A mastopexy is an operation that removes the stretched out skin to lift the
breasts and the nipples restoring them to a more normal position on the chest.
Many women find that with age the breasts sag. This is also frequently seen
following breast-feeding or in women who have lost weight. As the skin
surrounding the breasts stretches and the normal support is lost, the breast is
allowed to sag and the position of the nipple on the chest lowers often pointing
downwards. Many women complain that with saggy breasts the cleavage
disappears unless pushup bras are used to lift the breast. There may also be a
loss of breast volume that many women would like restored.

Who can benefit from a mastopexy?

With time all breasts will tend to sag due to the effects of gravity. Patients with
minor degrees of breast sag may be suitable for an augmentation mammoplasty
using an implant to camouflage the loss of breast tissue and the sagging. The
advantage of this procedure is the visible scarring is at a minimum. With more
significant sagging of the breasts with the nipple well below the level of the crease
beneath the breast, a breast lift or mastopexy is the preferred treatment.

How is a mastopexy performed?

The operation is normally done as a daycare procedure under general
anaesthesia. There are variations in the technique of the operation depending
upon the amount of lose skin present but all reduce the excess skin, lift the
breast and reposition the nipple to a normal location higher on the chest. For the
most severe skin laxity the " keyhole pattern" incisions are used which result in
inverted " T " scars. The incisions are made and the excess skin removed
surrounding the nipple leaving the nipple attached to the underlying breast tissue.
The nipple and breast tissue are elevated on the chest into a higher position, and
the skin is re-draped around it to form a tight skin bra to provide support. For less
laxity the incisions are made only around the nipple and vertically downward, and
for the least just around the nipple. Drains may be used for a few days and the
wounds take several weeks to heal. There is bruising and swelling for several
weeks. Pain is usually moderate after the first day. Arm activity is markedly
limited for the first week, with a gradual return to normal and vigorous activity after
four to six weeks.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is not
possible without scars. They are carefully designed such that with normal
clothing such as evening gowns or halter-tops they are normally concealed. The
incisions are sutured with care to promote optimal scarring. Post operative
activity and wound care instructions must be followed to promote healing.
Individual natural healing characteristics are the main factors in determining scar
appearance; however, breast scars tend to be noticeable when unclothed.

What are the more common complications?

The most common problem experienced with this operation is poor scar
formation. The central chest area is notorious for poor scar formation.
Approximately 25% of patients who have a mastopexy will develop poor scars. At
times these may be red, raised and itchy or tender (hypertrophic scars). The
scars do tend to fade and soften over the course of one to two years, but they are
never fine, hairline, "invisible" scars. They are, however, covered by clothing and
most bathing suits, and are not present above the nipple. Generally, if patients
are pre-warned about the scars, they do not become a major concern.

As in any surgical procedure, an element of risk exists. Although complications
are the exception rather than the rule, you should be aware they could occur.
General anaesthesia has risks as in any surgery. Bleeding, infection and delayed
healing are possible. Nipple sensation may be altered, however this is usually
temporary. Also, it is common to have a minor degree of asymmetry following
this procedure. This is related to the large amount of tissue, which has to be
shifted, the scar formation, and the high incidence of pre-operative asymmetry in
patients.

During the surgery blood vessels are divided to allow for shifting of the tissues
and in the post-operative period poor circulation may result causing loss of some
breast skin or, rarely, a portion or the entire nipple.

How does the operation differ should I have an implant?

Many women desire an increase in breast volume as well as the breast lift. A
silicone shell, saline filled implant may be placed beneath the breast or breast
and pectoral muscle through the same incisions during the operation if desired.

How is the size of the implant determined?

This is determined by discussion with Dr. Horton of your goals. The larger the
implant the less skin tightening is required thus shorter scars. However it is
important to realize that one's breast should be proportional to the rest of the
body as too large an implant can be aesthetically unpleasing.

What are the risks associated with the implant?

The complications of the usual mastopexy as mentioned above apply. The
addition of an implant is a relatively low risk procedure but there are certain
potential problems.

In 20 to 40% of patients the fibrous layer surrounding the implant can tighten and
apply pressure to the outside of the implant. This "fibrous capsule contracture"
causes the breast to feel unnaturally firm and appear too rounded. This is the
most common complication of a breast implant and can usually be dealt with
by a simple manipulation in the office if done early.

Certain patients may benefit from a secondary operative procedure to surgically
release this fibrous layer. Some who are prone to this problem may continue to
have firm breasts even after such secondary surgery. Rarely this is severe
enough to make removal of the implants advisable.

Infection although uncommon may occur and may require removal of the implant
for treatment.

Asymmetrical positioning of the implants is uncommon and is usually due to
some pre-existing breast asymmetry or the result of severe capsular contracture.

Occasionally, usually due to infection, the implant may erode through the skin
and be "rejected" by the body.

Uncommonly the implants can deflate requiring replacement.

Any of these complications may result in temporary or permanent disability or
deformity, may require further surgical treatment, and may possibly prolong the
recovery period and require time off work.