Breast lift (mastopexy) is an operation in which excessive breast skin is removed and the breast reshaped to look more youthful. In many cases the nipple is repositioned higher on the breast. After mastopexy, breast volume will be slightly reduced unless an implant is inserted. An implant may be recommended to enhance not only breast size but nipple position and breast contour. Mastopexy scars are visible around the nipple-areola complex and may extend down to and within the crease under the breast. Breast lift is performed with the patient asleep or heavily sedated.
Major complications after breast lift surgery without implants are uncommon. Smokers have a higher risk of healing problems. Asymmetries of nipple position and breast shape can occur, as can nipple numbness or poor quality scars. Continued sagging due to gravity always occurs; larger-breasted women and those with inelastic skin will experience recurrent sagging more quickly. Women who become pregnant or experience significant weight change will have permanent alteration of their breast shape.
Patients can expect moderate discomfort, swelling, and bruising for a week or two after surgery and will have some activity restrictions for about four weeks. Breast shape will be irregular and scars will be tight and firm for six months or longer after breast lift surgery. The bottom line: Breast lift without implants is a relatively lowrisk operation but achieves improved breast shape at the price of visible scars. As a general rule the benefits of breast lift last longer in small-breasted women. If implants are to be added, the risks associated with breast augmentation apply, and the disruption of skin blood supply inherent in a mastopexy makes it especially important that the patient avoid requesting excessively large implants.
Breast reduction (reduction mammaplasty) is an operation in which the breast is reshaped, repositioned, and made smaller. If the procedure does not intend to achieve significant volume reduction, it is more appropriately called a mastopexy (see Breast Lift).
Breast reduction surgery is one of the most commonly performed major cosmetic surgery operations in the “reconstructive” category, meaning that it is often performed for medical rather than cosmetic reasons. Still, some patients cannot obtain insurance approval and proceed on a self-pay basis.
Breast reduction scars are located around the nipple-areola complex and in the lower part of the breast. There are many similarities between breast reduction and breast lift operations; the final location of the scars is similar and the major difference between the operations is in the amount of breast tissue and skin that is removed. Liposuction may be added to breast reduction surgery.
Breast reduction surgery usually requires the patient to undergo two to four hours of general anesthesia, and the patient may stay overnight in a hospital or postoperative care facility.
Breast reduction entails a significant amount of surgery on the breast. Minor complications and healing delays are common, although major complications are rare. A patient can expect activity restrictions for six weeks, and her breast shape will be irregular for at least six months. The major risks include nipple numbness, nipple loss, asymmetry, poor quality scars, and less than optimal final breast shape, especially in overweight patients. Contour irregularities may require a touch-up surgical procedure six to twelve months after the first operation.
The bottom line: Most breast reduction patients experience significant relief of their physical symptoms at the price of noticeable scars. In older patients the final breast shape will be mature rather than youthful. Complications, mainly healing delays, after breast reduction surgery are common, although most are minor and do not require additional surgery.
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