Mastopexy is the medical name for a "breast uplift"operation - from masto meaning breast and - pexy meaning lift. Many patients find that with the passage of time, children, and breasting feeding that the shape of their breasts changes adversely. This is made worse by gravity, often leading to soft, droopy, unsightly breasts.
True mastopexy operations do not change the volume of the breast tissue but produce a more desirable shape. There have been several different mastopexy operations described in the surgical literature. Essentially, all these operations work by moulding the existing breast tissue into a better shape higher on the chest wall. Subsequently, the loose skin is tightened and then re-draped around the new breast with repositioning of the nipple. If a larger breast volume is desired in addition, a breast augmentation can be performed at the same time as the mastopexy.
Before the operation
There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill you should continue to keep taking it, and inform the surgeon or anaesthetist in the hospital. If you smoke it would be advised to stop for a month before and least two weeks after as this will improve wound healing and your post-operative recovery. It is a good idea to bring a soft sports bra (without wire), the same size as you would normally wear, to the hospital on your day of surgery. In addition, it would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.
The operation itself
You will come into the hospital on the morning of surgery. The surgeon will then draw markings on your breasts with a pen to help with the planning of the procedure. The operation is performed under general anaesthetic and takes about 2 to 3 hours. Normally no breast tissue is excised. After breast reshaping the skin is re-draped, the nipple repositioned, and the incisions stitched neatly. There will be a light dressing over the breasts and usually a drain is not required.
Post-operative follow-up and after care.
You need to stay in hospital overnight after the operation. The following day, all being well you can go home with some painkillers. It is import to leave the dressing alone and wear the sports bra day and night. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. At two weeks after the operation the stitches will be removed (this is not painful). At this point it is important to massage the scars twice a day with simple moisturiser (e.g E45 cream).
It is important to rest and take it very easy for at least 2 weeks after the operation. You wound be advised to take 2 weeks off work and it is essential to avoid all sexual activity during this period. The sports bra needs to be worn day and night for a month in total as it helps to mould the breast into shape. Vigorous sport such as jogging or the gym should be avoided for 6 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you.
All operations carry a risk of complications, although in breast surgery serious complications are rare.
It is impossible to perform breast uplift surgery without putting scars on the breast. There are always scars around the new nipple, which extend down to the natural fold under the breast in a straight line. Occasionally, a small horizontal scar may be required to avoid unsightly bunching of the loose skin. Sometimes scars on the breast may be red and lumpy for a few months, but these usually settle down by themselves. Some patients do get unfavourable scars despite very neat stitching at the time of surgery. As doctors we do now fully understand why some patients scar better than others and it is impossible to predict which patients are going to generate poor scars. Fortunately, most scars improve with time and this process of scar maturation may be helped by silicone gel pads.
The risk of infection post-operatively is about 5 %, and responds to antibiotics. Such problematic infections are usually related to "fat necrosis" that has occurred deep with in the breast tissue. A haematoma is a collection of blood under the skin and if significant may need to be drained. This is rare (also about 5%) and does not affect the final outcome. Precautions are taken to avoid both these problems developing by giving antibiotics at the time of surgery and by careful operating.
Many patients will notice that they have reduced sensation in the nipple. This is likely to be permanent and is related to small nerves being divided during the operation. Breast uplift surgery usually makes it impossible to breast feed successfully, although this is not always the case in some patients. Patients who are overweight, or smoke heavily, or are diabetic many have problems with slow wound healing. If this occurs, the wounds are left to close on their own, helped by applying regular clean dressings. Very, very occasionally problems with wound healing may involve the nipple area causing the skin of the nipple to undergo necrosis.
No two breasts are truly identical in size and shape before the surgery. Hence, no two breasts that have had mastopexy operations performed, are truly identical also. Although great care is taken during the operation to match both sides in terms of volume and size, very minor imperfections may exist. Perfect symmetry is always the aim but may not always possible. It is important to remember that the final appearance of the breasts may take several months to develop and with time the shape continues to improve as a result of internal re-modelling of the breast tissue.
Breast uplift surgery involves one overnight stay in hospital, and about 2 weeks off work. The complication rate is low, and patients are usually very happy with the results, which generate a more youthful appearance.
||2 -3 hours
|Nights in hospital
|Time off work
|Return to normality/exercise
||4 - 6 weeks