70% of the fat survives long-term (beyond 3 months), regardless of technique used. This is therefore adjusted for during the surgical planning. However the fat that survives will then last a lifetime and change with you (gaining or losing weight).
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Dr. Davison is a Canadian board certified Plastic Surgeon and an Assistant Professor of Plastic Surgery at McGill.
