Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Breast Lift: Mastopexy

If you are uncertain as to which breast procedure(s) might be right for you then have a look at my page on breasts.

Droopy, sagged or empty breasts can be treated with a breast lift, also called a mastopexy. Mastopexy is done to lift the breasts, particularly the nipple and areolar, and to elevate breast tissue to create greater fullness, usually in the upper pole. At the time of mastopexy tissue can be removed in which case the operation is called a short scar breast reduction, or an implant can be added – a mastopexy-augmentation (or just pexy-aug).

breast droop

Ptosis, or breast droop, is when the nipple descends to the infra mammary crease or below. We grade ptosis as follows:

grade 1: nipple at the crease up to 1 cm below the crease
grade 2: nipple 1-3 cm below the crease
grade3: nipple > 3 cm below the crease

As the nipple descends, so it also starts to face a down more. Normally it should point forwards.

I also consider a condition which I call “pre ptosis” where the nipple is not quite normally situated and may face down a little, but is not yet at the crease. Patients who have this are generally discouraged away from mastopexy, although I have done a number of patients like this and they tend to be happy with the surgery. The downside of the surgery is scars, but in time these fade.

Finally there is pseudootosis. This typically occurs in patients who have had prior breast surgery and where the crease is lower than it should be. In other words the breast has slid down the chest a bit like a drop of water may slide down a window pane. In these situations the surgery is slightly different in that the crease needs to be elevated and fixed higher up with sutures to hold it in place and then surgery  like a mastopexy, described below, needs to be done to address the breast tissue and nipple-areola.

Mastopexy is the usual procedure for breast droop. It is performed as a day case procedure (in and out the same day) in my own, private facility, Tranquillity Clinic. The procedure is performed under sedation so that you are asleep, pain free and unaware. This will be supplemented with local anaesthesia.

Most women for breast lift require an incision which leaves a lollipop type scar – around the areola with a vertical limb extending down towards the crease underneath the breasts. Very minor degrees of droop can sometimes be done with an incision simply around the areola (the Benelli approach – especially when a concurrent breast augmentation is done) and severe degrees of droop may require an anchor shaped scar: the lollipop plus a scar in the crease, the same scar that is left with a breast reduction.

The surgery involves an un-wrapping of the breasts, dissection between the breast and the chest wall to elevate the breast and a re-wrapping of the breast in its new, elevated position. I routinely do an auto-augmentation – the breast tissue is lifted from the the lower breast to the upper – your own breast tissue is used like an implant to further improve shape. With mastopexy, the nipple and areola are raised as well. The wounds are closed with dissolving sutures, tape is placed over the cuts and a dressing is applied.

If you are interested in seeing the surgical technique there are two videos below. The first is how I do it which is very similar to the second which is that of Dr. Giovanni Botti. His video shows less of the surgery. Be warned, these videos are of the surgery and not suitable for everyone.

I frequently construct a tape bra which is left in place for a few days after surgery to give additional support and to control bruising and swelling to a degree. A post-operative surgical bra is used for 3 weeks after surgery. The operation is performed in the morning and takes me about two and half hours. You will recover in the afternoon in my recovery room and once you are up and about and I am satisfied, you will be discharged home.

Painkillers will be prescribed for post-operative pain. Bruising and swelling will last about 2-3 weeks and once this has subsided, you can resume your normal activities. It does take a few weeks or months for the breasts to settle into their new shape. The effect should be long lasting but it does depend on your tissue as to how well your breasts hold up against the forces of gravity. You will still need to wear a bra after breast lift surgery.

Below is a before and 4 years after breast lift.

Breast lift

Hello again, Dr. Lazarus!
Once again I would like to say how pleased I am with the result of your handiwork!

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