Mastopexy – Breast Lift Procedures for Drooping Breasts

Age is not just a number. Age comes with many issues and associated anatomic changes. Anatomic changes related to aging can include drooping, pendulous, or hanging breasts. Sometimes, it is not easy for women with loose breasts to keep with the pace of the world. Other than not having a perfectly shaped body, there are many other medical conditions that large hanging breasts can cause.

According to the American Society of Plastic Surgeons, breast lift procedures are growing at double the rate compared to breast implant surgeries. Since 2000, the American Society of Plastic Surgeons reported the number of women undergoing breast lift surgery had increased by 70%. Breast implant surgeries remain the most commonly performed surgery among women, but breast lift surgery is also growing steadily.

The medical word for a breast lift is mastopexy. "Masto" comes from the Greek word for "breast." "-Pexy," or more accurately, "-pexia" comes from the Greek word for "affix."

Younger women have a taut breast skin. The elastic and suspensory ligaments hold the breasts firmly at their place. First described in 1840 by Astley Cooper, these suspensory breast ligaments are called Cooper's breast suspensory ligaments. Also, younger women have breasts that are short and tight. As women age, estrogen ratios change, and the density of their breast changes. Also, as women age, their breasts have been exposed more to the effects of gravity. Pregnancy and nursing also affect the position of the breasts on the chest wall. All these conditions disrupt and stretch these Cooper's breast suspensory ligaments and overlying breast skin. Often, these changes can lead to saggy, drooping breasts.

What is a mastopexy or breast lift?

A mastopexy is a surgical procedure that reshapes the breasts and gives the breasts a much better look in terms of position, shape, and size. During a breast lift, Dr. Katzen lifts the breasts. Dr. Katzen achieves this by removing extra, redundant breast skin and excess breast glandular tissue. Also, during the breast lift, Dr. Katzen raises the nipple-areolar complex, and sometimes, reduces the size of the nipple-areolar complex.

Often, women are confused about whether they need breast lift surgery. A simple test to determine if you need a breast lift can be done at home with a pencil and a mirror. All you need to do is place a pencil under the breast, where the breast meets the chest. If the breast tissue can hold the pencil in place, it means that there is hanging breast tissue. Look at your profile in the mirror and analyze where the nipple-areolar complex sits in relation to the pencil. The pencil is in a fold called the infra-mammary fold.

Plastic surgeons like Dr. Katzen categorize pendulous breasts. Ptosis is a medical term and describes sagging. Ptosis comes from the Greek word for "falling."

Dr. Katzen categorizes the severity of breast sag or ptosis by comparing the position of the nipple-areolar complex to the position of the pencil in the infra-mammary fold.

Normal: If the nipple-areolar complex is above the level of the pencil.

Grade 1: mild ptosis. On the profile view, if the nipple-areolar complex is at the same level as the pencil or infra-mammary fold.

Grade 2: moderate ptosis. On the profile view, if the nipple-areolar complex is below the level of the pencil or infra-mammary fold.

Grade 3: severe ptosis. On the profile view, if the nipple-areolar complex is at the bottom of the breast.

Pendulous breasts can be corrected with a breast lift or mastopexy procedure.

Before the mastopexy procedure takes place, Dr. Katzen will need to gather some critical information regarding your medical health. For instance, your medical history, weight and size change after pregnancy, breast measurement, the position of the nipple on the chest area, amount of breast skin, distribution of breast tissue, amount of skin below the nipple, areolar size, quality of the breast skin and whether the breasts are symmetric or not.

Often, mastopexy or breast lift surgery is performed in conjunction with other breast surgical procedures such as reconstruction breast surgery for breast cancer, breast reduction, and breast augmentation procedures. There are four types of mastopexy procedures. The common names for the different kinds of mastopexies are based on the shape of the breast skin that is removed.

1. Crescent Mastopexy

During a crescent mastopexy, a half-moon or crescent-shaped area of breast skin along the upper edge of the nipple-areolar complex is removed. Then, the nipple-areolar complex is raised. A crescent mastopexy is an ideal mastopexy for the patient who only requires "a little" breast lift. Often, a crescent mastopexy is performed with breast implant augmentation. The advantages of the crescent mastopexy are that of all the forms of breast lift procedures, the crescent mastopexy has the least scarring and least amount of risk of potential nipple sensation loss. The main disadvantage of the crescent mastopexy is that it offers the least amount of breast lift. Usually, the crescent mastopexy is for patients with very mild or Grade 1 ptosis. The crescent mastopexy is performed under local, IV, or general anesthesia and takes about 1 to 2 hours to complete.

2. Circumareolar Mastopexy

During a circumareolar mastopexy, an incision is made entirely or 360 degrees (thus, "circumareolar") around the nipple-areolar complex. Another round or elliptical counter incision is made several centimeters away from the incision mentioned above. The skin between these two circles is removed. The breast skin that is removed is in the shape of a doughnut. The nipple-areolar complex is reduced in size. Usually, to maintain shape and to reduce and fixate the nipple-areolar complex size, permanent sutures are placed deep in the breast tissue. The outer incision is pulled toward the inner incision around the nipple-areolar complex, and thus, the breast is lifted. The circumareolar mastopexy is also called the Benelli Mastopexy, after Dr. Benelli in Italy. The advantages of the circumareolar mastopexy are that it offers more of a breast lift than the crescent breast lift, the scar is hidden between the nipple-areolar complex and surrounding breast skin, and there is minimal nipple sensation disruption. The disadvantages of the circumareolar mastopexy are that it does not lift the breasts as much as the vertical or anchor breast lift. Another problem of the circumareolar mastopexy is that if the permanent suture breaks, the breast lift may be lessened or lost, and the nipple-areolar complex may stretch to its original size. Usually, the circumareolar mastopexy is for patients with Grade 1 or Grade 2 ptosis. The circumareolar mastopexy is performed under local, IV, or general anesthesia and takes about 2 to 3 hours to complete.

3. Vertical or Lollipop Mastopexy

During a vertical mastopexy, an incision is made very similar to the circumareolar mastopexy. However, to achieve more lift, breast skin from the base of the nipple-areolar complex (at 6:00) to the infra-mammary fold is excised. The breast skin that is removed is in the shape of a single scoop of ice cream in a cone. The vertical mastopexy raises or lifts the nipple-areolar complex by removing any inverted triangle on the skin between the breast fold and the nipple-areolar complex. When the triangle is closed, the nipple-areolar complex is pushed mobilized upwards. This final scar goes around the nipple-areolar complex and from the base of the nipple-areolar complex to the infra-mammary fold. Dr. Lejour popularizes the vertical mastopexy. The advantages of the vertical mastopexy are that it offers more of a breast lift than the crescent or circumareolar breast lift, and part of the scar is hidden between the nipple-areolar complex and surrounding breast skin. The disadvantages of the vertical mastopexy are that it does not lift the breasts as much as the anchor breast lift. Another downside of the vertical mastopexy is that there is a more visible scar on the front of the breast. Also, another downside of the vertical mastopexy is that there is an increased chance for nipple numbness when compared to the crescent or circumareolar mastopexy. Usually, the vertical mastopexy is for patients with Grade 2 or Grade 3 ptosis. The vertical mastopexy is performed under general anesthesia and takes about 3 to 4 hours to complete.

4. Anchor or inverted T mastopexy

During an anchor or inverted-T mastopexy, an upside down or inverted-T shaped area of breast skin is removed. An anchor mastopexy is a continuation of the vertical breast lift, but more breast skin is removed at the base of the breast, above the infra-mammary fold. Another way to look at the anchor mastopexy is that it is a lollipop mastopexy with extensions both medially and laterally. The final scar looks like an upside down letter T. The anchor mastopexy scar goes around the nipple-areolar complex, down the front of the breast from the base of the nipple-areolar complex to the infra-mammary fold, and then under the breast from the sternum around the side of the torso. The advantages of the anchor mastopexy are that of all the forms of breast lift procedures, the anchor mastopexy has the best ability to lift the breast. The disadvantage of the anchor mastopexy is that with this type of mastopexy, there is the most scarring and the most chance of nipple sensation disruption. Usually, the anchor mastopexy is for patients with Grade 2 or Grade 3 ptosis. The anchor mastopexy is performed under general anesthesia and takes about 3 to 4 hours to complete.

Most mastopexies do not require drains. However, the bigger the breast lift, the more time off you will have to take from work. Most patients can return to a sitting type job, 5 to 7 days after a crescent or circumareolar mastopexy. After a vertical or anchor mastopexy, most patients can return to a sitting type job in 7 to 10 days. Jobs that require more physical activity will increase the length of time before one can return to work. Most patients can start exercising one month after their breast lift, but should wear a supportive bra. To minimize scarring, silicone scar cream and strips should be applied to all breast scars once everything has healed.

Dr. Timothy Katzen is a plastic surgeon well known in Beverly Hills, CA, and Dr. Katzen is an experienced plastic surgery consultant ready to listen to your concerns and create your dream breasts. Call Dr. Katzen today to schedule your FREE breast lift consultation. If distance and traffic are a problem, virtual consultations can be scheduled through Face Time, Skype, WhatsApp, or Zoom. Call (310) 859-7770 today, to get the breasts of your dreams.

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