Patient Questions

QUESTION

Can I have a Breast Lift Without Implants?

I'm happy with the size of my breasts, but they could definitely be perkier. Is there a way to get a breast lift without implants?

ANSWER

Mastopexies (breast lift)

Mastopexy (breast lift) deals primarily with improving the shape of the breast by modifying the skin envelope around the breast tissue. Both breast augmentation and mastopexy can have an effect on the amount of sag that a breast has however individuals with a significant amount of breast sag typcially require a mastopexy (lift) as breast augmentation alone will not adequately correct the shape.

Since you asked about mastopexies let's talk about them a bit.

Believe it or not the first mastopexies were done as early as the late 1800s and principally used "suspension" techniques placing sutures to try to lift the breasts (think thread lifts). More modern thinking recognizes the need to change the skin envelope around the breast tissue to get good correction of sagging breasts.

How common is a mastopexy? In the US in 2004 there were reported over 98,000 mastopexy procedures performed.

Why do breasts sag? Gravity is the master of us all. Women with large breasts have a natural tendency to sag more over time. The structural elements that help keep the breast in a more youthful position include things called "Cooper's ligaments" and of course the skin. In addition weight gain, weight loss and post-pregnancy changes can cause breast ptosis (sagging).

Plastic Surgeons rank breast ptosis (sagging) in the following manner:

  • Grade 1: Mild ptosis - Nipple just below inframammary fold (your inferior breast crease) but still above lower portion of breast
  • Grade 2: Moderate ptosis - Nipple further below inframammary fold but still with some lower pole breast tissue below nipple
  • Grade 3: Severe ptosis - Nipple well below inframammary fold and no breast tissue below nipple; "Snoopy nose" appearance
  • Pseudoptosis - Inferior pole ptosis with nipple at or above inframammary fold; usually observed in postpartum breast atrophy

Treatment options: For patients with mild breast sagging (grade I) sometimes increasing breast volume can correction ptosis. Obviously ways to increase breast volume include breast augmentation or autologous fat transfers (I'd be happy to discuss these techniques in more detail - just contact me).

Some surgeons will combine a "peri-areolar mastopexy" with breast augmentation to try to get a lift in patients with a bit more sag. This technique invoves excising a donut of skin around the areola (the darker area around the nipple) and suturing the area closed. - it is important to understand the limitations of this technique both in terms of what it can achieve in terms of lift and the longevity of the lift.

More typically Patients require more extensive remodelling of the skin envelope. Techniques include "Wise Pattern" skin excisions which are the typical "anchor" scar, and a more vertical "lollipop" scar. Some surgeons employ additional suture techniques to suspend the breast mound however I have found that typically suture techniques do not improve the appearance or longevity of the lift and that the scar tissue that forms naturally is adequate to gettin a lasting result.

Recovery is typically quick with the final breast shape settling in in about 2-3 months.

I hope this helps!

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