Breast Reduction/Lift

One of the things that give women low self-esteem is when they realize that their bodies are not like before. This is particularly true when they consider how their breasts have drooped after breastfeeding or after gaining and losing a considerable amount of weight.

Breast ptosis is a rather complicated condition since several factors need to be considered. Among these are skin thickness, quality, color, presence of striae, breast, fibrous and fatty tissue amount and quality, and nipple and areola complex size, color and shape. It is also worthwhile to note that regardless of correction or repair, due to aging, breasts will always have the tendency to droop.

Any change in breast shape and size (weight gain, pregnancy, breastfeeding) stretches the skin, supporting ligaments and breast structures. Once these changes prove too much for these tissues’ ability to recover, they result in the breast losing its place on the chest wall. For those patients who have smaller breasts, they can expect lesser ptosis as they age. Conversely, those with larger breasts can expect ptosis because of their heavier breasts.

Breast Lift (Mastopexy)

The procedure of choice to correct breast ptosis is called a Mastopexy. Breast lift (Mastopexy), in itself, is an umbrella term consisting of several different procedures that may be used. These may range from merely addressing the skin envelope to rearranging the breast tissue and relocating the nipple-areola complex to adding a small breast implant.

Because of this wide spectrum of procedures, physical examination of the breasts and the patient’s aesthetic goal must be considered. It should be stressed that breast shape and size are two different things. Enlarging the breast with an implant usually does not lift it. On the other hand, lifting the breast can entail some resection/reduction of the breast tissue to obtain the desired lift. The degree of ptosis also affects the available procedure greatly.

Different procedures also carry with them different approaches, hence different future incision scars. Mastopexy is also the procedure used to address too large breasts that give countless women back and neck pains apart from the ptosis that comes with the heavy breasts. Teenagers who also develop some self-esteem issues due to their large breasts may also benefit from these procedures.

Your Consultation with Dr. Joel Nicdao

During physical examination at the initial consult, there are many things that must be discussed in order to manage expectations. Anatomically, whether the patient is high breasted or low breasted should be determined.

Being high breasted commonly has a better result because of the better volume at the upper pole of the breast. Low breasted women typically have a flattened upper pole. Pushing the inferiorly located breast tissue to fill the upper pole will result in an unstable and temporary lift. Patients must be made aware of this important fact in order to understand what results are possible for her.

The breast footprint and its relationship to the nipple-areola complex and the inframammary crease is another anatomically significant factor to note. This relationship can give the surgeon an idea of which procedure will be best for the lift and what sort of incision scars the patient can expect. The breast footprint can also give the surgeon an idea of which blood supply is appropriate to keep in order to decrease the risk for nipple-areola necrosis when it is relocated for the lift.

Different Techniques

The degree of ptosis also determines the appropriate procedure. Although most patients would prefer a periareolar incision for minimal scarring, only those with minimal ptosis are ideal candidates for this approach. The periareolar approach can only raise the nipple-areola complex to about 2cm but not higher, thus if the ptosis is considerable, even with breast parenchymal manipulation, the lift will still be limited.

For those with moderate ptosis, a periareolar and vertical scar approach is used. This type of approach also takes into account the pedicle (blood supply) that must be spared while the breast tissues are resected and repositioned to obtain the best breast shape possible. The chosen pedicle should also ensure good blood supply to the relocated nipple-areola complex. It must be kept in mind that the longest blood supply is not necessarily the best. Severe breast ptosis, expectedly, will have the most scars.

The Inverted T approach simultaneously reduces the size of the breast and reshapes it, lifts the breast parenchyma, relocates the nipple-areola complex and adds lift with the excision of the skin envelope. The spared vascular supply is from the inferior pedicle. In a number of patients, the addition of a small implant to help improve shape may be considered. However, most surgeons would opt to stage the procedure to see whether there will still be a need, or indeed a benefit to adding an implant after the mastopexy. The reason for this is that the weight of the implant counteracts the support created by the procedure. The implant may hasten ptosis after the lift. Regardless of which approach was used to restore lift, it must be stressed that these results are only considered semi-permanent.

Ideal Candidates

Ideal candidates for breast reduction and lift are healthy women with no or well-controlled co-morbidities. Laboratory workups including breast imaging are recommended along with a medical risk assessment prior to surgery.

Recovery & Results

After surgery, patients are fitted with a snug dressing, enough to support the breast but not too tight as to compromise the blood supply to the nipple-areola complex. The stitches are removed in one week. Compression dressings are worn for 24 hours for one month.

The scars are cared for with either a scar gel or silicone patches to make sure that they do not hypertrophy or form a keloid. Steroid injections may be done intralesionally once scars appear to thicken.