Breast Surgery

MASTOPEXY

The following is information regarding mastopexy (breast lift) surgery which is important to review, understand and discuss with family or friends before choosing to proceed with this surgery.

 

GOALS OF MASTOPEXY:  Mastopexy is an elective procedure performed to correct sagging of the breast and laxity of breast skin.  This may be the result of weight loss or pregnancy and occurs to some extent in every woman with aging. The goal of the procedure is to reestablish a more normal shape and positioning of the breast, which usually includes raising the nipple and removing some excess skin.  In any given patient, these goals may be only partially met.

 

LIMITATIONS OF THE PROCEDURE:  Mastopexy is performed through incision around the nipple/areola and usually on the skin underneath in the breast fold.  These incisions will heal with scars which will remain permanently visible, although some fading usually occurs with time.   Stretch marks, particularly on the upper aspect of the breast above the nipple, cannot be eliminated and can be potentially worsened by the procedure.  There is some degree of asymmetry between the breasts in all women and this difference in breast volume will continue after this procedure. The results of this procedure are only temporary since aging is accompanied by some degree of resagging.  Pregnancy following surgery will also result in an uncertain degree of breast sagging.

ALTNERNATIVE TO THE PROCEDURE:  Without surgery, the effects of breast sagging will persist and probably increase to some degree over time.  Exercise will produce some fullness in the upper chest, but will not reverse the effects of breast sagging since there are no muscle fibers within the breast itself.

 

For minor degrees of sagging, breast enlargement with implants or tissue flaps from elsewhere on the body can counteract some degree of sagging.  However, if the nipple position is very low, then breast enlargement alone will not be sufficient to correct the abnormal appearance of the breast.  In such instances, breast lift plus implant placement will recontour and reposition the breast as well as increase the breast size.

 

MASTOPEXY AND BREAST CANCER:  Mastopexy neither increases nor decreases the risk of breast cancer.  Mammograms can be performed following the mastopexy without compromise although there will be some scarring and possibly calcifications within the breast tissue as a result of this operation.  However, these findings are usually easily distinguished from the signs of cancer when the mammograms are performed and reviewed by well-trained radiologists. Physical examination is not significantly affected.


SURGICAL TECHNIQUES/ ANESTHESIA/ RECOVERY:  There are two parts to the mastopexy procedure.  The first is elevation of the nipple complex. This is performed in such a way as to preserve nipple sensation.  The nipple is not removed. Following this, the excessive skin is removed from the under surface of the breast producing an upside down “T” incision extending from the bottom of the nipple complex to the crease under the breast and running within the breast crease.  The procedure is performed under a general anesthetic and takes approximately two hours to perform. A supportive brassiere is recommended and should be worn day and night for at least four weeks following surgery. A sports brassiere should be worn during physical activities and three months following surgery.  Occasionally with large breasts, drainage tubes are placed to remove any blood or fluid, which may accumulate. If this is the case, instructions are given to explain the care of these drains. Blood transfusions are not usually required. However, if you desire, your own blood or donor designated blood can be collected prior to surgery.

RISKS/ COMPLICATIONS:  The most common complication following this surgery is a collection of blood or tissue fluid underneath the breast incisions.  If this causes swelling or tension on the skin closure it may be necessary for a second operative procedure to remove the collected fluid.  Infection is rare and usually responds to antibiotic treatment. In very rare instances, rehospitalization for antibiotic treatment may be required.  Discomfort in the area of the incisions, discoloration of the breast skin and a variable degree of swelling will be present for several days to a few weeks following surgery.  As noted previously, the incisions are permanent and scars will result although these are hidden on the lower pole of the breast and usually fade with time. There may be a permanent alteration in nipple sensations with permanent numbness.  There may be a difference in size or shape of the breasts or differences in nipple sensation and position. Initially, the breast may feel excessively firm or the skin excessively tight. This is a normal result of the surgery in that some loosening of the skin and lowering of the nipple position is anticipated in the months and years following this operation.  It is important to emphasize that although this surgery will reverse the current signs of aging, the breast will slowly change shape again with time.

 

Even though the risks and complications cited above occur infrequently, that are the ones that are peculiar to the operation or of greatest concern – other complications and risks can occur, but are even more rare.  Any and all risks and complications can result in:

 

Additional surgery Hospitalization Time off work Expense to you

 

On occasion, surgical revisions may be indicated following the original surgery.  If planned or performed within on year after the original surgery and if insurance does not cover these revisions, there will be no charge by the surgeon, but a facility fee will be charged by the hospital for use of the operating room, as well as a fee from the anesthesiologist.  NO GUARANTEE – the practice of medicine and surgery is not an exact science.  Although good results are expected there can be NO guarantee or warranty expressed or implied by anyone as to the results that may be obtained.  Many factors beyond the control of the surgeon affect both short and long-term outcomes, including but not limited to each patient’s individual tendencies toward scarring, skin quality, genetic makeup, and other health factors.  On occasion secondary surgeries may be indicated or desired to obtain the optimal result. If such procedures are performed, there may be additional charges incurred by you.

 

COMMENTS

 

If a smoker – must be off cigarettes for 3 weeks prior to surgery and 3 weeks following surgery.  There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers.

 

Must be off all aspirin containing products for 3 weeks before and after sugery.  You must stop all herbal medications 2 weeks prior to surgery. (Check all medications with us.  Some medications, such as Motrin and Advil may also affect clotting).