How flat breasts are improved and what to expect after surgery

What can be done to improve sagging or flat breasts?

Both the condition of breast skin, and the coinciding shape and position of the underlying tissue can result in breasts that sag and have a flattened shape. These conditions can be caused by heredity and aging. Sagging of the breast also can be the result of a reduction in breast volume, either from weight loss or changes of the breast associated with pregnancy and breast-feeding. In any case, poor elasticity of skin that has significantly stretched is a significant factor. In higher degrees of ptosis, the nipple and areola of the breast hang lower than the breast crease, and the upper portion of the breast is flattened. Many women who experience severe ptosis must wear a support bra at all times to keep the breasts in a more normal position. In many cases, these women avoid swimsuits, certain fashions, and even intimacy because of the appearance of their breasts. Exercise can firm the underlying pectoral muscles of the breast, but do nothing to change the shape and position of mammary tissue and fat. Creams and massage can somewhat improve the surface of skin that has lost elasticity, but can do nothing to reduce severely stretched skin.

In fact, there is no alternative to surgical breast lift. Only breast lift, also called mastopexy, has been proven to improve, raise, or restore breast shape. Breast lift changes the breast to a more youthful shape and position. It repositions the nipple to a higher location, with a more natural point of projection. It can also reduce the size of the areola (the darker skin surrounding the nipple). In general, breast lift reshapes and uplifts the breasts and areolas, resulting in a more youthful and "perky" appearance. They have a naturally appearing, more rounded shape, outward projection, and neutral position. Following breast lift, a woman can feel confident and comfortable in any style of clothing or swimsuit, and with the appearance of her figure. Breast lift is the least common of breast procedures. The American Society of Cosmetic Surgeons reported nearly 67,000 procedures performed in 2003.

What can I expect after a breast lift?

Breast lift restores firmness, reshapes the breast, and raises the breast and nipple to a higher, more natural position. It is surgery, and requires incisions made on the breast for your cosmetic surgeon to reshape the deep tissues of the breast and to reduce excess skin of the breast and areola. In general, they include one or a combination of all of the following incisions:

Around the areola
Extending vertically downward from the areola to the breast crease
Horizontally in or just above the breast crease

Your incision pattern will be based on the amount of correction that will achieve your goals, the quality of your skin tone and amount of skin that must be reduced, the size of the areola, and the location of the nipple. If a reduction in the size of your areola is necessary, then you will require an incision around the perimeter of the areola. Not all incision patterns are appropriate in all cases. Therefore, a consultation and examination by a cosmetic surgeon with experience in breast lift procedures, and the variety of techniques and incision patterns of breast lift, is essential to determine what is right for you.

Any woman who desires to improve the shape and position of her breasts, who is in general good health, and who has realistic expectations for the outcomes of surgery, is a good candidate for breast lift. Women who may have future pregnancies might consider postponing a breast lift. Breast lift may not affect breast-feeding; however, the results of your surgery can be significantly diminished by the changes in the breasts that occur during pregnancy and breast-feeding. Smoking can significantly affect your ability to heal, and any patient who smokes should stop smoking for several weeks before surgery and during recovery. Women considering breast lift need to understand that the improvement of breast shape and position is accompanied by permanent scarring on the breast. Additionally, breast lift does not reverse the effects of aging because less elastic skin and gravity on the breast and additional sagging (to some degree) are inevitable after surgery.

Breast lift most likely will be performed with general anesthesia, or local anesthesia with sedation. The procedure will be performed in an office-based, freestanding, ambulatory- or hospital-based surgical facility and is routinely done on an outpatient basis. Through the incision pattern your surgeon defines appropriate for you, the underlying breast tissue will be fashioned to a more uplifted and rounded position and shape. Deep sutures may be used to hold the breast tissue in place. If necessary, the size of the areola is reduced in circumference. Excess breast skin is removed and the nipple is raised to a higher position. The skin is brought together and incisions closed to achieve your new breast shape and position. You may awaken from surgery wearing a support bra or elastic bandage that you will continue to wear as recommended by your cosmetic surgeon. Small tubes may be placed at the incision sites to allow any excess fluid accumulation to drain; these will likely be in place for a few days. You will be sore and experience discomfort at the incision sites following surgery. However, this discomfort can easily be controlled with medication.

You may resume light normal activity as soon as you feel ready, and should be walking on the day of surgery. But you will want to avoid lifting anything heavy, or making any jerking or pulling motions for the first few days following surgery. If you have non-absorbable sutures, they will be removed in a week or two following surgery. You may be given silicone tapes or gel to apply to your scars to reduce the formation of raised, red, firm, or other undesirable scars. You will continue wearing the support bra around the clock for several weeks, or as directed by your surgeon. You should avoid wearing underwire bras until permitted to do so by your cosmetic surgeon.

The results of breast lift surgery are visible immediately, although breast shape will continue to settle for several months. Final results, including the softening and fading of scars, may take as much as one to two years. Scars will always be visible, but they are usually hidden under most swimsuits and bras. The risks of breast lift include the development of thick or wide scars. Follow all instructions for wound cleansing, massage of scars, and the use of tapes or topical ointments. This can improve the appearance of scars and lessen the chance of forming raised or firm scars. Following all instructions for wearing support garments is essential to your breasts healing properly. Some women wear a support camisole when sleeping. If that is comfortable for you, it can only enhance and help to maintain the results of your breast lift. An additional risk of breast lift surgery is blood pooling beneath the skin (hematoma) that may need to be drained, if possible. A loss of nipple sensation or temporary sensitivity is possible. There is also the risk of infection, but this is rare. As with any surgical procedure, there are risks associated with anesthesia. Breast lift should not interfere with your ability to breast-feed, and will rarely alter normal breast sensations. Breast lift surgery is not completely permanent. Over time as the result of natural aging, breasts may sag or lose elasticity. You can help to maintain your results by maintaining a stable weight.

Women who undergo breast lift find new confidence not only in their appearance when clothed, but also without clothing, so long as they accept the visible scars that will remain on their breasts. Following breast lift, fashion choices and confidence are greatly increased. Any visible scars on the breast are easily concealed by most swimsuits and clothing. More youthful and shapely breast appearance can be very fulfilling and appealing from the shape of the figure overall to personal confidence in appearance.

Will a breast lift make my breasts smaller?

Breast lift does not normally change the volume of breasts, only breast shape and position. Following breast lift, you may find that you are wearing a somewhat smaller bra size, but this is not likely the result of a reduction, but rather your now firmer and rounder breast shape. However, in some cases a very small reduction of breast volume may be performed on one or both breasts to achieve symmetry and to achieve good outcomes. Discuss this thoroughly with your cosmetic surgery. If your resulting breast size is as important to you as shape and position, then your discussion may include reduction of large breasts or the addition of an implant to enhance smaller breast size.

Why are breast implants sometimes placed with a breast lift?

A breast implant may be placed during a breast lift for several reasons:

If you desire an enlargement along with your breast lift
If the amount of breast tissue removed to achieve your uplift will result in a significant size reduction
To result in an naturally firmer breast, overall

To determine if breast implants are appropriate in addition to your breast lift requires candid discussion with your cosmetic surgeon. Make certain he or she understands your concerns, and thoroughly discusses all the options with you. Together, you can determine if breast implants will help you to achieve your goals.