Breast Uplift (Mastopexy)
What is breast uplift?
Breast uplift is an operation whereby breasts are reshaped. It is a very similar operation to a breast reduction, only the skin is tightened and no breast tissue is removed.
Who will the operation help?
Often as a result of weight loss, having children, breast feeding or just with aging, the breast skin stretches and the breasts sag. This sagginess can be corrected by a breast uplift.
What size will my new breasts be?
As no breast tissue is usually removed, your breasts will stay the same size, but will be reshaped to appear firmer and more pert.
It is very difficult to do a mastopexy on a very small breast (eg an A or small B cup) as there needs to be a certain amount of breast tissue left to reshape into a natural breast shape. If the breast is small and saggy, it may be that a breast augmentation is a better choice. Occasionally, I may recommend a combination of breast augmentation and mastopexy combined. This can carry a higher risk of complications and sometimes it is best done as 2 separate operations 6 months apart. This will be discussed at consultation.
Is breast uplift available on the NHS?
Breast uplift is rarely available on the NHS. The only time it may be considered is for women who have undergone massive sustained weight loss (more that 6 stones weight loss sustained for over a year) and whose breasts have shrunk to form empty, saggy folds of skin.
How is the operation done?
The operation is done under a general anaesthetic (with you asleep). The ideal position for a nipple is level with the crease under the breast. The first stage is to move the nipple upwards to its ideal position. The nipple has to be moved with a block of breast tissue in order to keep a blood vessel (and hopefully a nerve) with it, to keep it alive! Once this has been done, the skin is lifted off the lower half of the breast and the breast tissue is folded onto itself and reshaped. This is the key step in a mastopexy operation and once the breast tissue has been reshaped it is held in shape using buried, permanent stitches. You will then be sat upright on the operating table to ensure your breasts are of equal size and shape. A drain is then usually placed in each breast (which emerges from your skin close to your armpit). At this stage the skin is redraped over the reshaped breast and any excess skin is carefully tailored and cut off. The skin wounds are closed using buried, dissolvable stitches. Your wounds are then dressed and surgical tapes are applied all around your new breasts. The tapes help to support your new wounds and shape your breasts until they have healed a little.
What shape will my scar be?
You will have a scar around your areola and a vertical scar running down from the centre of this areola scar to the crease under your breast. In the early weeks the skin under each breast will contain many wrinkles which appear unsightly. Do not worry about this, it is normal. Over the next six weeks these wrinkles will disappear.
How long is the operation?
Mastopexy surgery usually takes about 2-3 hours
How many days in hospital?
Most women undergoing a mastopexy stay in hospital overnight and go home on the day after surgery. Occasionally the drain bottles may be quite full the next day and may need to stay in for a further day or two, delaying discharge from hospital.
Postoperative period in hospital
When you wake up you will have surgical tapes over your breasts. The operation causes a moderate amount of discomfort but you will receive regular painkillers which should keep you comfortable. You should limit your arm movements and wear your sports bra before being discharged from hospital.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your dressings and inspect your wounds, which may or may not have healed at this time. If they have, you will be given advice on wound care, bathing and exercise advice. If they have not quite healed by this one week visit, she will reapply the dressings and arrange to see you again the following week. Once your wounds have healed you will be given an appointment to see me six weeks after your operation. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
Will a mastopexy operation cause breast cancer?
Mastopexy surgery does not increase your risk of developing a breast cancer.
Will a mastopexy operation affect my ability to feel or detect breast cancer?
Mastopexy will not affect your ability to feel or detect a breast cancer. Your breast will, however, feel different after your operation. You should allow six weeks for the breast to properly heal and then you should start to feel your breasts so you get to know how they feel. There will be some internal scarring and lumpiness. This is normal. The important thing to do is to learn what is “normal” for your new breast, and with subsequent regular breast self-examination you will be looking for any new change from this “normal”.
What are the possible risks?
All surgery carries the potential for complications. The specific complications that may occur with a mastopexy are:
- Infection; infection is not uncommon with mastopexy and can result in swelling, redness and tenderness at any time up to 3 weeks after surgery. This usually responds well to a course of antibiotics. Occasionally however, it can result in some opening of the wounds. This wound breakdown is not a disaster and is usually managed by regular wound dressing and usually heals in four to six weeks.
- Bleeding: bleeding can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. Arm movements should be limited for the first week. Should a bleed occur into the breast, the breast can swell quite dramatically and you may develop visible bruising and tenderness. If this happens you usually need to return to theatre to have the blood removed and the bleeding stopped.
- Ugly scarring: although most scars settle very nicely to leave a pale flat line, occasionally scars may become red, raised, wide, itchy or ugly. This is fairly uncommon in mastopexy, but any wound breakdown which occurs in the early postoperative period (particularly of the vertical limb of the anchor scar or the vertical scar) may result in a stretched flat scar.
- Wrinkling: this is seen almost without exception; the skin under the breast is puckered and very wrinkly for the first six weeks after surgery. This is a necessary part of the operation and happens because we are trying to limit the size of the final scar. After six weeks, these wrinkles will have mostly disappeared to leave a fine scar. In about 5% of cases these wrinkles may persist up to 6-9 months after surgery. If they do not settle after this time, they can be simply cut out in a minor procedure under local anaesthetic.
- Dog ears: dog ears are small folds of skin which occur at either end of the scar, caused by a natural folding of the skin when the wound is closed. Great care is taken during the operation to avoid producing dog ears, but occasionally (5%) they cannot be avoided. Small dog ears seen in the early postoperative period will eventually settle on their own in the first 6-9 months after surgery. If they do not settle after this time, they can be simply cut out in a minor procedure under local anaesthetic.
- Nipple loss: One of the worst complications of this procedure is complete or partial loss of a nipple. As mentioned above, the nipple is moved on a block of tissue which preserves a blood vessel and nerve, but if this blood vessel becomes kinked or damaged, the blood supply to the nipple will fail and the nipple will die. If this happens, the nipple will become darker and darker and eventually blister and disappear. Fortunately this is a very rare occurrence and only happens approximately once in every 2000 mastopexies.
- Altered nipple sensation; in the same way, the nerve that we try to preserve to the nipple may be damaged at the time of the operation and results in a numb nipple. This is a much more common occurrence. If the nerve to the nipple is damaged, the nipple will be numb when you wake up. About 7 in every 10 women will experience a reduction in nipple sensation, but a few will find their nipples become very sensitive and even clothes brushing against them will be unpleasant. About half of all women who do experience altered nipple sensation will eventually regain some sensation.
- Breast skin numbness: in a similar way, some women will develop numb patches over the skin of part of their breasts. Again, this usually improves with time, but can occasionally be permanent.
- Asymmetry: no two breasts are almost ever the same, and some degree of asymmetry is common both before and after this procedure and cannot be avoided, it is one of the limitations of any given pair of breasts. Great care is taken to ensure that the two breasts are as symmetrical as possible, but occasionally an unacceptable asymmetry results. If this happens you will be advised to wait for 9 months for all scarring and swelling to settle fully before we reassess the final outcome. At this time you may have to return to theatre to have minor asymmetries of breast volume corrected by a small liposuction procedure or minor asymmetries of nipple position corrected by relocating the nipple under local anaesthetic.
- Blood clots: occasionally a blood clot may form in the deep veins of the legs (deep vein thrombosis). These clots can have the potential to break off and travel inside the veins into the lungs (pulmonary embolism). Any surgery carries a small risk of causing a blood clot in the leg viens. To reduce the risk of this happening, you will be given surgical compression stockings to wear throughout the first 2 weeks after surgery, special inflating compression devices will be applied to your legs in theatre and worn for the first 24 hours in hospital, and you will be given a daily injection to slightly thin your blood.
- Fat necrosis: in the same way that a nipple may die, if the blood supply to part of the breast tissue within the breast is damaged during the operation, a piece of breast tissue may die. This usually becomes apparent about 2-4 weeks after the operation. The breast may appear to be healing well, but then a firm, tender lump may develop. This lump of dead fat is called fat necrosis and does not usually require any treatment. It usually settles on its own over the following few months; though occasionally may discharge old liquid fat and fluid through a small hole in the scar on the breast and need regular dressing until this heals on its own.
- Breast feeding: It is usually not possible to breast feed after a mastopexy procedure because the milk ducts under the nipple have to be divided when relocating the nipple to its ideal position.
- Recurrence of drooping: your breasts drooped before surgery because the skin and tissues became lax. The mastopexy operation tightens up the skin and tissues but there remains a possibility that, with time, these tissues may become lax again and the breasts may start to droop again. This is just a part of the natural aging of your own tissues but may be helped by wearing a well fitting bra to support your new breasts.