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Breast Lift & Mastopexy - Surgical Techniques

Do I Still Need a Breast Lift if I get Implants

How Is a Breast Lift or Mastopexy Performed?

All types of breast lift surgery ultimately have to satisfy two requirements. First, they have to match the surface area of the breast skin envelope to the volume of the breast, which is achieved by either removing excess skin and/or by increasing breast volume via addition of an implant. Second, they have to restore the nipple areolar complex's normal location in relationship to the chest wall and breast mount. The following types of Mastopexy are designed to address different degrees of breast ptosis or sagging.

Crescent Lift for Minor Ptosis

The plastic surgeon removes a crescent-shaped piece of excess skin above the areola and repositions the nipple-areola complex superiorly by closing this gap. This results in a minor lift of up to one inch for patients who have minor ptosis.

Its advantage is that the scar is located at the periphery of the areola and thus is not noticeable. If needed, an implant can also be inserted through the same incision.

The disadvantages of this technique are that first, it can only achieve a minor lift, and second that by pulling the edge of the areola upwards there can be some temporary distortion of the shape of the areola depending on the degree of pull or lift.

Concentric, Peri-areolar, or Benelli Mastopexy for Moderate Ptosis

In this procedure, two circular or concentric incisions are made around the areola. A doughnut-shaped area of excess skin between the two incisions is then removed. By positioning the center of the outer ring of the doughnut higher than of the inner circle, the closure of this wound will result in superior repositioning of the areola-nipple complex.

The main advantage of this technique is that rather moderate amount of ptosis can be addressed without leaving a noticeable scar on the breast.

It disadvantage is that it tends to stretch our and enlarge the diameter of the areola and flatten the nipple areola complex. Therefore, the breast looses it cone like projection. More importantly, this procedure carries a higher rate of recurrent ptosis as compared to the Inverted-T mastopexy. Women who have poor skin elasticity and more that mild to moderate ptosis can experience some recurrent sagging; usually requiring a second minor procedure when more excess skin removed and the size of the areola is further reduced.

In terms of the scar appearance, although this scar is limited to the periphery of the areola, early on it may wrinkle or show some purse-stringing effect which usually resolves within weeks.

This technique works best for women with smaller breasts, and minor to moderate ptosis.

The Benelli-Lollipop Mastopexy

This technique is similar to the concentric lift, but with an extension of vertical scar extending to the mammary folds. It differs that the Inverted–T Mastopexy by eliminating the horizontal scar in the infra-mammary fold. This procedure is considered appropriate for those with medium ptosis that can’t be corrected with the Benelli Mastopexy, but who aren’t sagging enough to need a full Anchor or Inverted–T lift (see below).

Vertical Mastopexy- LeJour Mammoplasty

Madam LeJour, a plastic surgeon from Belgium, popularized Vertical Mastopexy in the 1980. This technique offered to lift the breast only with a vertical scar and without the additional horizontal scar, thus also being called a "short-Scar Mammoplasty." In this technique the excess horizontal skin in the breast fold area is "bunched-up" into the vertical component of the scar. This "bunched-up" scar although being unsightly at first, would stretch out and flatten over several months after surgery. Because there is limit to how much skin could be gathered-up at the bottom of the breast, this technique is not ideal for women with large breasts or those with severe ptosis. Furthermore, I have found that in the today's environment where women demand immediate results, many are not willing to wait five to twelve months until the unsightly gathered-up scar under the breast resolves.

Inverted-T or Anchor-Shaped Mastopexy

Inverted–T Mastopexy can achieve the tightest and most dramatic lift and is usually reserved for those with moderate to sever breast ptosis. It can eliminate excess breast skin, in both the vertical and horizontal dimensions. Because of this, it can create a breast that has excellent projection and a very "perky" look. It also carries a much lower incidence of recurrent ptosis as compared to the Benelli Peri-areolar Mastopexy.

This technique involves creating an opening in the shape of an anchor or inverted–T where the nipple is moved superiorly to the apex of the vertical incision and the base of the anchor is positioned in the Inframammary fold. Reshaping the breasts by this method involves extensive dissection of the breasts. This enables the surgeon to also remove excess breast volume from one breast in order to achieve size symmetry.

With respect to the resulting scar, the anchor or inverted-T scar tends to heal very well in the vertical limb. At times the horizontal limb of the scar can become hypertrophic and more noticeable, but fortunately this part of the scar is hidden in the Inframammary breast fold. Like Benelli Mastopexy, with this technique an implant can be inserted under the breast or chest muscle through the same incision. The combination of a breast lift and augmentation is called an Augmentopexy.

How to decide which type of breast lift is more appropriate for you.

For women with moderate breast ptosis, the decision of which type of breast lift is a most difficult one, both the patient and the plastic surgeon. Obviously, everyone wants to have minimal scar, with the maximum breast projection, along with a natural looking breasts. Removal of excess skin results in a tighter breast but carries more scars. Sometimes, adding a breast implant to increase the volume of the breast relative to the breast skin envelope will help to reduce the excess skin to breast volume discrepancy. But note that placement of a larger implant will only help to some extend. Ultimately, the decision comes to choosing between a Benelli Peri-areolar Mastopexy and an Inverted–T Mastopexy. To make your decision you have to look more at the cons than the pros of each technique. If you absolutely object to having the more extensive Inverted–T scar, and are willing to possibly undergo a second breast tightening revision, you might then consider a Benelli Peri-areolar Mastopexy. One the other hand, if you have to have the perkiest and most youthful breasts, and don't mind having a bit more scars, then the Inverted–T Mastopexy is for you.

What is involved with Mastopexy Surgery?

A mastopexy is a procedure that is usually performed under general anesthesia. An exception to this is a minor crescent lift that can be performed under local anesthesia with sedation. A Benelli Peri-areolar and an Inverted–T Mastopexy involves extensive measurements and marking by your plastic surgeon before the surgery, especially with you in a standing or upright position. At that time the approximate final location of the nipple is marked along with the incision lines. Then once you are taken to the operating room and put under general anesthesia, your entire chest and abdomen is cleaned with antiseptic solutions and the areas of skin incision are further anesthetized with local anesthetics. Previously marked incisions are made, the nipple is elevated to its final position and the remaining breast skin envelope is tailored to accompany the nipple in its new position. Usually before closing these incisions the other breast is lifted and then the two are compared. At this time most surgeons usually have the patient raised into a sitting position on the operating room table so that they can better evaluate the extent of the lift and symmetry. It is not uncommon to then make additional changes to further lift the breasts and also to make them more symmetrical. At times drains are also placed into the depth of the breasts to remove excess fluid. Finally, the incisions are meticulously closed to minimize scarring. The incisions are dressed in protective gauze dressings and the patient is placed in a surgical bra that supports the breasts.

During your consultation Dr. Younai will review your treatment options for Breast Lift & Mastopexy, including pros and cons of each procedure or technique, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. There are also many before-and-after pictures and high resolution images of different types of Breast lift available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.

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