Mastopexy - hitching up for droopy breasts
Indications
Drooping breasts occur in many women after motherhood and
breast feeding. Significant weight loss can also have the
same effect. Following the increase in breast size which
occurs with pregnancy and lactation the fibres which support
the breasts are weakened and stretch; the breast skin is
also stretched. As the breasts shrink after pregnancy and
breast feeding the breasts have lost their youthful shape
and firmness and sag. This appearance is exacerbated by
the effect of gravity and increasing age.
Women dislike this drooping, floppy appearance and request
surgery for cosmetic reasons. Rarely the drooping breast
chaffs the chest wall skin and leads to sweat rashes.
Anaesthetic
- general anaesthetic
Technique
Mastopexy is an operation which can reshape, hitch up and
improve the firmness of a sagging breast. Surgery aims to
improve breast shape by excision and tightening of surplus
skin. The nipple is lifted to a higher position and may
be reduced in size; the breast tissue itself may be tightened
to produce a more youthful shaped breast. There are several
mastopexy techniques. All involve an incision, and therefore
scar, around the areola; different techniques uses different
additional incisions and thus leave different scar patterns
on the breasts.
If breasts are small as well as droopy their size can be
increased by placing breast implants underneath the tightened
breasts (breast augmentation). With very floppy, droopy
breasts mastopexy alone may not achieve a satisfactory result;
a breast implant may also be used to achieve a better appearance.
Before surgery a pattern is drawn on the breasts which correspond
to the incisions used. The incisions are designed to be
hidden by a bra or bikini top. During surgery a tube is
placed in the breast to drain excess fluid and blood which
may form - this is usually removed in 24 - 48 hours.
Length
of operation - 1 - 2 hours
Time
in hospital - 1 - 2 days
Postoperative
discomfort/limitations
Severe pain is unusual; pain is controlled by the use of
local anaesthetics at the time of surgery and pain relieving
medication as needed. Dressings are usually left in place
for 1 - 2 weeks after which a well-fitting sports bra should
be worn until the swelling settles (4 - 6 weeks). If external
stitches are used; they are remove after 10 - 14 days.
Mastopexy does not usually interfere with the ability to
breast fed; but pregnancy invariably stretches the breast
again - the procedure is best deferred until your family
is complete.
Permanent scars are left on the breast and usually improve
with time. The final scars usually settle to a white line;
this may be fine or stretched. In some instances the scarring
is unsatisfactory (see below).
With time the breast shape will change and some drooping
is inevitable.
Time
off work - 3 - 4 weeks
Risks
and complications
General anaesthesia is safe; but in a tiny proportion caries
a very small risk.
General complications: bruising, swelling and bleeding which
may be heavy and need a blood transfusion and a return to
the operating theatre to stop; chest and wound infection,
unsatisfactory scarring (keloid or hypertrophic); leg vein
thrombosis (clot).
Specific complications: Changes in nipple sensitivity (increased,
decreased or lost); breast numbness; delayed wound healing;
asymmetry in size and shape; dog-ears (prominent folds of
skin which may be formed at the ends of any scar).
Several complications
of mastopexy are increased in smokers and in women who are
overweight.
If mastopexy is combined with breast augmentation additional
risks and complications exist.
