Breast Lift Surgery - Mastopexy

Mastopexy – Breast Lift Surgery - Italy
In the field of aesthetic breast surgery, with attention usually focused on breast reduction or enlargement surgery, we tend to forget to give space to an important type of operation: mastopexy, which favours those who decide to resolve the irritating aesthetic problem of the so –called “drooping breasts”, generally caused by an excessive relaxation of the tissues as a result of a weight loss diet, or “emptying”, as in the typical case of ptosis post pregnancy.
Breast ptosis can be caused by a range of factors such as age or hormonal disturbances, which thus produce a decline in the glandular component of the breast, leading to a complex reduction in the volume of the breast.
The breasts, in these cases, are not so large as to warrant a reduction, nor so small as to make necessary an enlargement.
 
  • How should does the operation work?
  • What are the fundamental principles of the technique?
  • Is the operation traumatic for the patient, causing pain?
  • What residual scarring is there?
  • How long does the result last for?
 
To these questions one must give a clear,
exhaustive response and precise information. A mastopexy operation is extremely delicate, necessitating great experience and specific preparation. It is a true “sculpturing of the breast” and the result is strictly connected to the artistic sense and ability of the surgeon.
 
 

Mastopexy – when and why

  • Aged 20 and above
 
The more or less sudden appearance, but certainly unexpected, of the relaxation of the mammary tissues, creates for the patient not only an aesthetic problem, but also a psychological one, as a result of the difficulty to accept such significant changes in the body.
 

Mastopexy – Surgical technique of Dr Domenico Miccolis

There are three fundamental points to performing an operation to sculpt and firm the breasts:
  1. Cutaneous lifting: an appropriate reduction and lifting of the excess skin and at the same time a reduction of the size of the areola made larger by the relaxation of the breasts.
  2. The remodelling and lifting of the mammary gland in such a way as to refill the upper half of the breast (the flattened and emptied section). It will in this way enable a true “auto-prosthetic gland”.
  3. The blockage of the breasts at the pectoral muscle with a new and natural ligament suspension. In this way the obtained results will last throughout the years. In fact, these reconstructed suspension ligaments are those which would naturally sustain a normal breast. This particular technique is truly innovative, opening new horizons in breast surgery.
 

 

Is scarring a problem? Can scarring be a limit to the operation?

There are those people who express reservations towards a mastopexy operation, above all those who think that to resolve an accentuated ptosis involves a simple prosthetic breast, and that it is not the case that fake breasts will make the chest area more beautiful.
There are many cases in which it a new operation is necessary because the original result, obtained using other methods, was not an improvement, but rather the opposite. When a significant grade of ptosis is present, if one wants to obtain good results an operation with lifting of the areola and a reduction of excessive skin is inevitable.
The aesthetic result obtained satisfies the appearance of the woman to such an extent that it will render the small residual scars unimportant. The result is preferable to the larger exit scars of other methods. It is therefore false to believe that this operation leaves disfiguring or obvious scarring. The patient, before undergoing surgery should be well informed and if necessary ask for clarification on the technique that will be used.

The techniques of reductive mastopexy and mastoplasty are distinguished by the residual scarring, as well as the thin scars that encircle the areola, which are reduced and raised.
 

 

Breast lift with only a periareola incision

There is only one cut which goes around the areola. This can be used in cases of thick elastic skin with not too excessive volume.
 

 Breast lift with vertical incision 

In this case there is a thin vertical incision from the lower edge of the areola to the fold below the breast.
 

Breast lift with L-shaped incision

A vertical incision which reaches the fold and goes across for a few centimetres towards the external part of said fold.
 

Breast lift with T-shaped incision

This involves a vertical incision, from the areola to the fold, as well as a horizontal incision across the line of the breast.

In this way the breast is remodelled by repositioning the areola and nipple at the correct level and eliminating excessive skin in order to achieve a desirable shape.
The scars left after the incisions have been made will improve in time until they are hardly noticeable.
The final intradermal suture, precise and minute, completes the operation. This will be removed around two weeks after the operation. Rarely, it is necessary to effect drainage.
During the post-operative period a protective medical support is worn which is then replaced by a containing bra which should be worn day and night for at least a month.
This operation can take place with local or general anaesthetic and requires only one night’s stay at the clinic before the patient is able to return home in the morning.
 

 

Breast lift - Results

The main objective of a specialist cosmetic surgeon has always been to obtain the best result possible from an aesthetic point of view while at the same time ensuring that this result will last. Remodelling of the breasts must therefore be seen not only in terms of the immediate result but in how this result holds over time. In all fields related to aesthetic surgery there are certain techniques which can be used to achieve this goal.
By utilising a method of drainage and definitive fixing of the mammary gland to the pectoral muscle, the results are able to last from 10 to 20 years. The suspension ligament is reconstructed after being worn down and destroyed over time due to the various processes of distension and relaxation of the tissues. This is an extremely well known textbook technique which has been recognised for its effectiveness.
For patients who are predisposed to heal quickly, if the cut is made correctly it is possible to wear a small bra after just 8 months to a year.
Even in the most difficult cases the scarring can be easily corrected over time.

It can be said with great certainty that with regards to breast operations, the results are closely connected to the ability of the surgeon performing the operation, in contrast to breast enlargement operations, where a particular reaction of an individual patient to the breast implant can compromise the results independently of how the operation was carried out.
Breast lift operations, if well planned and discussed in collaboration with the patient, do not bear any risks beyond those potential complications of any surgical intervention.

The sensitiveness of the nipple, very important for a woman from an erotic point of view, remains intact, as do the specific functions of the mammary gland.

 

 

Breast lift – post-surgery

Breast lift operations, which take place under general anaesthetic in an authorised structure, do not have a painful recovery period (sometimes, at the sides of the area operated on a slight burning sensation as a result of the incision made may be experienced) and 1-2 days in the hospital can be expected.
The stitches are generally removed 15-20 days after the operation.
The scars, which for a certain period remain thin and linear, around the third month will become red, before clearing away definitively after around 6-9 months.
After two or three days the patient can go back to their normal daily life, though taking care to avoid any strenuous activity that could damage the breasts for at least two weeks.
The sensitivity of the nipple and areola generally returns in a period of between 2 and 6 months. In some cases, however, above all if the operation was made on particularly large breasts, there is a possibility of the breaking of some nerves, invisible to the naked eye, which can lead to the recovery of the original sensitiveness of the area taking longer, and in some rare cases can lead to only partial sensitivity.
 
 

Sagging Breasts

Over the course of a life breasts undergo a spontaneous, natural and physiological evolution towards loosening or relaxation, and the drooping effect that occurs can come about as a result of various factors that can be schematically classified in the following way.

Constitutional factors: These form the basis of our appearance and many women as they age develop sagging breasts. This is tied to the structure and elasticity of the skin which covers the breasts and the strength of the suspension ligaments.

Structure of the gland: breasts which are mainly glandular and with a dense and compact structure are more resistant to the phenomenon of sagging breasts.

The volume of the breasts: Larger breasts put the skin under and supporting tissues and greater strain and can therefore be more likely to fall further.

The shape of the breasts: wide-based breasts keep their form better than thinner or pear-shaped breasts.

Pregnancy and diet: these are the most natural factors. In fact, the rise in breast volume causes an excessive loosening of the skin, frequently resulting in the breaking of its elastic fibres. It is difficult for the skin post-pregnancy to return to its original size, remaining in excess, with the glands also beginning to decay.

Significant weight loss or gain: if excessive, this can cause the same negative effects as pregnancy; a loosening of the skin and a deterioration of the glands and fat. From what we describe we can see how at the base of a sagging or drooping breast, there is a disproportion between the ‘container’ (the excessive skin) and the ‘contained’ (glands and fat reduced in volume). A surgical operation in this case has the goal of returning these two elements to a correct proportion with skin lifting; that is to say an appropriate reduction of the skin in order to create a new and permanent ‘natural bra’. At the same time the mammary glands are collected and lifted, fixed to a stable and higher position. This operation is known as mastopexy, or breast lift surgery.

Ptosis of the breast – sagging breasts – can be of three different grades according to the level of descent of the nipple and the distance between the infra-mammary fold and the nipple. The bigger the distance, the greater the ptosis and the larger the necessary skin reduction.
 

 

How is the grade of ptosis measured?

Very simply, by the centimetre. If the distance between the infra-mammary fold and the nipple is 1-2 cm the ptosis is light, if 3-4 cm the ptosis is medium, and more than 4-5 cm is considered serious. In basis of the volume of the glands and fat present, ptosis of the breast can occur in three forms, which each require a different surgical procedure.
  1. Ptosis with a normal volume of glands: the breasts are of normal volume, but loose and flaccid, with inelastic skin. A single mastopexy operation is necessary.
  2. Ptosis with abundant glandular volume: in this case a partial reduction in volume may be also be necessary in addition to the mastopexy.
  3. Ptosis with scarce volume of glands: Considered “empty breasts”, where there has been a state of re-absorption and decay in the glandular structure. The breasts appear like an “empty sack” which must be not only reduced, but also refilled. In these cases it is necessary to complete the mastopexy with the insertion of a breast implant to give an adequate volume and consistency to the breast. This operation is defined as a breast implant surgery
 
 

Mastopexy – Operation time

Anestethic: local or general sedation
Duration: 90-120 min
Time spent in clinic: 24 hours
Amount of medication: 3
Recovery period: 14 days
 

 

Mastopexy - Before and after


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