Hormone changes, through pregnancy or aging are the prime enemies, but time, gravity and weight gain/ loss are also culprits to loosen the fibrous support of the breast tissue itself and the skin envelope that covers and helps shape the breast. Surgeons grade the amount of sag (ptosis) from I to III. If your breast has lost its upper fullness but is still above the breast fold, you have pseudoptosis or grade I ptosis. If the nipple has dropped to even with the breast fold, the breast is said to be grade II ptosis. And if the nipple is below the breast fold (inframammary crease), the breast has grade III ptosis. Some have suggested than if the nipple points down in addition to this it should be called grade IV (but this is not a standard grading). The amount of ptosis will primarily determine the type of correction necessary. Often pseudoptosis is corrected with implant augmentation. A grade II ptosis is sometimes correctable with a lift around the nipple/areola or in combination with a breast augmentation. A grade III ptosis almost always needs a wise pattern (or anchor shaped incision) type of lift, sometime even grade II will require this if an implant is not desired. The best way to figure this out is with a consultation in our office.
This is where we listen carefully to what you want. We also will take some photographs and measurements to confirm and document your current shape, size and ptosis. If you want to be bigger or smaller in the process of correcting sag or droop, we take that into consideration. A careful assessment of your medical condition is a very important part of this visit, as safety is the first priority. We will discuss which sort of surgery will best solve your particular issues, and then describe that in detail. We’ll outline alternatives with the advantages and drawbacks of each so you can make a truly educated decision about whether this surgery is what you want. You will also see many photographs of other women just like you so you can make sure that the results are something you’ll be thrilled with and any scars will be inconspicuous and well tolerated. Bring lots of questions; this is your chance to learn everything you ever wanted to know about the subject. Both Dr Sweitzer and Zickler have been doing every sort of breast lift for at least 20 years!
Of course the surgery you pick at your consult determines this part, but a typical wise pattern mastopexy requires about 4 hours and is often done under general anesthesia at a surgery center. (Some types of lifts can be done in our office). The skin is released from the breast tissue and both are rearranged to safely support the breast while preserving the feeling to the nipple and usually preserving the ability to breast feed as well. A scar hides at the border of the areola and an inverted T-shaped scar extends downward from this to hide in the breast fold ( inframammary fold).
(Look for an entry on types of breast lifts in the near future)
This surgery usually doesn’t hurt as much as you might think. To be sure, you’ll know that you have had breast tightening, but most of our patients describe the discomfort as similar to when “their milk came in” during pregnancy. Mostly tight and a little crampy, but this will only last a few days (not months like pregnancy) . You will have a big dressing when you leave the operating room and it is arguably easiest to leave this in place until you see your surgeon for the first post op visit. (See our detailed post op instructions soon to be posted elsewhere on our site ..in a special section for post op instructions). Your stitches will be removed within a week as will any drain tubes if you have needed them. You will want to limit overhead reaching because it will not be comfortable, and certainly heavy lifting and straining are never smart immediately after surgery, but most other normal activities can be undertaken whenever you feel up to it. A word about driving motor vehicles.. You need to be a safe driver, unimpaired with pain medicines and without compromise from post op pain or limitations from range of motion. Otherwise there is nothing about driving that will adversely effect your healing of this surgery. It would be normal to expect to feel run down or tired for about two weeks after this surgery, and you will not feel like you are completely “over it” for about 6 weeks. We usually tell all our patients to leave at LEAST 6-8 weeks after surgery before planning any big events or trips just to make sure you will be ready to enjoy yourself and your new look.
Although this surgery is planned specifically to preserve sensation and function of the breast and nipple/areola, these structures are taken apart and reassembled, and biology is impossible to predict with certainty. Loss of sensation of one or both nipples is a very rare, but possible outcome. The breast tissue itself, or the skin over it can possibly have small areas of necrosis (cell death) leading to increased scarring or visibility on mammograms. Usually this procedure does not interfere with breast feeding, but no one would ever be able to guarantee this as sometimes women who have had no surgery are unable to breast feed. Of course any of the complications possible with any surgery such as bleeding, infection, or reactions to general anesthetic (and many others) are possible as this is a real surgical operation.