Breast lift (Uplift)

Breast lift

Over the years, most women’s breasts change due to pregnancy, breast-feeding, aging or weight loss. The breast skin loses its elasticity, the gland and fat lose a significant part of their volume, and these both cause sagging. Breast lift surgery, also known as breast uplift or mastopexy is the procedure performed in order to reverse these changes and is designed to enhance the appearance by lifting the breasts to a higher position. Mastopexy specifically corrects a number of breasts chabges.

Introduction and basic information about breast lift / breast uplift

Over the years, most women’s breasts change due to pregnancy, breast-feeding, aging or weight loss. The breast skin loses its elasticity, the gland and fat lose a significant part of their volume, and these both cause sagging. Breast lift surgery, also known as breast uplift or mastopexy is the procedure performed in order to reverse these changes and is designed to enhance the appearance by lifting the breasts to a higher position. Mastopexy specifically corrects a number of breasts chabges, such as:

  • loose breast skin and change of breast shape
  • nipples that begin to point downward
  • loss of fullness in the upper breast
  • loss of cleavage and breast closeness
  • loss of breast volume
  • other concerns women develop as they notice the effects of aging

By removing the excess skin and tightening the breast tissue, a breast lift raises a woman’s breasts and helps reshape them into a more youthful look. A breast lift frequently also reduces the size of a woman’s areola but does not significantly change the size of your breasts. If you want your breasts to look fuller, especially at the upper pole and/or cleavage, a breast lift combined with breast implants may be more appropriate.

There degree of droopiness (ptosis) of the breast depends on the nipple position in relation to the under-breast crease. This determines the degree (grades) of ptosis and is depicted below:

In a youthful breast, the nipple is above the crease.
Grade I Ptosis – The nipple is located above the breast crease but the breast is deflated and droopy.
Grade II Ptosis – The nipple is located at or lower than the breast crease but still points forward.
Grade III Ptosis – The nipple is located lower than the breast crease and is pointing downward.

The breast lift procedure changes the contour and position of your breasts but not their size. However, due to the tightening and excess skin removal, the breasts frequently breasts appear smaller after a lift. If you’re interested in changing the size or fullness of your breasts, you will need to undergo a breast augmentation or breast reduction during the same procedure. This is usually done through the same incisions as the ones used during the breast uplift.

Breast augmentation is performed in order to make the breasts fuller and larger whereas a breast lift is performed to raise the breasts. These two procedures may be performed alone or in combination. If the breast has a good position without ptosis (droopiness), then a breast augmentation is the best choice. If the breast skin has significant laxity and the nipple sits low on the breast, a breast lift is the ideal option. However, patients who require a breast Lift will quite commonly have a significant loss of fullness that makes the breasts appear deflated and flat. Combining a breast implant with the breast lift, can create a natural and fuller breast as long as the implant is not too big. Actually the combination of both procedures has a much longer lasting result than an isolated breast lift.

Breast lifts do not impair breast function, which means that you should be able to get pregnant without problems with your breasts. However, it is generally best to wait until after you are done having children due to the fact that the weight gain and lactation changes to your breasts can reverse the breast lift benefits. You should also be aware that if you are planning on breastfeeding, you may have more difficulty doing so after a breast lift as this procedure may affect the amount or milk produced.

Breast aesthetics – the basics you need to know

The most important parameter for a natural-looking breast is the upper pole area and upper pole fullness of the breast (which is the upper half of the breast). In a natural-looking breast uplift procedure, a “natural breast slope” is maintained which means that the chest- to-breast transition is natural and smooth.

If an implant is used:
To make sure that we maintain a natural chest-to-breast transition, the implant (if used during your breast lift) must follow this parameter. Beyond this specific point of upper pole fullness and if a larger implant is placed, it will start to have a visible upper pole “step-off” and the chest-to-breast transition will start showing the round edge (perimeter) of the breast implants which constitutes an unnatural “operated look” result. It is mainly this chest-to-breast transition area at the upper pole of the breast that determines the breast implant placement technique selection (above or below muscle) and the implant width, type (anatomical or round) and projection. In every breast there is a specific cut-off point above which, if we insert a larger breast implant, the implant edge will be visible. We make the final decision about this point for each breast inside the operating theatre with the aid of special breast sizers that we place inside the breast enlargement pocket and we inflate with saline fluid to the point of maximal breast fullness without implant visibility. We then remove the sizer and place a permanent breast implant of the same size with the sizer we had previously filled.

Natural look – Chest-to-breast transition with smooth slope

“Operated” unnatural look – Chest-to-breast transition with step-off, frequently seen with large implants relative to body frame

At the HAPSI we believe that breast size should follow your body type dimensions. During consultation we obtain detailed measurements of your chest and breast area and we recommend the maximum size that can be achieved in a natural way for your individual anatomy. You will also try several sample implants under a bra in order to better visualize your size result. If permitted by your breast anatomy, we also use the 3D simulation technology in order for you to actually see your new breasts digitally before your surgery.

Most importantly, as mentioned above, during surgery we always use a test-sizer implant which is placed temporarily inside the planned implant pocket and inflated with saline fluid while the surgical bed is lifted in order to also see the effect of gravity on your breasts. This way we can measure the amount of fluid that fills the test-sizer and we then remove it and place the same size silicone implant which will be the perfect sized implant for your individual body and chest anatomy.

It is critical to hide the implant completely and we do several things in order to achieve this like placing the implant under the muscle. Paradoxically, usually the larger your existing breast the larger the breast implant that can be placed as there is more tissue available to cover it. Conversely, the smaller your existing breast the smaller the breast implant that can be placed as a natural breast result is always the goal.

The final breast shape after a breast lift has mainly to do with your existing breast tissue, skin and fat as well as the size and shape of the breast implants, if they are used. The shape of the upper half of the breast should ideally follow the natural chest-to-breast slope as explained above. The middle and lower part of the breast depends mainly on your existing amount of breast tissue and on the remaining skin after the excess skin is removed.

Before surgery information

Common preparations include:

  • A medical evaluation and lab tests.
  • A baseline mammogram.
  • Quitting smoking if you currently smoke for at least 4 weeks before and after surgery.
  • Learn how to handle post-operative care and scheduling any necessary follow-up appointments.
  • You should arrange transportation and care well ahead of time. You should not drive yourself to or from surgery and it’s important to have someone with you for at least one night following the procedure.
Your consultation, evaluation and preparation for breast lift

On your first appointment you will need to allow about one hour. We will show you animations of how the breast lift procedure is performed as well as many before/after pictures from patients that have consented for their pictures to be shown during consultation. We will measure your chest and breasts and discuss with you the different surgical techniques as well as what may or may not be achievable for your anatomy. We will also explain what complications are associated with mastopexy and how we prevent them and deal with them in the rare occasion that they occur. This helps you to make a fully informed decision. Depending on your anatomy, we may be able to use imaging software, which produces graphic simulations of your potential appearance after surgery.

If implants are planned we can also use silicone sizers and place them under a surgical bra (that we provide) in order to help you understand the possible breast sizes after surgery. We will also inform you about the potential complications associated with implants and potential long term problems and how to prevent them.

We need to obtain information about your medical history, previous surgeries or medications that you are on. You will be asked whether you have a family history of breast disease and about your recent mammogram if you had one. If you decide you would like to proceed with surgery then you can come back for a second appointment to ask any further questions. You will receive a prescriptions for pain medications or antibiotics. You can come back for another visit before your surgery if you feel you have more questions or concerns.

If you smoke, you must stop smoking at least 3-4 weeks before surgery and for several weeks after surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for at least 7-10 days before surgery. We will provide you with additional preoperative instructions including the basic preoperative tests that are routinely performed before surgery (blood tests and electrocardiogram usually).

Surgery information

The surgery takes place at JCI-accredited hospitals with specialized day-stay units. Once you reach the hospital you will be taken to the registration area and then to your hospital room. The surgeon will evaluate you before surgery in order to place the preoperative surgical markings and also answer any last minute questions you may have. The consent for the surgical procedure must also be completed by both you and the surgeon at this time. You will then be taken to the preoperative area where the Anesthesiologist will place an intravenous line for the administration of the anesthesia medications. You will then be taken to the operating room. Your safety is our number one concern during surgery and anesthesia and please do not hesitate to ask the Anesthesiologist any anesthesia-related question you may have.

Breast uplift is performed under mild general anesthesia and the Anesthesiologist that will be giving the anesthetic will be with you at all times. The operation takes approximately 2-3 hours, and at the beginning and the end of the procedure local anesthetic is injected in order to minimize your postoperative pain.

The procedure starts with the incision. There are several techniques that can be used for a breast lift and we individualize the procedure to your anatomy depending on several factors including the following:

  • The size of your breasts and areolas.
  • How much excess skin you have as well as its elasticity and quality.
  • The degree to which your breasts are sagging.
  • The shape of your breast gland architecture

The incisions are made around the areola and it is frequently necessary to make an incision from the areola to the crease of your breast (lollipop incision). However, it is very rare with modern breast lifts to use an additional horizontal incision done along the lower breast crease as was used in the more traditional techniques. Once the incision is made, we are able to lift and reshape the breast tissue, reposition the areola/nipple while reducing its size (if needed) and we remove all the excess skin. At this time frequently an implant is also placed for improved upper breast and cleavage fullness, if this is needed according to your individual anatomy. The nipples/areolas are not removed or detached from the underlying breast tissue during repositioning. Then, all tissues and the skin are sutured closed and all incisions are covered with special surgical tape (steri-strips) as well as gauze and the finally the entire area is wrapped or covered by special bra.

Breast lift is achieved through a variety of incisions in order to remove the skin. However, if we only remove the skin, then the risk of future sagging is significant whereas if we also reconstruct your breast tissue as well, then it’s much more likely your breast lift results will last longer. At the HAPSI we use the most modern and efficient breast tissue anchoring techniques in order to maximize the longevity of your breast lift results. We have a wide range of experience with a number of techniques and we customize the procedure based on your unique anatomy and preferences.

Breast Lifts can be performed, depending on the severity of your ptosis, through an incision:

  • around the areola only (periareolar or donut or Benelli technique)
  • around the areola and a short vertical incision (vertical or lollipop technique)

As mentioned earlier, in both techniques, the areola is repositioned at a higher position but it is not removed completely and sutured back on as many people believe. The appropriate technique for you is determined based on your current breast size and shape, the desired breast size, the size and position of your areolas, the degree of breast sagging and the amount, quality and elasticity of your skin.

Below please find a more detailed analysis of the breast lift techniques:

This technique is also called a Benelli or donut mastopexy. For women with mild droopiness (ptosis) needing a minor breast lift, this circumareolar (circular) breast lift is a great choice. This technique is most commonly performed in conjunction with breast implants, however it can also be performed as an isolated procedure on a small group of women with minor breast ptosis and good breast volume.

The circumareolar breast lift is performed by initially making a circular incision (which also will mark the new smaller size of the areola). Next, another, larger circular incision is created at a distance from the first incision. Finally the circular pattern of skin is removed in between these two circular incisions. The skin is then tightened around the areolas like a “purse string”, the breasts are lifted and the areolas are repositioned in a higher location. The areola is not removed and sutured back. Additional sutures are then placed to precisely close the circle incision.

In most cases women needing a small lift also desire additional breast fullness so a combined circumareolar breast lift and breast augmentation is the best approach. The breast implant in this situation is placed through the bottom edge of the circular incision. The implant may be round or tear-drop and is placed in the above-muscle or below-muscle position depending on the individual needs of the breast (amount of breast tissue in the upper pole, amount of fat, skin quality etc.) This is an approach used frequently as it provides excellent cosmetic results through a small circular nipple incision. However it does not provide a very significant uplift and it works ideally only in small degrees of ptosis but not for moderate or severe ptosis of the breasts.

The vertical breast lift (mastopexy) technique is for women with moderate to severe degrees of breast ptosis. This is the most frequently performed breast lift technique. With this technique a vertical key-hole incision is made and the skin inside the key-hole which is created is removed. Once the keyhole skin is closed, the final incision is a lollipop-shaped incision.

Most women undergoing this type of breast lift also desire additional breast fullness so a combined vertical lift with breast augmentation is usually performed. The breast implant in this situation is placed through the bottom edge of the vertical incision. The implant may be round or tear-drop and is placed in the above-muscle or below-muscle position depending on the individual needs of the breast (amount of breast tissue in the upper pole, amount of fat, skin quality etc.)

Step 1: Appropriate “keyhole” design on skin. This must be marked before surgery with great precision.

Step 2: Excision of superficial skin layer and access to the deeper tissues. If an implant is required, it is placed through the lower end of this opening.

Step 3: Tightening of the internal breast tissues in order to adequately lift the breast and achieve a long-term breast lift result. There are several types of tissue anchoring techniques depending on the individual’s breast anatomy. At the HAPSI, we select to utilize the techniques that combine safety and ideal breast reshaping.

Step 4: Closure of skin with special layered techniques in order to minimize scarring. The areola is sutured into a higher position and the skin is closed around the areola and down close to the crease of the breast. The final scar is like a lollipop, with a scar around the areola and straight down the center of the breast. On occasion, a small horizontal scar is placed in the under-breast fold to help smooth out the closure. Absorbable sutures are used for closure.

All types of breast lift surgery will leave some scarring. These scars may be very minor and hidden in the areola or more significant that extend on the breast vertically (lollipop scar). Very rarely there is also a small scar in the crease under the breast. In general, trying to avoid incisions in breast lift when they are necessary will lead to an unsatisfactory breast shape result due to persistent tissue sagging and skin excess. Scars are permanent but will improve significantly over time.

After surgery / Recovery information

After a breast lift you can expect to go home the following morning. Due to the modern surgical and anesthetic techniques used today, pain relief needed by most patients is usually limited to anti-inflammatory pain medications. Some patients however require stronger tablets which we prescribe for usage only “as needed” (these are rarely used by most patients). Generally there is moderate pain and discomfort for the first 2-3 days and many women describe the type of pain similar to the discomfort that they feel after a very intense workout of their chest muscles. After the first couple of days, the discomfort becomes more of a slight “pulling” or “heaviness” sensation. In all techniques, the pain of the surgery is generally short-lived after which most patients are definitely fine by using only anti-inflammatory medications.

No, there is no need for drains after a breast uplift procedure and they are used very rarely.

Most patients are able to do most of their regular activities in 3-4 days and can expect to be back at work within a week. The wounds are closed with absorbable sutures and special surgical paper tape (steris-trips). We strongly advise you to wear a sports bra at all times for at least 4 weeks after surgery. If you have any concerns or if you are worried about anything please call us promptly or visit our office. You will be seen again the day after surgery, then 3 days later and then ten days to two weeks after the procedure. Ideally we should see you again at 4 weeks, 2 months, 3 months, 6 months and 1 year after surgery. You will then require an annual check up.

For the first month the breasts are generally swollen and the implants ride a bit high. It may take two to three weeks for the implants to drop down into the surgical pocket and for your breasts to look more natural. However, you should be socially presentable 7-10 days after surgery, even with light clothing. Sometimes there is some bruising that usually resolves within the first week after surgery. Also the incisions are a bit red in the beginning and it may take several weeks to months for the red line of the incision to become pink and then a pale white line which is barely visible in most cases.

You should keep the scars dry for the first 10 days until the incision has sealed and completed the initial phase of healing.

Light activities can be resumed almost immediately and you should be able to drive only 7 days after surgery in most cases. You can go back to low impact exercise such as walking and bike riding 10-12 days after surgery. However, all intense exercise like swimming and bouncing exercises like running should be avoided for at least 6-8 weeks. This allows for the normal internal scar tissue to form to support the implant and minimize the risk of it dropping more than desired. If your implant is under the muscle you should avoid heavy chest exercises for 8-10 weeks.

You will be seen again the day after surgery, then after 3 days and then ten days to two weeks following the procedure. Ideally we should follow-up on your progress again at 4 weeks, 2 months, 3 months, 6 months and 1 year after surgery. You will then require an annual check up.

You will wear sports bras at all times for at least 4 weeks and then day only for 6 weeks to support and gently compress the breasts as they are healing. We encourage you to come in and see us if you are worried about anything.

In case breast implants are placed, we recommend a breast MRI at 3 years postoperatively and then every 2 years.

Complications from breast lift surgery are rare. By far most patients that undergo this procedure experience a very safe medical process and enjoy a long-term result without any problems. The satisfaction rate of this procedure is one of the highest among plastic surgery procedures. However, complications can occur and we explain them in detail during your consultation visit. This is why you need to be extremely careful when select your plastic surgeon. Doing your homework in terms of surgeon selection is by far the most important choice you will make.

American-Board Certified surgeons spend a very large part of their surgical training and maintenance in learning on how to adequately prevent, diagnose and effectively manage the various complications of surgery. The rigorous evaluation and examination of doctors by the American Board of Plastic Surgery requires that all US-certified doctors undergo in-depth continuing medical education focused specifically on patient safety and clinical complication management. ABPS surgeons have profound knowledge on how to avoid complications and deal with them in the best way. And this is why choosing an American-Board certified surgeon can make a big difference for you.

Your safety is our first priority. We work very diligently and meticulously in order to prevent complications and we utilize the most updated medical knowledge and current surgical techniques for this purpose.

Most of the complications listed below happen at a rate smaller than 1% with the most frequent being capsular contracture which happens at a rate of approximately 4-5%.
The risks of the breast lift procedure include:

  • Swelling and bruising
  • Bleeding (hematoma)
  • Infection
  • Poor healing of incisions, scar hypertrophy
  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Breast contour and shape irregularities
  • Skin discoloration of the scar and scar permanent pigmentation changes
  • Breast asymmetry
  • Fatty tissue deep in the skin could die (fat necrosis)
  • Fluid accumulation (seroma)
  • Partial or total loss of nipple and areola
  • Prolonged pain
  • Capsular contracture if breast implants are used
  • Possibility of revisional surgery
  • Deep vein thrombosis / pulmonary embolism

Not all of these risks specifically apply to you and are used more as a general guide to risks that are possible. Also, in case silicone breast implants are used during your breast lift, you must be aware that they also may potentially cause some issues as presented at the FDA website link below:

Long-term information

Breast lift results last for a long time and your breasts will always look much better than they would if you didn’t have the procedure. However, aging and gravity continue and they do cause the breasts to change over time in terms of their tone, elasticity and shape. Several factors such as weight gain and loss, pregnancy and/or breast feeding, your genetics and your tissue characteristics will influence the longevity of the results. Not wearing a supportive bra will also lead to earlier drooping. It’s especially important to wear a bra while exercising or jogging if you want to maximize your breast lift results. Finally, as pregnancy and other weight changes negatively affect breast lift results, it is better to avoid having this procedure until your weight has stabilized.

If you have implants, their position will not change over the years although they may move slightly downwards due to gravity. In general the breast shape is maintained better if you have implants as the fullness is maintained. The main changes that you will notice over the years will mainly have to do with your breast tissue, fat and skin overlying the implants which will definitely change and the shape alterations depend on the amount of overlying tissue and skin. If you have small breasts and minimal skin, your overall breast shape will not change much. However, if you have significant amount of gland, fat and skin overlying the implant, over the years you may notice increased droopiness (ptosis). At some point in the future you may consider a repeat breast lift although this is rare and is usually required for large sized breasts. Therefore the duration of the results achieved through surgery are variable.

There is no need to change your breast implants every 10 years if there is nothing wrong with your breast. If you’re happy with your breast surgery and there are no issues, then you don’t need to have your implants changed. If there is a problem with your breast implant, you will notice it, feel it as a lump or you will find out by your diagnostic tests (MRI, mammogram or ultrasound).

Mammograms should be continued after breast lift for women in the appropriate age range (usually over 40). It is very important that you advise the technician if you have implants so that specialized techniques can be used and additional views can be taken, if needed. Mammograms are generally not affected and modern mammography techniques are able to visualize your entire breast without problems, even if implants are placed.

Usually there is no effect on breastfeeding or the ability to produce milk from breast lift if an appropriate technique is used. However, sometimes due to scarring at the breast ducts, the amount of milk produced may be affected and rarely it may be entirely compromised.

FDA guidelines recommend patients to monitor their silicone implants with an MRI scan at 3 years and then every two years to make sure their implant is not ruptured. As mentioned above, all women should undergo their regular screening mammography according to their age.