Breast Lift (mastopexy) Loss of breast contour following weight loss or pregnancy are problems seen in many women. In cases of breast ptosis (sagging breasts), reconstruction can be done with a breast tuck where the nipple is repositioned higher on the chest and excess skin removed. The breast is then reshaped around the existing breast mound. In some cases the breast shape can be restored by increasing the breast volume of the sagging breast with a breast implant. In other cases there may be so much excess skin and so little breast tissue that both a mastopexy (breast tuck) and augmentation are necessary. Pregnancy following any type of breast surgery can cause problems. There is the stretching of the skin as well as a darkening of your incisions. It is best for an augmented patient not to nurse after delivery to allow the breast size to reform to its pre-partum shape and contour and to avoid permanent stretching of the skin and scars. Ideally, mastopexy, or augmentation with mastopexy should be delayed until after your last child. In most cases where patients wear a good supporting bra, breast changes in pregnancy minimally affect the operative results. The mastopexy procedure may be done without need of augmenting breast tissue. The incisions are around the nipple and include a wedge of skin under the breast. This wedge is removed and the nipple repositioned to give a closure around the nipple with an upside down “T” scar with the horizontal portion in the inframammary crease of the breast. There usually is little disruption to the nerves. However, the problems of scarring, bleeding, and infection are possible even though they are seldom seen. If there is no sufficient breast tissue, then either a subglandular or subpectoral augmentation is done. A mastopexy alone does not carry the risks associated with the implants (hardness, etc.), but a mastopexy cannot restore missing breast tissue. In borderline cases where an augmentation through a small incision is an option to restore breast/nipple contour position versus the breast tuck alone (mastopexy), the choice must be made by both patient and surgeon. The operative procedure itself is done in the office surgery unit under general anesthesia or local anesthesia and heavy sedation. Patients are not aware of the local injections into the breast area owing to the level of sedation. Patients are constantly monitored and usually have no difficulty with the procedure, which lasts approximately 1-1/2 to 2 hours. Patients are asked to have nothing to eat or drink after midnight before surgery. The day before surgery patients are place on oral prophylactic antibiotics. They are to shower and shampoo well the morning of surgery. They are also asked to refrain from Vitamin E and Aspirin products for at least two weeks prior to surgery as these medications can thin the blood and increase their chances of bleeding. Since nicotine compromises blood supply to the skin, patients are requested not to smoke or chew Nicoret gum for two weeks prior to and one week after surgery. The usual down time from the operation is essentially 24 hours before you can really be up and around. Patients recover initially in the recovery area and then are driven home by a loved one. Dressings are changed the day following surgery and the patient is allowed to shower and to wear a support bra day and night approximately one week. After that, a bra need not be worn at night and will probably not be required even during the course of the day at intermittent times. The down time from heavy lifting or performing elaborate household chores would be approximately one week from the time of surgery. We generally use the index of pain to govern what activities the patient can or cannot perform. If it hurts, don’t do it. There is usually a three to four week period following surgery before the last discomfort has disappeared and the patient feels capable of returning to the working situation. It is also best that the patient peruse this letter in terms of side effects of this operation and to gain a better grasp of the procedure, and to discuss it with a neutral third party. Having someone with an objective mind, but with your interest at heart, you can better discuss the points in this letter and objectively approach a decision regarding surgery. You are encouraged to return with that person for your next meeting in my office so as to further discuss the points that have been raised. Please feel free to ask questions of any of the points raised in this letter of Dr. Kennedy or members of the staff.
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