Breast Lift indications
Sagging is a natural progression of breasts, which intensifies over the years. In some women, sagging occurs earlier, either due to anatomical construction of the breasts, or due to large fluctuations in size, as occurs in pregnancy and breastfeeding. In many cases the breasts show asymmetry, which is due to the different degree of relaxation and fall or pre-exists due to construction. Sagging can occur in the following forms:
- Loss of volume, especially of the upper pole, which creates pseudo-relaxation
- Sagging skin, usually appearing with stretch marks and excess skin
- Loss of gland support
We see that there are three different parameters that lead to relaxation and sagging. The loss of gland volume and fat, skin quality and sagging connective tissue that supports the breast. Under this perspective, breast lift aims to restore lost volume, reduce excess skin and better support the mammary gland. The choice of each technique is based on the correct assessment of each breast, in order to achieve maximum lift and minimize scars.
The main cases where breast lift is indicated are the following:
- After pregnancy and breastfeeding
- After weight loss
- In large, heavy and drooping breasts
We distinguish according to the degree of relaxation 4 stages.
Stage 1: Slight loosening with the nipple above the submammary fold
2nd stage: Medium sagging and loss of volume with the nipple at the height of the submammary fold
3rd stage: Great loosening with the whole nipple complex under the submammary fold
4th stage: Very large sagging with most of the breast below the submammary fold
The main indications for breast lift are the following:
- After pregnancy and breastfeeding
- After weight loss
- Premature sagging due to breast weight
- Asymmetry or malformations of the breast
- After contralateral mastectomy for symmetrization of the breasts
Breast lift or breast augmentation?
We notice that many women who come to the office for consultation do not have a clear picture of the operation they want to perform and ask for a breast augmentation. Even women with relatively large breasts may initially be looking for breast augmentation, because the main problem is the loss of volume in the upper pole and décolleté. There is a fine line regarding the indication of a breast lift or a breast augmentation with silicone implants or the combination. In general, there are several cases with small or medium sagging, in which we can achieve a satisfactory lift only with the use of silicone implants, without the need for any further tightening of the chest with the advantage of completely avoiding any scar.
In some cases, it is clear that the gland and nipple need to be lifted while correcting excess skin. This is usually necessary in 3rd and 4th degree relaxation, where the entire nipple and parenchyma of the breast have receded significantly and are below the height of the breast fold. Depending on the relaxation and quality of the tissues, we choose the appropriate technique, as we will see below.
The difficulty is in the milder cases of laxity, where there is 2nd or 3rd degree relaxation, but the quality of the tissues is relatively good. Such cases are, for example, after pregnancy in women who had relatively large breasts at an earlier age, which atrophied considerably after pregnancies. A key role in the choice of technique is played here by the experience of the plastic surgeon, in distinguishing whether an adequate correction can be made only with silicone implants, or if a lift is needed. If we manage to achieve a good result without the scars left by a lift, it is always ideal.
Breast Lift techniques
There is a plethora of breast lift surgeries and each technique is fully adapted to the problem we need to face. Our main goal is to adequately treat breast sagging with the fewest possible scarring. Briefly we can distinguish the following techniques
- Periareolar lift
- Lollipop type lift
- Keyhole lift
- Lift with T-section or anchor
In cases of minor to moderate relaxation, the technique of periareolar lift is chosen, i.e. with an incision around the nipple. In this case, the whole breast is mobilized and using a special Goretex suture, we can achieve support and long-lasting results. This technique is preferable when simultaneously augmenting the breasts and aims to correct the sagging skin around the nipple. There are several limitations to this technique, because mechanically it cannot withstand much weight and if applied in cases that are inappropriate it can lead to excessive enlargement of the nipples or enlargement of scars, so it is preferred only when only a relatively small degree of lifting is required.
When the sagging is more intense, the periareolar is not sufficient and an extension is made downwards, with an additional vertical scar, which at the end looks like a lollipop and for this reason has been called lollipop lift. This method combines the periareolar lift with a tightening of the central and lower poles of the breast. If the scar needs to be extended further to remove more excess skin, an extension of the vertical scar downwards can be made, so we are talking about the Lejour technique. Alternatively, a turn of the scar in the submammary fold in a J-shape or a small T can be done. This technique is usually called keyhole lift because the skin resection resembles the shape of old-style keyholes. Finally, when we have more excess skin, a technique can be applied with a T incision or anchor, which extends more to the right and left of the keyhole and is more similar to the technique of mammoplasty, i.e. breast reduction.
The above techniques mainly concern the shape of scars and the way we manage excess skin, but do not describe how we manage tissues internally. Since breast sagging does not only concern the skin but basically the deeper tissues, a rearrangement and support is needed internally, in order for the result to have a satisfactory duration. If the lift was based only on the skin, the result in a few months would be very poor. So, we need to bring the mammary gland back to a higher position and support it in such a way that it will last over time. This can be done with various techniques, such as folding the central part of the gland upwards, removing part of the gland, or with inner bra support or even with special mesh such as Galaflex.
In some cases with large breasts and intense relaxation, the lift is performed with the breast reduction technique, in order to lighten the breasts, for both functional and aesthetic reasons. This procedure can be performed either with a T incision or with a Lejour technique, depending on the excess skin.
Finally, we need in some cases to further address the volume loss at the upper pole and decide whether it needs to be replenished in an additional way, beyond the displacement or folding of the gland. Ideally, sometimes it is preferable to choose the combined lift along with the placement of silicone implants, in order to achieve a completely satisfactory correction. This technique is known as augmentation mastopexy. It is not necessarily intended to significantly enlarge the breasts and the silicone implants we use are relatively small in size and low projection, mainly to restore the upper pole and décolleté. Also, if we choose this method, we can remove part of the gland at the lower pole, where there is most relaxation, in order to completely reverse the shape of the chest and the distribution of weight. A great advantage of simultaneous breast augmentation and lift is the greater longevity of the result, compared to lifting without silicone implants. Since for some reason the placement of silicone implants is not desirable or not possible, we can alternatively add fat to the upper pole of the chest at the same time as the lift, to achieve to some extent the same result.
Recovery after breast lift surgery
Recovery after breast lift depends on the technique we choose and whether silicone implants will be placed at the same time or not. All breast lift procedures are performed under general anaesthesia, with the exception of periareolar lift which can also be performed under local anaesthesia. Lift surgeries usually last 1 and a half to 2 and a half hours, and there is almost no postoperative pain. An exception is augmentation mastopexy, i.e. the simultaneous lifting and augmentation of breasts with silicone implants, where there may be some postoperative pain for 3-4 days.
In none of the operations are drains placed, i.e. tubes to remove fluids and after surgery either an elastic bandage or the special postoperative bra is placed. Sutures do not need to be removed because they are internal ones that break down on their own.
It usually takes 3-10 days to abstain from work and avoid physical exercise for 4 weeks. Scars disappear almost completely after 4-6 months.
