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Breast Lift (Mastopexy)

A breast lift (mastopexy) is indicated when the breasts have lost their youthful volume, the skin has become stretched and saggy, and the nipples have drooped. This is quite frequently the case after pregnancies or significant weight loss. During mastopexy, excessive skin is removed, the breast gland is lifted and the breast is newly shaped in order to harmonize the appearance of the whole body.

On occasions it is necessary to add a breast implant in order to enhance the overall volume of the breasts.

If you're considering a breast lift, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer / Dr. Zettl.

 What are some of the most common benefits of breast lift surgery?

Breast lift surgery is quite successful at making the breasts firmer and more shapely. Many women find that they no longer need to wear a bra to feel comfortable and look good in their clothes.

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 What will happen at the initial consultation?

During the consultation, you and Dr. Kremer / Dr. Zettl will discuss the changes that you would like to make in your appearance. Because this is a highly personal decision, you’ll want to take time to discuss all of your concerns and desires. It will also be helpful to show Dr. Kremer / Dr. Zettl pictures of breast sizes you like.

Dr. Kremer / Dr. Zettl will explain the procedure, including what kind of anesthesia he will be using. At this time, he will also ask about your medical history, and inspect your breasts. Dr. Kremer / Dr. Zettl will also measure your breasts, take photographs, and possibly require a mammogram (breast x-ray). He should also discuss the new placement of your nipples and ask if you want to reduce the size of the areolas (the darker skin around the nipples). If applicable, Dr. Kremer / Dr. Zettl will make you aware of the possibility to use implants at the same time in order to enlarge your breasts.

Be sure to ask all the questions you have about the surgery. The key to making an informed decision is learning everything you can about your options, risks and benefits.

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 How is breast lift surgery done?

Several different techniques can be used to correct this condition, depending on the size and shape of your breasts as well as the degree of sagging. Surgery consists of removing excess skin from around the areola, and possibly also from the bottom of the breast. The breast gland is then being reshaped, lifted and sometimes even fixed to the underlying tissues. After resection of more skin, the remaining skin envelope of the breast is shifted to tighten the skin envelope. For additional volume an implant can be inserted for added projection and smoothing of the skin. In doing so, the position of the nipple and areola can be elevated to a more youthful position.

The specific breast lift techniques may vary, but they generally fall into different categories: the concentric (or doughnut) mastopexy for women with smaller and less droopy breasts, the vertical mastopexy and the anchor-shaped mastopexy. In general, the more tissue that is cut, the more shaping is possible. This means that in women with extensive sagging, the skin has stretched so much that a smaller incision will not remove enough skin to lift the breast. In these cases, the larger incision is necessary.

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 Concentric (doughnut) and vertical mastopexy:

For women with smaller and less severely drooping breasts, this procedure (which requires fewer incisions) may be possible. Concentric circles (like a doughnut) around the areola are drawn and cut. The doughnut-shaped skin around the areola is then removed. Depending on the individual findings, the skin may be undermined and separated from the breast gland. Then the gland itself is reshaped and moved upwards. Finally, the outer skin is sutured around the areola.

Sometimes the skin that is stitched to the areola may wrinkle because there is more skin than needed around the areola (think of sewing the edges of a hole in a piece of fabric to a smaller circle of fabric in the middle of the hole. This wrinkling is much like the pleats you would see in a pair of pants at the waistline.) Often the wrinkling will subside in just a few weeks to months after surgery as the skin envelope adapts to the new shape and weight of the tissues. If Dr. Kremer / Dr. Zettl does not think that this is possible he may instead elect to make a cut that descends from the areola down to the bottom fold of the breast where it meets the chest. A strip of skin is removed along this cut and the two sides stitched together. Even with this additional vertical cut, this procedure leaves less scarring than the more common anchor-shaped mastopexy.

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 Anchor-shaped mastopexy:

For women with larger or more severely drooping, sagging breasts with a fairly large skin envelope, the anchor-shaped mastopexy is more effective.

First, Dr. Kremer / Dr. Zettl will draw a key-hole shape above the nipple and areola. At the bottom of the key-hole, he will draw an anchor shape from the right to the left side of the breast. The lines will then be incised  and the skin carefully elevated off the breast gland. Excess skin along with some excess breast tissue are removed and the breast gland is then reshaped and moved upwards. Then the skin is sutured around the areola, vertically down to the chest and side to side along the newly created bottom fold of the breast.

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 How long does the surgery take?

Breast lift surgery usually takes about three to four hours to complete. The length of the procedure varies according to the technique used, the size of the breast and whether or not implants are used.

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 Do I have to stay in the hospital?

Probably not. Most breast augmentation surgery is performed as an outpatient in a surgicenter. This allows you to return home within a few hours of the surgery, and spend the night in the comfort of your own home. Sometimes, if a large amount of tissue is removed, it is necessary to spend the night in the hospital so your recovery process can be monitored by a medical staff.

Most often, breast lift surgery is performed under general anesthesia. If the procedure requires fewer incisions, a patient may be given local anesthetics combined with intravenous sedation under monitored anesthesia care.

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 How much pain is there?

Your breasts will probably be sore for two or three days. The discomfort is greatest within the first 48 hours, but improves with each day and is usually relieved by pain medications.

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 What can I expect after surgery?

After the operation, you will notice an immediate and dramatic change in the shape of your breasts. Most women are very pleased immediately after surgery. Some numbness is normal after surgery and may persist permanently, but almost all women feel that it is worth it. You must wear a special bra for support for at least several weeks to a couple of months to aid in healing and shaping the breasts.

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 What is the recovery period like?

The gauze dressing as well as drains will be removed after a couple of days, and you will wear a surgical bra for many weeks. Your breasts will be bruised, and you may experience temporary numbness around the nipples as well as random shooting pains. These conditions generally subside within several weeks.

For the first few days, you need to limit your activities and movement in order to prevent breaking the stitches and stretching the scars. Most women can return to work about two weeks later, although overhead lifting and strenuous movements should be avoided for several weeks to ensure proper healing. Dr. Kremer / Dr. Zettl will provide you with a schedule for resuming your normal routines.

Most bruising, swelling, shooting pains and loss of sensation should subside within three to six weeks. However, it may take up to a year for your breasts to settle into their new look and feel. Over time, your scars will fade but may remain red and bumpy for many months.

Read our Postoperative Care Form from the comfort of your home NOW! 

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 What is the long-term outcome like for most people?

After the surgery, the breasts are fuller and more shapely. The surgery is designed to minimize scarring, and although scars are possible, the surgery generally results in faint lines where the surgical incisions were made.

Some patients who seek breast enlargement actually will need a breast lift for the most desirable result. Dr. Kremer / Dr. Zettl is trained to help you make the best decision. For more information about breast implants, see the section on breast augmentation.

You may also notice slight size or shape differences between your breasts. It is important to keep in mind that the body is never completely symmetrical and that cosmetic surgery can only partly change these preexisting differences. 

The quality of wound healing and your acceptance of the resulting scars unfortunately is not predictable. With a breast lift, the most significant tradeoff for better-positioned breasts is the appearance and permanence of the surgical scars that may take some time before they flatten and become pale and that sometimes will stay visible for good.

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 How long do the results last?

A breast lift will not keep you firm forever. Your breasts will be more youthful and full than they would have been without the surgery. However, the effects of gravity, pregnancy, and weight changes will continue to affect your breasts over time.

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 Ideal candidate:

In general, the best candidates for a breast lift are:

• Women 18 years of age or older
• With stretched skin
• With less breast volume than previous years
• Not intending to lose a great deal of weight, get pregnant, or breastfeed
• Not currently pregnant or breastfeeding
• In good health
• Wanting to improve their appearance
• Realistic in their expectations

The above is only a partial list of the criteria that Dr. Kremer / Dr. Zettl will consider in determining whether or not this procedure is appropriate for you.

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 Risks:

Breast lift (mastopexy) is fairly safe, but no surgical procedure is completely risk free. Risks specific to breast lift surgery include:

• permanent and noticeable scarring
• unevenly aligned nipples, mismatched breasts
• sores or numbness around the nipples
• rarely, death of tissue around the nipple and areola
• risks associated with the use of breast implants if used.

Additionally, there are risks associated with any surgery involving anesthesia, including complications such as bleeding, infection, or adverse reaction to anesthesia.

Read our Specific Surgical Risks Form from the comfort of your home NOW! 

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 Be sure to:

• Tell Dr. Kremer / Dr. Zettl about any allergies you have (to foods, drugs, environmental elements)
• Tell Dr. Kremer / Dr. Zettl if you have a history of bad scarring, such as keloids.
• Tell Dr. Kremer / Dr. Zettl about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription)
• Carefully follow any instructions Dr. Kremer / Dr. Zettl gives you regarding eating and drinking and smoking.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
• Try to schedule surgery at a time other than your menstrual period.
• Arrange for someone to drive you home after surgery or after discharge from the day surgery center or the hospital.
• Please inform Dr. Kremer / Dr. Zettl immediately in case you should experience fever or symptoms of an infection after surgery.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. 

The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer specific questions related to your situation.

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