Mastopexy (Greek μαστός ''mastos'' "breast" + -pēxiā "affix") is the plastic surgery

mammoplasty Mammaplasty (also called mammoplasty or mastoplasty) refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are two main types of mammoplasty: # Augmentation mammaplasty ...

procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate

bust Bust commonly refers to: * A woman's breasts * Bust (sculpture), of head and shoulders * An arrest Bust may also refer to: Places * Bust, Bas-Rhin, a city in France *Lashkargah, Afghanistan, known as Bust historically Media * ''Bust'' (magazin ...

for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for

lactation Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The proces ...

and

breast-feeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that brea ...

. The breast-lift correction of a sagging bust is a surgical operation that cuts and removes excess tissues (

glandular In animals, a gland is a group of cells in an animal's body that synthesizes substances (such as hormones) for release into the bloodstream (endocrine gland) or into cavities inside the body or its outer surface (exocrine gland). Structure De ...

adipose Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular ...

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

), overstretched suspensory ligaments, excess skin from the skin-envelope, and transposes the nipple-areola complex higher upon the breast hemisphere. In surgical practice, mastopexy can be performed as a discrete breast-lift procedure, and as a subordinate surgery within a combined mastopexy–breast augmentation procedure. Moreover, mastopexy surgery techniques also are applied to

reduction mammoplasty Reduction mammoplasty (also breast reduction and reduction mammaplasty) is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the woma ...

, which is the correction of oversized breasts. Psychologically, a mastopexy procedure to correct

breast ptosis The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and secret ...

is not indicated by medical cause or physical reason, but by the

self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that h ...

of the woman; that is, the combination of physical, aesthetic, and mental health requirements of her

self The self is an individual as the object of that individual’s own reflective consciousness. Since the ''self'' is a reference by a subject to the same subject, this reference is necessarily subjective. The sense of having a self—or ''selfhood ...

The patient

The usual mastopexy patient is the woman who desires the restoration of her bust (elevation, size, and contour), because of the post-partum volume losses of

fat In nutrition science, nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such chemical compound, compounds, most commonly those that occur in living beings or in food. The term often refers spec ...

and milk-gland tissues, and the occurrence of breast ptosis. The clinical indications presented by the woman—the degrees of laxness of the suspensory

Cooper's ligaments Cooper's ligaments (also known as the suspensory ligaments of Cooper and the fibrocollagenous septa) are connective tissue in the breast that help maintain structural integrity. They are named for Astley Cooper, who first described them in 1840. ...

; and of the breast skin-envelope (mild, moderate, severe, and pseudo ptosis)—determine the applicable restorative surgical approach for lifting the breasts. Grade I (mild) breast ptosis can be corrected solely with

breast augmentation Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Augmentation mammoplasty is ...

, surgical and non-surgical. Severe breast ptosis can be corrected with breast-lift techniques, such as the Anchor pattern, the Inverted-T incision, and the Lollipop pattern, which are performed with circumvertical and horizontal surgical incisions; which produce a periareolar scar, at the periphery (edge) of the nipple-areola complex (NAC), and a vertical scar, descending from the lower margin of the NAC to the horizontal scar in the infra-mammary fold (IMF), where the breast meets the chest; such surgical scars are the aesthetic disadvantages of mastopexy.

Breast ptosis

;Etiology Gravity is the most common cause of breast ptosis, or sagging. * In a young woman with large breasts the sagging occurs because the volume and weight of the bust is disproportionate to body type, and because of the great elasticity of the thin, young skin envelope of each breast. * In middle-aged women, breast ptosis usually is caused by postpartum hormonal changes to the maternal body (e.g., depleted adipose fat tissue and atrophied milk glands) and because of the inelasticity of the skin envelope, which is overstretched by engorgement during

. * In post-menopausal women, in addition to gravity, breast ptosis atrophy is aggravated by the inelasticity of overstretched, aged skin. ;Pathophysiology and presentation In the course of a woman's life, her breasts change in size and volume as the skin envelope becomes inelastic, and the Cooper's suspensory ligaments—which suspend the mammary gland high against the chest—become loose, and so cause the falling forward and the sagging of the breast and the nipple-areola complex (NAC). Moreover, additional to tissue prolapse, postpartum diminishment (involution) of the voluminous milk glands in the breast aggravates the looseness of the suspensory ligaments, and of the inelastic, overstretched skin envelope. Mastopexy corrects said degenerative physical changes, by elevating the (internal) parenchymal tissues, cutting and re-sizing the skin envelope, and transposing the nipple-areola complex higher upon the breast hemisphere. The degree of breast ptosis of each breast is determined by the position of the nipple-areola complex (NAC) upon the breast hemisphere; ptosis of the breast is measured with the modified Regnault ptosis grade scale. Stades de affaissement

;The Regnault ptosis grade scale * Grade I: Mild ptosis — The nipple is located below the inframammary fold (IMF), but remains located above the lower pole of the breast. * Grade II: Moderate ptosis — The nipple is located below the IMF; yet some lower-pole breast tissue hangs lower than the nipple. * Grade III: Advanced ptosis — The nipple is located below the IMF, and is at the maximum projection of the breast from the chest. * Grade IV: Severe ptosis — The nipple is far below the inframammary fold, and there is no lower-pole breast tissue below the nipple.

Laurence Anthony Kirwan Laurence Anthony Kirwan (born 31 March 1952 in Liverpool) is a British doctor. Education and career Kirwan graduated from the Victoria University of Manchester in 1974. He is a Fellow of the Royal College of Surgeons of England since 1979, ...

published an alternative classification system for ptosis of the primary or non augmented breast that is meant to be better suited than the Regnault scale for planning surgery. ;Additional mastopexy considerations Pseudoptosis — The indication is the sagging of the skin of the lower half (inferior pole) of the breast, featuring the nipple located either at or above the inframammary fold (IMF); as such, pseudoptosis is a usual consequence of postpartum milk-gland atrophy. The nipple is located either at or above the IMF, while the lower half of the breast sags below the IMF. Pseudoptosis usually occurs when the woman ceases

nursing Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ...

, because the milk glands have atrophied, and so reduced the volume of the breast, thus the sagging of the breast-envelope skin. Parenchymal maldistribution — The lower breast lacks fullness, the inframammary fold is very high under the breast hemisphere, and the nipple-areola complex is close to the IMF. Such indications of the maldistribution of parenchymal tissues indicate a developmental deformity.

Surgical anatomy of the breast

Composition

Surgically, the

breast The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and secret ...

is a milk-producing

apocrine gland Apocrine () glands are a type of exocrine gland, which are themselves a type of gland, i.e. a group of cells specialized for the release of secretions. Exocrine glands secrete by one of three means: holocrine, merocrine and apocrine. In apocrine ...

overlaying the chest; and is attached at the

nipple The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth mu ...

, and suspended with ligaments from the chest; and which is integral to the skin, the body integument of the woman. The dimensions and the weight of the breasts vary with the woman's age and her ''habitus'' (body build and physical constitution). Hence, small-to-medium-sized breasts weigh approximately 500 gm or less, and large breasts weigh approximately 750–1,000 gm. Anatomically, the breast topography and the locale of the nipple-areola complex (NAC) on the breast hemisphere are particular to each woman; thus, the statistically desirable (mean average) measurements are a 21–23 cm sternal distance (nipple to sternum-bone notch), and a 5–7 cm inferior-limb distance, from the nipple to the inframammary fold, where the breast joins the chest. Breast anatomy normal scheme

Blood supply and innervation

The

arterial blood Arterial blood is the oxygenated blood in the circulatory system found in the pulmonary vein, the left chambers of the heart, and in the artery, arteries. It is bright red in color, while venous blood is dark red in color (but looks purple through ...

supply of the breast has medial and lateral vascular components; it is supplied with blood by the internal mammary artery (from the medial aspect), the lateral thoracic artery (from the lateral aspect), and the 3rd, 4th, 5th, 6th, and 7th intercostal perforating arteries. Drainage of

venous blood Venous blood is deoxygenated blood which travels from the peripheral blood vessels, through the venous system into the right atrium of the heart. Deoxygenated blood is then pumped by the right ventricle to the lungs via the pulmonary artery whic ...

from the breast is by the superficial vein system under the

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

, and by the deep vein system parallel to the artery system. The primary

lymph Lymph (from Latin, , meaning "water") is the fluid that flows through the lymphatic system, a system composed of lymph vessels (channels) and intervening lymph nodes whose function, like the venous system, is to return fluid from the tissues to ...

drainage system is the retromammary lymph plexus in the

pectoral fascia The pectoral fascia is a thin lamina, covering the surface of the pectoralis major, and sending numerous prolongations between its fasciculi: it is attached, in the middle line, to the front of the sternum; above, to the clavicle; laterally and bel ...

. Sensation in the breast is established by the peripheral nervous system innervation of the anterior and lateral cutaneous branches of the 4th, 5th, and 6th intercostal

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...

s, and

thoracic spinal nerve 4 The thoracic spinal nerve 4 (T4) is a spinal nerve of the thoracic segment.

Mechanical structures of the breast

In realizing the breast lift, the mastopexic correction takes anatomic and histologic account of the biomechanical, load-bearing properties of the three tissue types (

) that compose and support the breast; among the properties of the soft tissues of the breast is near-incompressibility (Poisson's ratio of ∼0.5). # Rib cage. The 2nd, 3rd, 4th, 5th, and 6th ribs of the thoracic cage are the structural supports for the mammary glands. # Chest muscles. The breasts lie upon the

pectoralis major muscle The pectoralis major () is a thick, fan-shaped or triangular convergent muscle, situated at the chest of the human body. It makes up the bulk of the chest muscles and lies under the breast. Beneath the pectoralis major is the pectoralis minor, a ...

, the

pectoralis minor muscle Pectoralis minor muscle () is a thin, triangular muscle, situated at the upper part of the chest, beneath the pectoralis major in the human body. Structure Attachments Pectoralis minor muscle arises from the upper margins and outer surfaces ...

, and the intercostal muscles (between the ribs), and can extend to and cover a portion of the (front) anterior serratus muscle (attached to the ribs, the rib muscles, and the shoulder blade), and to the

rectus abdominis muscle The rectus abdominis muscle, ( la, straight abdominal) also known as the "abdominal muscle" or simply the "abs", is a paired straight muscle. It is a paired muscle, separated by a midline band of connective tissue called the linea alba. It exte ...

(a long, flat muscle extending up the torso, from pubic bone to rib cage). The body posture of the woman exerts physical stresses upon the pectoralis major muscles and the pectoralis minor muscles, which cause the weight of the breasts to induce static and dynamic

shear force In solid mechanics, shearing forces are unaligned forces acting on one part of a body in a specific direction, and another part of the body in the opposite direction. When the forces are collinear (aligned with each other), they are called t ...

s (when standing and when walking), compression forces (when lying supine), and tension forces (when kneeling on four limbs). # Pectoralis fascia. The pectoralis major muscle is covered with a thin superficial membrane, the

, which has many prolongations intercalated among its fasciculi (fascicles); at the midline, it is attached to the front of the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sh ...

, above it is attached to the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the rig ...

(collar bone), while laterally and below, it is continuous with the fascia. # Suspensory ligaments. The subcutaneous layer of

adipose tissue Adipose tissue, body fat, or simply fat is a loose connective tissue composed mostly of adipocytes. In addition to adipocytes, adipose tissue contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular e ...

in the breast is traversed with thin suspensory ligaments (

) that extend obliquely to the skin surface, and from the skin to the deep

. The structural stability provided by the Cooper's ligaments derives from its closely packed bundles of

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...

fibers oriented in parallel; the principal, ligament-component cell is the

fibroblast A fibroblast is a type of cell (biology), biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework (Stroma (tissue), stroma) for animal Tissue (biology), tissues, and plays a critical role in wound ...

, interspersed throughout the parallel collagen-fiber bundles of the shoulder,

axilla The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...

, and

thorax The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the cre ...

ligaments. # Glandular tissue. As a mammary gland, the breast comprises lobules (milk glands at each lobe-tip) and the

lactiferous duct Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth mus ...

s (milk passages), which widen to form an ampulla (sac) at the nipple. # Adipose tissue. The fat tissue of the breast is composed of lipidic fluid (60–85% weight) that is 90–99 per cent

triglycerides A triglyceride (TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids (from ''tri-'' and ''glyceride''). Triglycerides are the main constituents of body fat in humans and other vertebrates, as we ...

, free

fatty acids In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, f ...

diglycerides A diglyceride, or diacylglycerol (DAG), is a glyceride consisting of two fatty acid chains covalently bonded to a glycerol molecule through ester linkages. Two possible forms exist, 1,2-diacylglycerols and 1,3-diacylglycerols. DAGs can act as s ...

, cholesterol

phospholipids Phospholipids, are a class of lipids whose molecule has a hydrophilic "head" containing a phosphate group and two hydrophobic "tails" derived from fatty acids, joined by an alcohol residue (usually a glycerol molecule). Marine phospholipids typ ...

, and minute quantities of

cholesterol Cholesterol is any of a class of certain organic molecules called lipids. It is a sterol (or modified steroid), a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell mem ...

ester In chemistry, an ester is a compound derived from an oxoacid (organic or inorganic) in which at least one hydroxyl group () is replaced by an alkoxy group (), as in the substitution reaction of a carboxylic acid and an alcohol. Glycerides ar ...

s, and

monoglycerides Monoglycerides (also: acylglycerols or monoacylglycerols) are a class of glycerides which are composed of a molecule of glycerol linked to a fatty acid via an ester bond. As glycerol contains both primary and secondary alcohol groups two differen ...

; the other components are water (5–30% weight) and protein (2–3% weight). # The skin envelope. The breast skin is in three layers: (i) the

epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and hypodermis. The epidermis layer provides a barrier to infection from environmental pathogens and regulates the amount of water rele ...

, (ii) the

, and (iii) the

hypodermis The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and macro ...

. The epidermis is 50–100 μm thick, and is composed of a

stratum corneum The stratum corneum (Latin for 'horny layer') is the outermost layer of the epidermis. The human stratum corneum comprises several levels of flattened corneocytes that are divided into two layers: the ''stratum disjunctum'' and ''stratum compact ...

of flat

keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...

cells, that is 10–20 μm thick; it protects the underlying viable epidermis, which is composed of keratinizing

epithelial cells Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...

. The dermis is mostly

and

elastin Elastin is a protein that in humans is encoded by the ''ELN'' gene. Elastin is a key component of the extracellular matrix in gnathostomes (jawed vertebrates). It is highly elastic and present in connective tissue allowing many tissues in the bod ...

fibers embedded to a viscous water and

glycoprotein Glycoproteins are proteins which contain oligosaccharide chains covalently attached to amino acid side-chains. The carbohydrate is attached to the protein in a cotranslational or posttranslational modification. This process is known as glycos ...

medium. The fibers of the upper dermis ("papillary dermis") are thinner than the fibers of the deep dermis, thus the skin envelope is 1–3 mm thick. The thickness of the hypodermis (adipocyte cells) varies from woman to woman, and body part.

Surgical procedures

;Indications The surgeon–physician evaluates the woman requesting a breast-lift operation to confirm that she understands the health risks and benefits of the mastopexy procedure. The surgeon confirms that her ideal

body image Body image is a person's thoughts, feelings and perception of the aesthetics or sexual attractiveness of their own body. The concept of body image is used in a number of disciplines, including neuroscience, psychology, medicine, psychiatry, ps ...

(aesthetic goal) corresponds to what can realistically be achieved with the plastic surgery options available. The following conditions are indications for mastopexy. * Sagging breasts, which prolapsed (fell forward) consequent to postpartum milk gland diminishment,

menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

, gross weight-loss, et cetera. * Post-explantation ptosis, the sagging of the inelastic skin envelopes, once emptied of the breast implants. * Congenital ptosis and pseudoptosis, as observed in conditions such as

tuberous breast deformity Tuberous breasts (or tubular breasts) are a result of a congenital abnormality of the breasts which can occur in both men and women (also see Hypoplasia), one breast or both. During puberty breast development is stymied and the breasts fail to deve ...

(constricted breast). * Acquired or relative ptosis, as seen in the post-

mastectomy Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operat ...

breast reconstruction Breast reconstruction is the surgical process of rebuilding the shape and look of a breast, most commonly in women who have had surgery to treat breast cancer. It involves using autologous tissue, prosthetic implants, or a combination of both wit ...

of a

that is of natural and proportionate size, look, and feel.

Mastopexy of the sagging breast

The following descriptions of the ''full breast-lift'' and of the ''modified breast-lift'' techniques are limited to the surgical incisions used to address the skin envelope of the breast, not the internal

parenchyma Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word π ...

, the substance of the breast. ;Full breast lift The sagging bust is lifted using the circumvertical- and horizontal-incision plan of the ''Anchor mastopexy'' (also Lexer pattern, inverted-T incision, Wise pattern, inferior pedicle), which features three incisions: * The Anchor ring: a circular incision at the upper-edge of the periphery of the nipple-areola complex. * The Anchor shank: a vertical incision from the lower edge of the nipple-areola complex to the inframammary-fold incision. * The Anchor stock: a horizontal incision along the inframammary fold, where the breast joins the chest. In cutting the folds of excess skin from the sagging, inelastic skin-envelope of the breast (and occasionally reducing the nipple-areola complex diameter), the three-incision technique of the Anchor mastopexy allows maximal corrections to the breasts, thereby producing an elevated bust with breasts of natural size, look, and feel. Moreover, each of the three scars to the breast hemisphere produced by the Anchor-pattern mastopexy has a characteristic healing pattern: * at the periareolar area — the edge of the nipple-areola complex — the surgical scar is concealed by the light-to-dark skin color at the

pigment A pigment is a colored material that is completely or nearly insoluble in water. In contrast, dyes are typically soluble, at least at some stage in their use. Generally dyes are often organic compounds whereas pigments are often inorganic compo ...

transition, where the light-color breast skin becomes the dark-color areola skin (the ring of the Anchor pattern) * the medial vertical scar (the shank of the Anchor pattern) extends from the lower edge of the nipple-areola complex to the inframammary fold; the shadow of the breast hemisphere hides it * the horizontal scar (the stock of the Anchor pattern), which follows, and is hidden in, the inframammary fold. Post-surgically, of the three breast-lift surgery scars, the scar to the inframammary fold exhibits the greatest tendency to hypertrophy, to thickness and large size. Although the coloration of mastopexy scars fades with the full maturation of the tissues, they do remain visible. ;Modified breast lift The incision plans of the techniques for modified breast lift feature fewer cuts and fewer scars, but limit the plastic surgeon by allowing fewer changes to the skin envelope of the breast. In surgical

praxis Praxis may refer to: Philosophy and religion * Praxis (process), the process by which a theory, lesson, or skill is enacted, practised, embodied, or realised * Praxis model, a way of doing theology * Praxis (Byzantine Rite), the practice of fai ...

, the modified breast lift often is a sub-ordinate surgery within a mastopexy–breast augmentation procedure, the simultaneous lifting and enlarging the bust. Moreover, these incisions are applied to correct the ptosis discussed above; some technical variants of the modified breast lift are: # the periareolar lift (crescent lift), featuring a crescent-shaped incision, above and at a variable portion of the nipple-areola complex perimeter, allows the cutting and removal of a crescent of flesh, thereby facilitates the elevation (transposition) of the nipple-areola complex to its higher (new) locale upon the breast hemisphere. # the circumareolar lift (Benelli breast lift, donut lift), featuring the cutting out of a concentric ring of flesh from around the nipple-areola complex, limits the size and diameter of the circular scar. # the circumvertical lift (lollipop lift, vertical scar), featuring a circumareolar incision, around the circumference of the nipple-areola complex, and a vertical incision from the lower edge of the nipple-areola complex periphery to the inframammary fold.

Mastopexy of the augmented breast

Women who have undergone

also are susceptible to breast ptosis; which incidence might be induced by the physical and mechanical stresses exerted by the

breast implant A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital ...

s upon the internal tissues and the skin envelope; such overstretching thins the skin and atrophies its elastic qualities. Statistically, breast augmentation and mastopexy are plastic surgery operations with low incidence rates of medical complications; yet, when performed as a combined breast-repair procedure (mastopexy–augmentation), the physiologic stresses upon the health of the woman increase the risks of incision-wound infection, breast-implant exposure, damage to the breast and nipple nerves leading to sensation changes, malposition of the nipple-areola complex, and malposition of the breast implant in the implant pocket. Therefore, a mastopexy–augmentation procedure features increased surgical complication rates, when compared to the lesser complication rates of

and mastopexy as discrete surgical operations; likewise, the individual incidence rates of surgical revision and complications, when compared to the revision and complication rates for the combined mastopexy–augmentation procedure. Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications. The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the result, before making any surgical incisions to the breast.

Contraindications

The contraindications for mastopexy are few:

aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...

use,

tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or simply released from the mouth, as is generally done with pipes and cigars. The practice is believed ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

, and

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

are medical and health conditions associated with increased incidences of nipple

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

. In resolving the perceived ptosis of a woman with encapsulated breast implants, the surgeon determines her suitability for a breast lift procedure after explantation, which facilitates assessment of the true degree of ptosis present in the explanted breasts; likewise the assessment of the effects of a combined breast-lift and revision-augmentation procedure, featuring the removal and the replacement of breast implants. For the woman who is at high risk for developing

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...

(primary or recurrent), the mastopexy might alter the

histologic Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...

architecture of the breasts, which tissue change might interfere with the accurate

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

detection and subsequent treatment of cancer; the risks and benefits will be discussed in that setting.

Surgical techniques

General

In realizing a breast lift, a conservative surgical technique produces the fewest, least visible

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

s after excising (cutting) excess folds of skin from the skin-envelope, when either replacing or rearranging or augmenting the internal breast tissues (

l and

). Breast lift techniques are known according to the number of scars produced, which is related to the achievable degree of breast-lift. Pre-operatively, the patient and the surgeon decide upon the appropriate surgical technique (superior, medial, or inferior pedicle) that will achieve the best degree of breast lift. Generally,

(sagging) is determined by the locale of the nipple-areola complex upon the breast; the lower the nipple-areola complex, the greater the degree of breast prolapsation (ptosis). Nonetheless, in breast-lift surgery, the primary consideration is the tissue viability of the nipple-areola complex, so that the outcome is a functionally sensate breast of natural size, contour, and feel.

Evaluating severity

The surgical management of breast ptosis is evaluated by the degree of severity. * Grade I: Mild breast ptosis, which can be corrected with breast implant augmentation, or with a periareolar skin resection (crescent lift), with or without breast augmentation. * Grade II: Moderate ptosis, which can be corrected with a circumareolar ''donut mastopexy'' technique featuring Benelli cerclage suturing; and with circumvertical-incision (lollipop mastopexy) techniques such as the ''Regnault B Mastopexy'' (and the ''Lejour–Lassus breast reduction''). * Grade III: Severe ptosis, which usually can be corrected with the circumvertical and horizontal incisions of the ''Anchor mastopexy'' (inverted-T incision), regardless of the type of pedicle used (inferior or superior).

Repairing false ptosis

''Pseudoptosis'', or false breast prolapse, can be addressed two ways: * With a breast augmentation, or with a skin excision, or with both procedures; and without transposing the nipple-areola complex, which requires cutting the skin of the lower pole of the breast. * With the circumareolar suturing that encircles the nipple-areola complex. To achieve the desired degree of breast lift in accordance with the woman's anatomy, the circumareolar mastopexy technique (circumvertical lift) can be modified with an additional vertical incision. The extra skin-envelope tissue remaining after a vertical-incision technique can either be gathered in a series of pleats, along the vertical limb of the incision, or can be resected, cut and removed, at the inframammary fold, thereby producing a horizontal incision of varying length, as in the circumvertical and horizontal breast lift.

Mastopexy procedures

;Pre-operative matters The plastic surgeon delineates the mastopexy incision-plan upon the patient's breasts and torso; the principal corrective consideration is the correct level of the nipple-areola complex upon the breast hemisphere. In most women, the nipple should be located at, or slightly above, the inframammary fold, because emplacing it too high might later lead to a difficult revision surgery. The proper topographic locale for the nipple is determined by transposing the semicircular line of the inframammary fold to the face of the breast (anterior aspect), thereby configuring a circle, wherein the nipple-areola complex is centred. After determining the nipple locale, the surgeon delineates the remaining skin incisions of the correction, while maintaining the inferior limit of the vertical-incision at a distance above the pre-operative inframammary-fold, which precaution avoids extending the surgical scar to the chest wall after the lifting of the breast and the inframammary fold. ;Intra-operative matters The sole application of

mammoplasty to correct minimal breast ptosis (Grade I) usually is effected with a breast implant prosthesis. The dual application of mastopexy and of breast augmentation surgeries — as one surgical procedure — requires thorough planning, because of the required resections of the parenchymal tissues. The periareolar incision lends itself to breast prosthesis implantation and to nipple-areola complex transposition, whilst maintaining the tissue viability of the nipple-areola complex. Mastopexy by internal surgical approach applies to the woman who has undergone explantation of breast prostheses. In operative praxis, the plastic surgeon elevates the flaps of the cut breast-implant capsules, and folds them in order to increase the volume of the internal mass of the breasts — thereby increasing the projection of the bust from the chest surface. The nipple-areola complex is elevated with plication sutures, and requires no skin resection when there is no excess skin. ;Pedicles — superior, inferior, and medial Although the aforementioned descriptions are of the incisions used to address the breast skin envelope, the surgical management of the breast tissue (parenchyma) is a separate consideration, including maintenance of the neurovascular integrity of the nipple-areola complex. The degree of hemispheric elevation of the nipple-areola complex determines the type of pedicle (superior, inferior, medial) that will provide the best

venous Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...

and

arterial An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...

vascular supply to the nipple-areola complex. Therefore, the application of the superior pedicle approach affords the surgeon greater procedural flexibility in determining the incision site for emplacing the breast implant, but it limits the possible degree of elevation of the nipple. Application of the inferior pedicle approach affords a greater degree of nipple-areola complex elevation, but makes difficult emplacing the breast implant, and the subsequent contouring of the breast. Application of the medial pedicle approach preserves breast sensation with a reliable venous and arterial vascular supply, and avoids the technical and procedural limitations of the superior pedicle and the inferior pedicle approaches. ;Post-operative matters After the breast-lift surgery, wound care is minimal when the sutured closure is subcuticular (under the epidermis), and reinforced with strips of absorbable adhesive tape (butterfly stitches) applied to maintain the wound closed. Post-operative surgery scars upon the breast hemisphere can alter the way that the woman conducts her breast self-examination for cancerous changes to the tissues; thus exists the possibility that masses of

necrotic Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

fat might be mistakenly palpated as

neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

lumps; or might be detected as such in the woman's scheduled

mammogram Mammography (also called mastography) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through d ...

examinations; nonetheless, such benign

changes usually are distinguishable from malignant neoplasms. ;Complications General medical complications of mastopexy include

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, and the secondary effects of the

anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...

. Specific complications include skin necrosis, and

dysesthesia Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation" (abnormal sensation). It often presents as pain Joseph J. Marbach, Joseph Marbach hypo ...

, abnormal changes in sensation (numbness and tingling). Serious medical complications include occurrences of

seroma A seroma is a pocket of clear serous fluid (filtered blood plasma). They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical signs, ...

, a pocket of locally accumulated

serous fluid In physiology, serous fluid or serosal fluid (originating from the Medieval Latin word ''serosus'', from Latin ''serum'') is any of various body fluids resembling Serum (blood), serum, that are typically pale yellow or transparent and of a benign ...

, and occurrences of

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...

, a local accumulation of blood outside the vascular system. Necrosis of the nipple and necrosis of the skin flap (or both), when it occurs, can either be partial, and heal imperceptibly with wound care, or can be complete, and necessitate reconstruction. A complication of the Anchor mastopexy is the tension-caused wound breakdown at the junction of the three limbs of the incision, yet the scars usually heal without undergoing hypertrophy. Asymmetry of the bust is usually present pre-operatively, and the breast-lift surgery usually does not definitively eliminate it, regardless of the applied mastopexy technique or of the plastic surgeon's operative expertise. Moreover, a combined mastopexy–breast augmentation procedure can make the surgical revision of breast asymmetry more difficult because of the overstretched tissues of nipple-areola complex. Moreover, a possible, undesirable outcome of the periareolar mastopexy (circumareolar incision) is the underprojection of the corrected breast from the chest wall.

Mastopexy with medial pedicle flap

;Pre-operative matters To realize a breast lift using the medial pedicle technique, the surgeon delineates the incision plan upon the breasts, chest, and torso of the woman: # The breast meridian for the length of the sternum bone (from the sternal notch at the lower-throat) to the xiphoid process (at the lower tip). # An ellipse, centered upon and bisecting, the breast meridian line on the sternum. # The form and dimensions of the medial pedicle skin-flap, the base of which is above the midline of the ellipse. A long pedicle-base will provide an adequate vascular supply of

and

blood to ensure the tissue viability of the nipple-areola complex. # A semicircle at the superior face of the ellipsis — either a hemisphere (1/2 circle) or a crescent (3/4 circle) — to indicate the transposed locale of the nipple-areola complex. The top of the semicircle is marked at from the superior margin of the sternal notch. In surgical praxis, the incision plan is modified to the woman's anatomy (height, weight, degree of ptosis), and the treatment of the parenchymal tissue. ;Operative technique ;Incision plan After delineating the surgical incision-plan that establishes a technically reliable central axis of the front torso, and before cutting into the breast(s), the plastic surgeon confirms the

topographic Topography is the study of the forms and features of land surfaces. The topography of an area may refer to the land forms and features themselves, or a description or depiction in maps. Topography is a field of geoscience and planetary scie ...

accuracy of the delineated incision plan, by triangulating the measures at the upper sternum and at the umbilicus, and modifying the incisional lines, if required. Afterwards, the surgical incision lines are infiltrated to the breast skin with a

local anaesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

mixture (

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

1.0% and

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

1:100,000) that constricts the pertinent vascular system to limit bleeding. ;Pedicle skin-flap After establishing the dimensions of the new nipple-areola complex, the surgeon de-epithelializes the medial pedicle skin-flap that provides the venous-arterial vascular system for the nipple-areola complex. The first incisions are through the parenchymal tissue, and separate the medial pedicle. The incision is effected to avoid undercutting the skin pedicle and so preserve the nipple-areola complex blood-supply vessels. Hence, the tissue volume of the pedicle flap is essential for establishing the adequate projection of the upper pole of the breast, where the breast originates from the chest. The surgeon resects (cuts and removes) an almost-triangular segment of tissue below the medial pedicle. Finally, for emplacing the nipple-areola complex, the incisions are completed by cutting the ellipse and the tissue adjacent to the medial pedicle. If the incisions to the breast are satisfactory, the patient's

homeostasis In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...

is feasible at that juncture of the mastopexy operation. The surgeon then evaluates the tissue-thickness of the medial pedicle flap, and its physical capability for rotating in a superomedial direction (above and to the center) with no resultant torsion tension to the tissue of the inferior portion of the pedicle; afterwards, the surgeon reduces the tissue thickness of the skin pedicle. Once positioned superiorly, the pedicle tissue thickness is reviewed to ascertain that it fits into the new position, without undue pressure or constriction; thus are assured the tissue viability of the medial pedicle and of the nipple-areola complex. ;Symmetry The critical procedural step in forming the new breast is the collecting and the joining of the three folds of breast tissue (the medial pillar and the two lateral pillars) of the lower pole of the breast, where it meets the chest. The suturing is critical to supporting and shaping the flaccid breast tissues into a hemispheric breast-mound that well projects from the chest wall—a lifted breast. The supine patient then is elevated to a sitting position so that the breasts drape naturally, and the surgeon then delineates upon them the incision plan for the resection (cutting and removing) of the excess folds of skin from the lower sides (inferolateral) and the lower midline (inferomedial) of the new breast. Afterwards, the patient is laid supine, and the excess breast skin is cut; to avoid a

at the inframammary fold, a purse-string closure gathers the excess folds of skin at the lower pole of the breast; in due course, the three joined pillars of skin will integrate to the inframammary fold. Again, the supine patient is elevated to a sitting position so that the surgeon can ascertain the size, shape, and symmetry, or asymmetry, of the corrected breasts. If the degree of breast-lift is satisfactory, the patient is re-laid to the operating table, and the plastic surgeon sutures the incision wounds. ;Post-operative matters During the initial post-operative period, the plastic surgeon examines the patient for occurrences of

, and to evaluate the histologic viability of the breast-pedicle skin flaps and of the nipple-areola complex. During the first three weeks of post-operative convalescence, the surgeon monitors the healing of the mastopexy wounds during weekly consultations with the patient. Depending upon the wound-healing progress of the woman, more or fewer follow-up examinations shall follow. ;Complications Tissue

of the nipple-areola complex is the principal mastopexy medical complication. To prevent nipple-areola complex necrosis, the surgeon monitors and evaluates the viability of the transposed tissue; by the presence of oxygenated, bright red

demonstrates the proper functioning of the nipple-areola complex vascular system. A more common post-operative nipple-areola complex complication is

, manifest as an abnormal sensation of numbness, and as a sensation of tingling, that perdures for the wound-healing period, yet it diminishes as the full functioning of the breast's innervation resumes the full sensitivity to the nipple-areola complex; nonetheless, permanent numbness of the nipple-areola complex is rare. Tissue necrosis of the medial pedicle flap is a potential, but rare, complication of mastopexy procedures. Moreover, the occurrence of

also is possible; in post-operative praxis, a large hematoma is drained immediately, whereas a small hematoma can be observed for self-resolution, before draining.

Wound dehiscence Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. Risk factors include age, collagen disorder such as Ehlers–Danlos syndrome, diabetes, obesity, poor knotting or grabbing of stitches, and trauma ...

, the bursting of a surgical

wound A wound is a rapid onset of injury that involves laceration, lacerated or puncture wound, punctured skin (an ''open'' wound), or a bruise, contusion (a ''closed'' wound) from blunt force physical trauma, trauma or compression. In pathology, a '' ...

at the line of closure sutures, is a medical complication resulting from the poor healing of the wound. Unless wound dehiscence aesthetically compromises the breast-lift outcome, it is managed conservatively. Breast contour irregularities occurred when the tissues of the inferior part of the incision are gathered to avoid forming a scar at the inframammary fold. If the complications do not self-resolve, if the tissues do not flatten, or become smooth, they are revised with additional surgery.

Mastopexy with B-pedicle

;B mastopexy or Regnault mastopexy technique The ''B mastopexy'' (breast lift) is a variation of the ''circumvertical approach'' that features an inverted, upper-case letter-B incision, which, when performed with simultaneous

via submuscular or subglandular implantation of the

breast prosthesis Breast prostheses are breast forms intended to look like breasts. They are often used temporarily or permanently by women after mastectomy or lumpectomy procedures, but may also be used by for aesthetic purposes. There are a number of materials a ...

, restores the natural contour and appearance of the breasts. Moreover, the B mastopexy technique can procedurally include the simultaneous microliposuction to reduce the lateral

l and

tissues in order to achieve the correct size, volume, and contour of the corrected breasts. The B mastopexy can correct several types of breast deformity, every form of

, and

breast hypertrophy Breast hypertrophy is a rare medical condition of the breast connective tissues in which the breasts become excessively large. The condition is often divided based on the severity into two types, macromastia and gigantomastia. Hypertrophy of the ...

; it usually has low incidence rates of hypertrophic

ring, and of loss of sensation in the nipple-areola complex; furthermore, the B mastopexy technique also applies to

, the correction of oversized breasts. The technical and procedural efficacy of the ''B-technique mastopexy'' was established in ''Clinical Techniques: B Mastopexy: Versatility and 5-Year Experience'' (2007), a retrospective study of a 40-woman

cohort upon whom were performed 13 breast-lift procedures without breast augmentation, and 27 procedures with simultaneous

, using a medium-sized breast implant. The cohort reported no medical complications, only one woman underwent scar-revision surgery; and each of the 40 women was satisfied with her mastopexy outcome. Surgical consultation — The plastic surgeon explains the technical and aesthetic considerations of the breast lift operation to the woman. That the B technique mastopexy yields improved aesthetic results with a breast-skin pedicle created with a curvilinear incision (an inverted, upper-case letter-B). That said curvilinear incision technique eliminates the medial vertical incision of the Anchor mastopexy, and so creates a lifted bust with breasts of natural size, appearance, and contour, and few surgical scars. The consultation includes detailed, pre-operative, post-operative, and healing-stage photographs that illustrate the nature and extent of the mastopexy incisions and the resultant scars. That the full healing (scar maturation) might require approximately one year to establish the final contour of the lifted breasts, after the suspensory ligaments and the parenchymal tissue have settled into and upon the chest as an aesthetically satisfactory bust of natural size, appearance, and contour. ;Pre-operative matters To the standing patient, the plastic surgeon delineates the mastopexy incision-plan to the chest, breasts, and torso of the woman. The distance from the suprasternal notch (atop the sternum) to the nipple is measured and recorded to the medical record; the level of the inframammary fold is identified and delineated to the front of the breast (anterior aspect), which indicates the elevated locale to which the nipple-areola complex will be transposed. The medial aspect of the new nipple-areola complex locale is marked approximately from the midline, along the mid-breast; and a semicircle with a 38-mm-diameter is delineated around the nipple; the distance of the semicircle from the ptotic nipple-areola complex indicates the new locale of the nipple-areola complex upon the breast hemisphere. ;Operative technique ;Incision plan With the patient laid supine upon the operating table, the surgeon performs a free-hand, curvilinear delineation of an inverted, upper-case letter-B pattern to the breast. Then, per the landmarks of the initial incision-plan, a semicircular pattern is delineated around the nipple-areola complex. The vertical and horizontal component-incisions of the B mastopexy are created with a tapering, curvilinear incision that begins from the lower margin of the areola to the lateral crease of the breast. The B-pattern incision results in a vertical closure long, from the bottom margin of the nipple-areola complex to the inframammary fold. ;Wound closure The surgeon tests the closure tension of the wound sutures by in-folding the breast over the index finger, and towards the transposed nipple-areola complex, to observe if the skin blanches (whitens) or over-stretches, afterwards, the nipple-areola complex-area dermis is de-epithelialized. In the combined mastopexy–augmentation procedure, wherein the breast prosthesis is emplaced to a submuscular implant pocket, an anaesthetic tumescent solution is injected along the marked incision line. When the breast implant will be emplaced to a subglandular implant pocket, the hypodermic needle penetrates un-resisted into the anatomic plane above the pectoralis major muscle; the tumescent solution

allows blunt dissection. After establishing anaesthesia, the surgeon de-epithelializes each edge of skin by undermining it , with a razor scalpel, thereby facilitating the closing of the surgical wound without tight sutures. In a mastopexy–augmentation, the breast-implant pocket (locale) determines when the surgeon performs the de-epithelialization of the B pedicle; for submuscular implantation, the skin pedicle de-epithelialization is performed after the emplacement; for subglandular implantation, the skin pedicle de-epithelialization is performed before the emplacement. If the mastopexy includes simultaneous breast augmentation with submuscular emplacement, the surgeon observes that the

is divided from the sternum and the ribs. After cutting the implant pocket, the surgeon then de-epithelializes the B-pedicle. To facilitate the dermal closure (joining the wound edges) with minimal tension to the sutures, the breast implant either is displaced up, into the implant pocket, or is partially deflated. For the subglandular emplacement of breast implants, the technique is different; the de-epithelialization of the pedicle dermis is performed initially, after which an incision is made through the de-epithelialized dermis, at the base of the vertical limb of the mastopexy, and then, by means of blunt dissection, an implant pocket is cut above the pectoralis major muscle. ;Symmetry During the dermal closure, the nipple-areola complex is transposed to its new locale, as determined by the skin pedicle. To create the curvilinear scar, the deep dermal closure is accomplished by rotating the lateral flap down and then medially. The deep dermis is approximated (joined) with sutures, in a simple, interrupted fashion. The key suture is emplaced at the junction where the apex of the vertical incision meets the nipple-areola complex—because it is the skin area of the breast subject to the greatest tension(s). The subcutaneous dermal closure is effected with interrupted sutures. As required, the final adjustments before suturing the skin closed, might include either micro-liposuction or additional de-epithelialization. After the dermal closure, a suture is emplaced to achieve the continuous approximation of the nipple-areola complex to the adjacent skin edge, and to the lower skin incisions. ;Post-operative matters Convalescence — Post-operative care is minimal after a mastopexy procedure; the lifted breasts are supported with a porous, soft elastic tape, which is removed at 7–10 days post-operative, and then is reapplied to the mastopexy incisions for an additional 1–2 weeks during convalescence. For comfortable healing of the wounds, the woman wears a surgical brassière, and avoids wearing an underwire brassière until the breast implants have settled into position. The mastopexy outcome is photographed at 2–3 months post-operative.

Mastopexy technique observations

Mastopexic correction results in surgical scars on the lifted breasts; the periareolar mastopexy outcome often is a breast of bottom-heavy appearance, with puckered surgical scars; and the Anchor mastopexy outcome is an aesthetic breast of natural size, look, and feel, but with many scars. Whereas, advocates of the mechanical principle of the B technique mastopexy propose that the creation of a rotational pedicle (with an elevated epidermal flap that rotates around the nipple-areola complex), lifts the breasts with an incision plan with vertical and horizontal incisions that eliminate the medial incision (and its vertical scar), whilst providing good projection of the corrected bust from the chest, and a viable nipple-areola complex. Furthermore, advocates of the B technique mastopexy report that it usually does not require secondary correction, because it allows for the better transposition of excess lateral tissues of the breasts by means of curvilinear incision (inverted, upper-case, letter-B) to the skin envelope.

References

{{Operations and other procedures of the integumentary system Breast surgery Obstetrical and gynaecological procedures

The patient

Breast ptosis

Surgical anatomy of the breast

Composition

Blood supply and innervation

Mechanical structures of the breast

Surgical procedures

Mastopexy of the sagging breast

Mastopexy of the augmented breast

Contraindications

Surgical techniques

General

Evaluating severity

Repairing false ptosis

Mastopexy procedures

Mastopexy with medial pedicle flap

Mastopexy with B-pedicle

Mastopexy technique observations

See also

References