Breast Lift

The word “ptosis” comes from the Greek word meaning fall.

The nipple areola complex usually descends disproportionately more than does the glandular portion.

Causes include: – loss of breast volume, decrease in skin elasticity, increase and decrease in breast volume with pregnancy and breast feeding, gaining and losing weight – this stretches the skin and the supporting ligaments and even the ductal and glandular structures.

• Classification (Regnault’s)
• Treatment
• Complications
• Post Operative

Classification (Regnault’s)

1st degree – (minor) when nipple descends to the level of the inframammary crease.

2nd degree – (moderate) the nipple lies below the fold but is still anterior on the breast mound.

3rd degree – (major) the nipple has descended to the lower portion of the contour of the glandular breast. The nipple points inferiorly.

Pseudoptosis – the nipple stays in the same place but the breast tissue “bottoms out” with loss of volume.

The nipple position dictates the type of operation needed.

Treatment

1. Minor Ptosis or pseudoptosis require Breast Augmentation (implants).
2. Moderate Ptosis – During a crescent  mastopexy (or lift) an incision is made around the top border of the areola, and continues in a crescent shape on the breast skin above the nipple. The excised skin will be removed and the incision closed.
3. Major Ptosis - The nipple needs to be reposisitioned, the excess skin needs to be excised and the breast tissue remodeled. A breast augmentation (implants) is best done 3 months later, if needed. This is to allow the suturing to heal well.

Complications

• Nipple too high or not on true breast meridian.
• Inadequate skin resection resulting in a floppy breast. Excessive skin tension may lead to fat necrosis.
• Inadequate glandular resection or overly ambitious resection may lead to less projection of the breast.
• Asymmetry. To correct implants of different volumes (usually 25 – 50ml) are used after confirming the volume discrepancy with a sizer. In a reduction or lift more volume is removed from the larger breast, the pattern is adjusted with fine tuning by liposuction before closure.
• Hypertrophic scarring. May be aggravated by increased skin tension or placement of scars outside the inframammary fold.
• Infection – rare only 1 – 2% of cases.
• Post operative bleeding or haematoma – uncommon.
• Nipple necrosis or loss of sensation or altered sensation – around 2 – 10% of cases.
• Correcting 2nd degree or moderate ptosis with large sub-glandular implants ultimately leads to a lower breast position. Correction requires a mastopexy and smaller implants.

Post Operative

• Oral analgesics as required.
• You will need to wear a support bra day and night for 4 weeks (or longer, if comfortable).
• Scar treatment with EssentiaA (a vitamin A oil) – which is available from my rooms.