Mastopexy

WHAT IS A MASTOPEXY?

Mastopexy is the name given to the surgical procedure designed to lift a sagging breast and restore it to a more pleasing location on the chest wall.

Different surgical techniques exist to achieve this and which of these is the most appropriate for any given woman will basically depend on the degree of sagging, known medically as ‘ptosis’.

CAUSES OF PTOSIS

Every woman’s breasts change in size and volume with age as:

  • the skin envelope becomes looser; and
  • the supporting Cooper’s Ligaments within the breast itself—and whose function is to hold the breast up high on the chest wall – become weaker and allow the breast to droop.

These changes are accelerated by pregnancy and breast-feeding.

The main groups of women presenting with breast ptosis are as follows:

  1. Young women with large breasts in whom the breasts have sagged from the sheer weight and volume of the breasts.
  2. Women after pregnancy and breast-feeding due to the overstretching of the breast skin and the subsequent shrinkage of the breast tissue when finished thereby leaving the breasts smaller and droopy to varying degrees.These changes result because the breasts:
    • lose volume through shrinkage of the breast tissue and milk glands; and
    • the inelastic, overstretched breast skin does not return to its former state leaving the skin envelope looser.
  1. Post-menopausal women due to progressive loss of breast tissue and skin elasticity.

DEGREES OF PTOSIS

MASTOPEXY TECHNIQUES

In a Mastopexy, unlike a Breast Reduction, NO BREAST TISSUE IS REMOVED.  Only the overstretched, excess skin is removed and the breast volume remains unaltered.  By lifting the nipple/areola and tightening the skin envelope the breast is automatically lifted to a more aesthetic position on the chest wall.  Any one of various skin removal patterns can be used according to the degree of ptosis.  The various patterns available to the surgeon, usually named according to the appearance of the scar they leave, are as follows:

  1. Anchor (‘Wise’) Pattern – used for the more severe forms of ptosis. The scars resemble an anchor with a scar around the edge of the areola, a vertical scar down to the breast fold, and a scar within the breast fold.
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  2. Vertical (‘Lollipop’ Mastopexy) – for lesser degrees of ptosis
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  3. Circumareolar Mastopexy (Benelli Lift or ‘Doughnut Lift’) – involves removing a ‘doughnut’ pattern of skin from around the areola but its ability to “lift” is somewhat limited.
  4. Crescent Mastopexyis the least invasive pattern and involves removing a crescent of skin above the areola.  Sometimes, it is necessary to extend the incisions a little sideways in which case it then changes its name to a ‘Batwing’ Mastopexy as follows.
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AUGMENTATION MASTOPEXY

Each of the Mastopexy techniques described lifts the breasts but do not alter the actual breast volume. Accordingly, if a woman is happy with her breast size and only wishes the ptosis to be corrected, a straightforward Mastopexy will suffice.

However, if the woman also wishes her breasts to be larger, implants can be inserted at the same procedure and this combined technique is known as an AUGMENTATION MASTOPEXY.

PSEUDO-PTOSIS

This is the term given to very early degrees of sagging where the breast mound is below the level of the breast fold but the nipple is still above the fold, when the breast is viewed from the side (refer  diagram below).

Pseudo-ptosis is often correctable with implants alone.

CHOICE OF SURGEON & TECHNIQUE IS IMPORTANT

Mastopexy & Augmentation Mastopexy are complex procedures and as such need to be performed with a surgeon trained in the various techniques.  At Breast Excellence, our surgeon Dr George Mayson, trained in the unique ‘Staple First’ Mastopexy Technique with its originator, Dr Ted Eisenberg, in Philadelphia, USA.  The ‘Staple First’ Mastopexy Technique has the distinct advantage of allowing the surgeon to pre-visualise and safely maximise the amount of skin to be removed thereby achieving the maximum amount of ‘lift’ and in less operating time.