Breast Lift (Maxtopexy) in San Francisco
A Breast Lift, also known as a Mastopexy, is designed to improve the appearance of a woman’s breasts. Women who have either lost volume in their breasts, or whose nipples have slipped in position, or women who have both conditions, may be candidates for a mastopexy.
A Breast Lift is a surgical technique that elevates the nipple and reshapes the breast tissue. The technique is most commonly used for women who have had children, lost weight, or have a genetic predisposition for breast ptosis (drooping). During pregnancy, the breasts increase in size and the breasts expand further with the engorgement that accompanies breastfeeding. These processes can stretch the skin envelope, resulting in loss of breast volume and often, dramatic changes in breast contours.
Having the breasts lifted will reposition the nipple-areolar complex and reconstruct the remaining breast tissue. Often, if there is not enough breast tissue, breast implants can be inserted.
There are three popular Breast Lifting techniques. The optimal technique for each patient is dependent on the degree of skin and nipple laxity. The types are: from least to most aggressive, (1) peri-areolar mastopexy, (2) vertical short scar or lollipop incision and (3) the inverted-T technique. Since patients have varying preferences for breast shape, the various techniques will be described as to how each method will enhance the appearance of the breast.
- The Peri-areolar Lift is a good technique for patients who require a small lift. The incision is made around the areola and a doughnut-shaped section of skin is excised. The skin is sutured with a purse string technique and the incision is hidden in the borderline of the areola. This technique is most often accompanied with a breast implant since the purse string suture will tend to flatten the breast. The technique will tighten the skin envelope, but does not reshape the underlying breast tissue.
- The Vertical Mastopexy, short scar, or lollipop technique is widely used. This procedure produces beautifully shaped breasts. The shape has a nicely proportioned diameter and a conical shape. This conical shape in a breast lift is very youthful, whereas the peri-areolar mastopexy is somewhat flattened and rounded.
- The Inverted T Technique is used to excise more skin and is commonly used in reductions of larger breasts. This is a gold standard procedure that has a high rate of success.
Today’s trend is toward the smallest incisions possible, even if some sacrifices are involved.
The advantages and disadvantages of each technique are:
|Type of Lift||Pros||Cons|
|Peri-areolar||1) A more hidden scar
2) A simpler procedure
|1) Requires an implant to reduce flattening
2) The shape is round and less conical
3) Limited to small lifts
|Vertical or Lollipop||1) No implant required if there is adequate breast tissue
2) Conical, projecting shape
3) Long-lasting lift
|1) Lollipop scar
2) Takes more time for the breast to settle
|Inverted T||1) Able to resect larger amounts of skin
2) Quick healing
|1) Longer scars
2) Risk of “bottoming out”
Before Breast Lift Surgery
A personal consultation is the first step for every patient considering a Breast Lift. This appointment can take place at either Dr. Delgado’s San Francisco office or his Marin County office.
At this meeting, Dr. Delgado will have the patient describe her concerns about the appearance of her breasts. Sometimes he will use digital photography and computer imaging to discuss any asymmetries that are present. He will also discuss where the nipples should be positioned. In addition, he will discuss the variables that affect the individual procedure, such as age, breast size, breast shape, and the condition of the skin and the possibility of a breast implant.
Depending on the patient’s age and family history, Dr. Delgado may advise a mammogram before surgery.
A detailed preoperative booklet is given to each patient. The booklet provides pre- and post-operative instructions, including medications to be taken prior to surgery. Patients are instructed to avoid aspirin and aspirin-containing products, including anti-inflammatory products, for two weeks prior to surgery as these substances interfere with a patient’s clotting ability. The preoperative instructions include a comprehensive list of the medications to avoid. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage. Suggestions are given for homeopathic and vitamin supplements which are known to promote healing and reduce bruising. These can be taken prior to and following surgery, if the patient so desires.
Breast Lift Cosmetic Surgery
DAY OF SURGERY
The Breast Lift Mastopexy surgery takes place at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, a surgical marking pen is used to draw a detailed map on the breasts and chest. This architectural drawing enables the doctor to make accurate adjustments that allow for the gravitational changes that occur as the body moves from a sitting to a lying position.
If the peri-areolar lift is done, a doughnut of skin is excised around the areola. The outer circle of the skin is closed with a purse string suture that tightens the diameter to the smaller circle of the nipple-areola complex. A breast implant is usually placed before the purse string is tightened.
The vertical lift mastopexy includes the excision of skin around the areola, as well as a section of the skin below the areola, extending down to the skin crease under the breast. The breast tissue can be used in a variety of ways to enhance the projection of the breast. The skin is then meticulously closed.
The inverted T incision is a versatile technique. It can be used for a Breast Lift or Breast Reduction. The incisions are longer, but it works especially well with larger breasts. The inverted T technique involves excision of both vertical and horizontal sections of skin and results in an incision along the bottom skin crease as well.
Dr. Delgado prefers the lollipop lift or vertical lift because this technique reshapes the internal breast tissue, holding the shape well over time. In contrast, the inverted T technique relies on the skin envelope to hold the shape. Over time, the skin below the areola can sometimes stretch which is called bottoming out. Nevertheless, it remains a sound, time-tested technique.
The goal of each technique is to lift the nipple complex to the correct level and to tighten the skin. A breast implant can be used if more volume is desired.
|Peri-areolar||Note: The incision is around the areola. Shape is rounder, flatter and with less projection.|
|Vertical or Lollipop||Note: Extended incision, but gives a more projecting, conical shape as a result.|
|Inverted T||Note: Results in vertical and horizontal incisions, in addition to the incision around the areola. Shape is round and projected.|
Most breast lifts are performed under general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. (See credentials for Randy Gaynor, MD on this website.) The anesthesiologist calls the patient the night before surgery to review his/her medical history, confirm last minute instructions and answer any questions the patient may have relating to the anesthesia.
After Breast Lift Surgery
The first few hours after surgery will be spent in the recovery room. When the patient is fully alert, she will be able to go home with the assistance of a friend or family member. At this time, it is important that she sleeps with her head and back elevated to reduce swelling in the breasts.
If a drain is placed, it will be removed two or three days after surgery, at the patient’s choice of either the San Francisco office or the Marin County office. At that time, the dressing is removed and the bra is replaced.
Breasts will be bruised, swollen and uncomfortable for a day or two, but the pain is not severe. This discomfort is more noticeable if the patient has had breast implants placed underneath the muscle. These patients will notice more tenderness and soreness around the chest region and may experience just as much, or even greater, relief from taking the prescription muscle relaxant, either alone, or in combination with the prescription pain medication.
Patients generally take pain medications the first day or two after surgery in order to be more comfortable. By the third day, patients should not need strong medications or should be able to at least reduce the dosage. A few patients will have low pain thresholds and they might use pain medication for as long as five days.
The recovery period is generally two weeks. Once the bruising and tenderness are gone, the patient can return to normal activities. Most patients can drive a car and return to work and social activities within one week. Strenuous exercise should be avoided for three to four weeks following surgery and sexual activity should be avoided for one to two weeks after surgery, as both of these can trigger swelling and discomfort in the chest if resumed too soon.
RISKS AND COMPLICATIONS:
A Breast Lift is not a simple procedure, but is safe when performed by a qualified plastic surgeon. Like all surgeries, it carries the risks of bleeding and infection, as well as the risks associated with anesthesia.
Breast surgery leaves incision lines, but they fade significantly over time. The incision lines are hidden by a bra or swimsuit.
Breast sensation may be altered temporarily, but it is rare for sensation not to return to what was normal for the patient.
If a breast implant is used, it carries the same risks associated with breast augmentation.
The goal of a Breast Mastopexy Lift Surgery is to elevate the nipple-areolar complex and to reshape the breasts. This surgery turns back the clock and restores a youthful relationship of the breasts to the body. If there is insufficient volume, the shape can be further enhanced by adding breast implants.
FREQUENTLY ASKED QUESTIONS
Who is an ideal candidate for mastopexy breast lift surgery?
What causes breasts to sag?
How does a breast elevation surgery work?
Can I get breast implants placed during my breast lift procedure?
Should I wait to have a breast lift surgery until I have children?
What is a peri-areolar breast mastopexy?
Will I be put under anesthesia?
How long will recovery take?
How much does a mastopexy/breast lift cost?
If you are considering breast lift surgery or breast augmentation, you are invited to book a consultation with Dr. Delgado at his San Francisco office or his Marin County office, 22 miles north of the Golden Gate Bridge in Marin County.
Dr. Delgado’s goal is to help you look as good as you feel.