Philadelphia Breast Lift Specialist
Dr. Kathy L. Rumer, D.O.
 

What is Breast Lift? 

Mastopexy is the surgery of the breast that incorporates excision of excess skin and re-suturing of the tissue to lift the breasts and give them a more youthful, perky appearance.  The anchor incision used to be the only option and still may be your only option should you have excessive ptosis (or sag) to lift your breasts to their former appearance.

What Causes Breast Sag?

Breast Sag is a result of several factors.  The first being the increase in breast size due to pregnancy, weight gain, natural or unnatural hormonal changes, breast implants, or medications.  Secondly, the heaviness of a full breast can cause the tissue envelope to thin and stretch.  Thirdly, if proper support is not worn, or natural aging further reduces the elasticity of the breast envelope, superficial fascia and suspensory ligaments (Cooper's ligaments).  A fourth factor, gravity, takes its toll and the breasts begin to sag.  Women with medium to larger breasts who often engage in sports which cause the breasts to bounce (such as running, aerobics, and jumping rope) without sufficient support are more prone to stress the ligaments and skin envelope which in turn cause premature and significant ptosis.

Are You a Candidate For Breast Lift?

First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions which may inhibit wound healing.  You must also have realistic expectations of the outcome of the surgery.  Breast lift surgery is not without scars and not everyone will scar as well as the next patient.  There are treatments which can lessen their appearance, but the pre-existing disposition to scarring well is preferred.  This may depend upon your health, heredity, eating habits, if you smoke, your post-operative protocol and your surgeon's ability.

You must also be mentally and emotionally stable to undergo an cosmetic procedure.  Cosmetic surgery is not getting a cavity filled.  This is an operation which requires patience and mental stability in dealing with the healing period.  There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

Your Consultation Appointment

The consultation  appointment is ultimately designed to interview with Dr. Rumer and discuss, in her opinion, what your options are. 

At this appointment you should bring a list of questions you have prepared to ask Dr. Rumer, photos of what you like or do not like, and discuss any concerns you may have. Communication is crucial in reaching one's goals.  You must be able to voice your desires to the Doctor if she is to understand what your desired results may be.

Discuss your goals with your surgeon so that you may reach an understanding with what can realistically be achieved.  If you are planning to still have children it is a good idea to wait to have surgery until you no longer wish to have any additional children.  The skin may naturally stretch and then sag again after pregnancy, this would create an even thinner skin envelope.

Determining What Grade Breast Ptosis (Sag) Do You Have?

Your consultation will include a physical examination to determine the laxity of the skin and degree of ptosis of the breasts.  Determining your grade of ptosis can be done at home in advance if you are curious.  This can be done by placing a ruler under the breasts at the natural breast fold, called the infra-mammary fold.  The top edge of the ruler should be at the junction of the breast where it meets the ribcage.

• Grade 1 (Mild Ptosis): The nipple is at the same level of the mammary fold, or slightly above the top of the ruler, and is still above the lower pole of the breast.

  
  

• Grade 2 (Moderate Ptosis): The nipple is 1 to 3 cm below the top edge of the ruler and still above the lower pole of the breast.

  
  

• Grade 3 (Severe Ptosis):  The nipple is 3 cm or lower than the top of the ruler, it is a possibility that you may have Grade 3 ptosis.

  
  

• Pseudo-ptosis (Pseudoptosis):  The nipple is still above the top edge of the ruler, but your breasts appear as if they are sagging due to a prominent, (and sometimes flattened) breast lobe.

Dr. Rumer will also discuss the type of Breast Lift Technique (see below) for your situation, as well as the choice of anesthesia she prefers for your particular breast lift procedure. Most breast lift procedures are performed under either General or Light Sleep Sedation. If you do go under General, we will need to ascertain a list of all of the medications that you presently take for both the the surgeon and the anesthesiologist. Please bring a list of all medications prescribed, over the counter or otherwise (and dosage amounts) with you to your consultation.

Finally, you may choose to book a surgery with Dr. Rumer at this time. If you do, you will more than likely be expected to place down a deposit  to hold your surgery date. You will then usually make an appointment for your pre-operative appointment and make arrangements for preliminary blood tests and other lab work.

Breast Lift Techniques

Resulting Breast lift Scars Depicted In Blue

Diagram 1-5

Breast Lift Techniques:

• The Crescent Lift (Diagram 1): This technique involves removing a crescent-shaped piece of tissue above the areola and resuturing the tissue higher.  This creates a minor lift for patients who have slight ptosis. The areola skin is thinner than the surrounding tissue, so slight distortion at the top is possible if proper support is not worn, or with natural sag and aging.  This can cause the areola to appear oval or egg-shaped as a result.
  

• The Benelli Lift (concentric, or peri-areolar, donut or doughnut lift, Diagram 2) This technique is considered less invasive and was designed with the incisions being made around the areolae (or areolas).  With the Benelli, a doughnut shaped piece of tissue around the areola border (or includes areolar tissue as well to reduce its size) is removed and the surrounding tissue sutured to the areola.  The incisions are sometimes closed with permanent purse string sutures.   The Benelli lift results in flatter projection, yet a rounder breast shape post-operatively as opposed to a naturally sloped breast.

• The Benelli Lollipop, or simply Lollipop (or Keyhole, Diagram 3): This lift is the same as the above but with the addition of a straight scar from under the areolae to the mammary fold (crease). This is for those who have medium ptosis, too much for the Benelli only and too little for a full anchor incision. Puckering at the edge of the areola is possible.

• Full Mastopexy (anchor, Diagram 4): The most commonly used technique for those with severe ptosis is with an anchor-shaped incision that starts at the base of the areola, then vertically to the where the breast crease meets the rib cage and then along the lower portion of the breast at the natural crease (or slightly higher).  Nipple re-positioning is sometimes necessary with this technique as the nipple must be partially removed (see above) and left on a pedicle of flesh to retain the blood flow. This is considered one of the major scarring techniques (with the below being the most scarring) but it sometimes necessary with severely sagging breasts.  With the Standard Mastopexy, the resulting scar appears as the shape of an anchor at the natural crease of the breast up to the areola (darker skinned area) and nipple area. 

• Full Mastopexy (anchor) with an areolae reduction or relocation (Diagram 5): This is sometimes needed or requested to decrease the size of the areolae complexes.  This includes the anchor lift scars with the scars around the areola as with the peri-areolar lift.

  
  

  
  

  Diagram depicts the dramatization of a patient undergoing a Benelli Lift with Areola Reduction and Breast Implants.

Diagram 6

• Areola

  Reduction: (Diagram 6) This is pretty much a Benelli lift, however the only tissue excised is a doughnut of tissue on the actual areola itself.Some women may be displeased with the size of their areolae which may be enlarged due to genetic predisposition, previously having had large breasts then undergoing tissue loss, stretching of the areola due to implants or other reasons.  The areola reduction surgery is designed to remove the redundant areola tissue to improve the overall cosmetic appearance of enlarged areolae.  The reduction may result in a slight lift and may also produce  slight irregularities at the incision line if the reduction was significant.  The areola skin is thinner than the surrounding tissue, so slight distortion is possible if proper support is not worn.

How Breast Lift Surgery Is Performed

Mastopexy surgery usually takes about 1 1/2 to 3 hours depending upon the technique, degree of ptosis (sag) and if prosthetic mammary implants will be used to augment the breasts as well. Dr. Rumer may take longer if other procedures are being performed in conjunction with your breast lift such as reduction or non breast-related procedures. 

The O.R. staff will then scrub your torso (and other areas if you are having other procedures) with a 7.5% Betadine Surgical Scrub.  The O.R. staff will then rinse off the area with sterile gauze soaked in saline and then paint your surgical area with the 10.% Betadine Solution which resembles a brownish, iron-colored liquid.  This will sterilize the area by killing surface bacteria, fungi, protozoa, viruses and yeasts.  A common bacteria found on the skin is the naturally occurring Staphylococcus aureus, or simply Staph) and decrease your risks of an infection. 

Dr. Rumer then makes the incisions - there are several techniques so your incisions may be different depending upon your needs. Determine the intended technique beforehand so there are no surprises.

The actual incisions will either be smaller or larger than the diagrams depict, depending upon your indivudual level of ptosis.  After the breast envelope is pulled together and sutured the incision line is a lot thinner, as depicted above.  Although the scars may stretch due to tension, poor elasticity due to age or illness, the implantation of very large breast prostheses or improper support during the healing phase. Scar tissue can take up to a year to mature. 

Here is a dramatization of an incision for a standard full (anchor) mastopexy with areola reduction for a patient with medium ptosis, the closure of the breast envelope/incision, suturing and the resulting scar:

Anchor Mastopexy With Areola Reduction

After the predetermined incisions are made the excess skin is removed from the breast. The skin underneath the breast (the incision line) is drawn together and sutured, lifting the breast to a new higher position. The areolae and nipples are removed (if applicable) to reposition at a higher placement for the rejuvenated breast. The sutures will remain in this anchor fashion and around the areolae until about 10 days, depending upon the heaviness of the breast and if implants were utilized for augmentation.

With the Lollipop (or keyhole) Mastopexy, the incisions are around the areolae and nipple area and in a straight line down from underneath the areola to the natural crease of the breast. It is like the Standard Mastopexy but a little less tissue (in the shape of a triangle) as well as excess tissue around the areolae is removed. This is generally for breasts which have a medium amount of ptosis (sag). The incision edges are drawn together as in the Standard Mastopexy and sutured together. The nipple and areolae complex is moved up as well.

Again, if you have minimal ptosis (sag) you can possibly have the opportunity of having a Concentric (Benelli, peri-areolar, doughnut) Mastopexy.  If you have VERY minimal sag, the crescent lift may be enough for you. If you have severe sag, usually the anchor lift is the commonly-chosen game plan.  

Usually before closure the operating room staff performs an instrument and sponge check.  After all is accounted for your sutures are fully closed and you are dressed in your medical bra. You are then gently woken up.

Risks, Complications & Contraindications of The Benelli (Peri-areolar) Breast Lift

There are great benefits in getting a mastopexy for those who need it, but everything comes with risks. 

• The most severe risks are attributed to anesthesia.  There may be an allergic reaction to the anesthesia or medications, especially if you have failed to make known your current medication consumption, or if you have not ceased consumption of alcoholic beverages or illegal drugs as instructed.  Abide by the Doctor's instructions regarding the consumption of food and liquids before your surgery as well. Risks of intubation are exacerbated when the patient is an asthmatic.

• Other risks include hematoma (internal bleeding) and/or seroma (fluid build up which may require aspiration) are possible, leading to additional surgeries.

• Infections, although rare can happen when bacteria such as Staph, which naturally lives on your skin, gets into your incision area and multiply or develop.  Washing your breasts, neck and torso with an anti-bacterial soap like Hibiclens or even Dial anti-bacterial soap for several days up until your surgery can reduce the amount of Staph on your skin. Infections can also result from the introduction of bacteria post-operatively through improper dressing changes, bathing or swimming in water which contains infectious agents.  

• Although very rare, another risk is tissue necrosis.  Necrosis can happen when the tissue loses its blood supply.  Your chances of necrosis increase if you smoke and/or you have poor oxygen-tissue saturation, or severe post-operative swelling disrupted the blood flow.  Necrosis can also be the result of an infection.

• Numbness and lack of sensation can be problematic, although usually temporary.  Unfortunately this can be a permanent problem in some cases.  It is a complication we must be aware of before undergoing mastopexy or mastopexy with breast augmentation. 

• Keloidal & hypertrophic scarring is possible in those who are prone to such. This is when the scar tissue forms outside of the area of the wound.  It can result in thick, ropey scars. 

• Asymmetry, where one breast or nipple may appear higher, or larger than the other.  Your areola may not be completely round, edges may appear jagged or the areola may appear oval in shape.

• You may have incision line puckering, which may resemble the opening of a drawstring bag - which usually lessens over time, but can sometime be permeant, but not usually.

• The breasts may also have less projection if you have chosen to have a breast lift without the insertion of breast implants.  Breast implants (sometimes can) have slightly less projection as compared to before of your natural breast projection.  

Your chances of any of the above happening can be significantly decreased when you following Dr. Rumer''s instructions, and can further decrease your chances of having a complication. Please abide by the surgeon's instructions for a smoother, more pleasant recovery and results.

General Risks & Complications

First and foremost there could be an allergic reaction to the anesthetic.  General is considered to be more risky yet any anesthetic could bring on a negative reaction. Negative reactions to medications may also be an issue so watch for sudden rashes, difficulty breathing, increased or decreased heart rate, hives, wheezing, anxiety, fainting, dizziness, nausea, vomiting, etc.

Medications which may commonly cause an allergic reaction include anticonvulsants, barbiturates, penicillin or other antibiotics, Novocain, Xylocaine, sulfa drugs, and some pain medications.

Loss of Sensitivity or Numbness
Loss of sensitivity is common, although temporary.  Nerve endings are severed during this surgery, so you must be patient until they regenerate and sensations begin to return. This can take several months, however permanent sensation loss in the areola (nipple) area or breasts, in general, can and may happen. 

Scarring Irregularities
While scars are going to be a reality, there is also a risk of hypertrophic scar tissue, keloids or inner scar tissue. If you smoke or have a history of abnormal collagen formation or scarring, you may have irregular scarring. A regimen of Steri-Strips directly post-op, switching over to scar gels and Silicone Gel Sheeting after suture removal.

Wound Separation
The separation of the wound edges may be an issue in some cases.  If this occurs, keep the area very clean and contact Dr. Rumer immediately. Revision surgeries are not always necessary but can be in some cases.  Wet bandages can keep wound edges moist and encourage collagenation and wound binding.  If this is not the case, an additional surgery to either excise the wound edges or score the edges and resuture the incision may be necessary.  Regardless of the method needed to close the wounds, the healing process will take longer for a patient with separation than it would with a patient with normal wound healing.

Asymmetry
There may be asymmetry.  Although Dr. Rumer will attempt to make your breasts as even in volume and height as possible, the body is not made of modeling clay and some Asymmetry may and can occur.

Scar Treatments
There are many studies which report that keloid scars were prevented (and lessened in existing cases) with the use of silicone sheeting and gels. There are several scar therapies on the market, including the below sheets which are made specifically for mastopexy procedures made by www.BioDermis.com