What is it?
Breast Lift is an operation to that lifts the nipples and improves the shape of the breast by excising excess skin.

Who is a candidate for this operation?
This procedure is indicated for any woman with significant differences between the shape and size of the breasts. Although this operation can be performed as early as the mid teen years, it is preferable to wait until the breasts have completely formed. Women who seek Breast Lift have loss of breast fullness and have low-lying nipples. Sometimes this is a congenital condition that was present from the time that breast development started. Surgical candidates must be in good general health, and have realistic expectations. This does not mean that you cannot perform this operation if you do not meet these criteria. However, the best results are seen in individuals who have moderate to major ptosis (“sagging”) of the breasts. Generally the younger you are the better a candidate you are for surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Who is not a good candidate for this operation?
There are no real contraindications to surgery unless your health precludes an elective operation. People who have unrealistic goals are not good candidates. Having keloid (bad scar) producing skin can be a relative deterrent to surgery. Your surgeon can tell you if he or she think that a good result is possible in your case.

What does it accomplish?
The purpose of mastopexy is to restore the natural shape and contour of the breast making it firmer, with a tighter skin and a better nipple position.

Will Breast Lift cure my back pain or shoulder pain?
If you have heavy breast, lifting the breast may help your posture and therefore your back pain or shoulder pain. However the main purpose of this operation is not to remove tissue from the breast. Because of this the size or weight change is not significant.

What happens during the first consultation?
In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you. You will receive information booklets and pricing on the procedures.

How is it done?
The incisions are made around the areola (the pink skin surrounding the nipple) and under the breast. The nipple and areola are repositioned to a higher more appropriate level and the redundant skin is removed from the lower part of the breast. After the skin is closed the natural form of the breast itself generally hides the incisions. Occasionally it may be necessary to augment the breast with an implant to provide more volume in the breasts or it may be necessary to reduce the volume of the breast in order to achieve the desired result. Your surgeon will discuss these possibilities with you prior to surgery.

What are the goals of surgery?
Our objective is to tighten the skin of the breast and lift the nipple to its ideal position on the breast mound. By repositioning of the nipple on your breast you will see a significant improvement in your shape. You will be less likely to have skin related problems such as rashes or sores under the breast. In addition, this surgery will enable you to exercise more and live a healthier life.

What is short scar mastopexy?
There are several techniques that strive to limit the extent of the incisions in breast lift. You may have heard of the “Donut Mastopexy” for example. This technique is used in minimal breast lifts and the incision is hidden in the nipple areola region. The natural change of color between the areola skin (the darker skin around the nipple) and the breast skin serves as a camouflage for the scar. A short vertical scar may be used in many instances in addition to the scar around the nipple for lifting most breasts. This newer method of breast lift is being used more commonly and has the advantage of not placing scars in the mammary fold. The traditional anchor incision is still used today for cases in which short scar techniques cannot provide an adequate lift.

What kind of anesthesia will I have?
General anesthesia. In certain, small breast lifts it may be possible to do this surgery under straight local or local sedation.


Procedure: Breast Lift continued

What can I expect after surgery?
After surgery you will have a minimal to moderate amount of drainage from the incisions. You will need to rest for the first two or three days, but most people are up and about shortly after surgery. We generally recommend our patients to take off 7 days from work. Heavy lifting and exercising should be avoided in the first two weeks. Your body will tell you when you are ready to get back into your regular exercise routine. You will have a supportive bra or bandage for the first few days. This helps in the attachment of the skin back to the underlying tissues after surgery and reduces the chances of fluid collections under the skin. Once the dressing is off you can shower normally. We usually remove the dressings in the first 2 or 3 days after surgery. There will be some numbness associated with the surgery. This numbness usually persists for about four to six weeks. A moderate degree of swelling is normal after this operation. This swelling is related to accumulations of fluid in skin and subcutaneous tissues. Most of the swelling resides in the first two or three weeks after the surgery. Minor asymmetry between the two sides can be seen after Breast Lift. No one has completely symmetrical breasts and you have to accept these minor differences in size and shape.

Will it be natural?
Unnaturalness and imperfection in the result of Breast Lift is not a common aesthetic complication. The breasts heal quite well and minor differences and irregularities usually resolve by themselves after several weeks. Most surgeons try to get the best possible result in the initial operation. However even when everything is done right there is still a chance that you may develop some irregularity in the shape of the breast or the scar and if this does occur you may need to fix this problem in a touch up procedure. This touch up procedure is done approximately 3-6 months after the initial procedure.

What are some of the complications of Breast Lift?
Before I tell you about the complications of Breast Lift let me tell a little bit about how to digest these bits and pieces of information. Reading about complications can be quite scary. Many people cannot comfortably sit through a consultation session without having real doubts about surgery. This is a natural response. But it is different when you have these complications explained to you by a Doctor. He or she can put it in perspective for you and tell you the likelihood of such complications occurring. Most complications are very rare. Some are less rare and need to be explained to you in more detail so that you know how we would tackle these problems if they occurred. The purpose of explaining risks and complications is for you to know what steps we take to treat you and put you back on the road to recovery. Remember that every surgeon has his or her own way of treating problems. You must go over these potential risks with your surgeon to gain better insight and understanding.

Sometimes this procedure like breast augmentation may involve use of an implant. With implant breast surgery, the most common complication is the capsular contracture. This term refers to firmness of the breast caused by the shrinking of the scar tissue surrounding the implant. Unfortunately there is no way that one can predict in whom this problem will occur. It may occur in one breast but not the other.

If this problem occurs we may have to perform a corrective procedure. The treatment options for resolving this type of problem include non-treatment if the condition is mild and acceptable to the patient or it is surgical correction. Closed capsulectomy (release of the contracture by external pressure) is no longer done. Open capsulectomy would entail returning to the operating room for releasing the capsule either by making incisions in the scar tissues or by removing the scar tissue completely. This allows the breast implant to sit comfortably in its pocket and stay soft. The risk of developing Capsular contracture is approximately 10 % although higher numbers have been reported in some studies.
Bleeding is very uncommon with breast lift because we are generally not cutting deeper breast tissues. However we have had some reports of bleeding in the literature about this complication. There are those who are at higher risk of bleeding. The use of certain medications such as aspirin or coudamin (a blood thinner) could put you at higher risk of bleeding. Some people with history of uncontrolled hypertension can be at higher risk of bleeding after the surgery. There are some individuals who have some problem with their coagulation system that they were not aware of and consequently have had bleeding after surgery. If you do not have any of these risk factors you should not be at high risk for bleeding. However if you do have bleeding for whatever reason, we will treat it immediately
The implants themselves have a failure rate. They may leak or rupture. The risk for future implant replacement is approximately one percent per year for each implant.
Sometimes with breast surgery there may be a small degree of trauma to the breast tissues or the fatty tissues in the area and this may result in late calcifications. Occasionally, these calcifications may create some doubt as to the presence of breast cancer and may necessitate a biopsy.
There are risks associated with anesthesia. With modern equipment and techniques available in modern hospitals risks from surgical anesthesia are minimal.
Any surgery will have risks of bleeding or infection but the likelihood of such problems is very little.
There may be scars around your areola (the darker skin around the nipple) and under the areola. Sometimes there may be a scar under the breast fold. Anytime that you have incisions and scar there is the potential for poor healing and obvious scars. This happens very rarely however, and it does improve with time. Sometimes we may need to revise the scar at a later date. I generally do this after nine to twelve months from the time of the initial surgery.
There will be temporary breast and nipple sensory changes that usually resolve in 6-8 weeks. Very rarely there may be permanent loss of nipple sensation. Unfortunately there is no relationship between the type of incision used and the development of this problem
Loss of the nipple due to inadequate blood flow is a rare complication. With newer techniques of breast lifting this complication has been virtually eliminated. However if there is an extensive amount of surgery and lifting of the skin the circulation to the nipple may be compromised. If this occurs there are ways in which a new nipple can be reconstructed.
A few patients in the literature have been reported to have chronic pain as a result of Breast lift.
Most women have minor asymmetries in their breasts and this is completely natural. If there is a major difference between the two sides of the breasts this can be corrected to a certain extent. Major problems of asymmetry cannot be completely corrected and may persist after the operation.
Certain position changes may cause indentations in the breast that reveal the presence of the implant. This has generally been a problem in women who are very muscular and whose muscle contractions can displace the implants in its pocket.
Some patients are disappointed with the results of their surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation

When and where are touchup procedures done?
Touchups are done after three months. These procedures are usually much simpler than the first procedure and are not as painful. I can do them in the office with a small amount of local anesthetic solution if it is a minor deformity or problem. However if the problem were more complicated or difficult, I would do it in the outpatient surgery center under general anesthesia.

When are the sutures removed?
Breast sutures come out in 10-14 days. Sometimes you may have absorbable sutures that do not need to come out.

How many visits do I have after surgery?
We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I wear make-up?
Yes. You should be able to wear makeup if you have had breast surgery. We do not recommend your putting makeup on your incisions however, because this may result in tattooing of the skin by the pigments of the makeup.

Procedure: Breast Lift continued

What does the surgery cost?
The cost of surgery varies depending whether or not you are having this done in the office or an outpatient-operating suite. But here are some guidelines that will help you determine roughly what you could expect.

Remember that these are only rough estimates. The best way for you get an accurate cost analysis is to see a doctor.

How do I pay for surgery?
You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?
Yes. The scars of Breast lift are going to be around your nipple, under the nipple and sometimes in the breast fold. If your breast has only a minor ptosis or sagging, you may be able to get away with a simple scar around your nipple (circumareolar mastopexy). However this is usually not the case and vertical scar going from the nipple to the inframammary fold may be necessary. Today this technique of lifting is becoming more prevalent and the scars are not as bad as the older techniques. The traditional scar of the breast lift was the anchor shaped scar located under the fold. This scar was the main deterrent to surgery for many women. As we improve our short scar techniques, more women will be able to do this surgery.

Does it hurt?
The pain involved in mastopexy is very tolerable. We have heard our patients describe it as ‘muscle aches’ or just ‘soreness in the chest’. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?
If you are having just a small area of your breast removed and this can be done in the office then you will be awake. However if you are having a normal Breast Lift you will most likely be done in an outpatient facility under general anesthesia. Breast Lift can be a complicated and time-consuming procedure. If you want a good result it is better to let the surgeon concentrate on your breasts and not on your level of discomfort during the case.

Where is the surgery performed? (i.e. office suite or hospital)
I like to do this procedure in an outpatient surgery center. If the procedure is very minor and the area in question can adequately be anesthetized with local numbing medicine, then it may be possible to do it in the office.

Are medical photographs taken?
Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1/25/07

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