Mastopexy (Breast lift, Breast modeling) is a medical term coming from theGreek words mastos – breast and pexia – affixing. It is a plastic surgery procedure for raising/sagging breasts upon the chest, by correcting and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish aesthetically proportionate breasts, the critical consideration is the viability and sensitivity of the nipple-areola complex, to ensure the function of the breasts (i.e. breast feeding and sexual activities).
The breast-lift is a surgical procedure that cuts and removes excess tissues (gland, fat), overstretched suspensory ligaments, excess skin from the skin-envelope, and transposes the nipple-areola complex to a higher position. In surgical practice, mastopexy can be performed as a discrete or extensive breast-lift procedure, as a subordinate surgery within a combined mastopexy–breast augmentation procedure and also as a reduction mammoplasty, which is the correction of oversized breasts.
The usual mastopexy patient is a woman whose personality profile indicates psychological distress about her personal appearance and her body image and who desires the restoration of her breasts, because of the post-partum volume losses of fat and gland tissues, and the occurrence of breast ptosis. Post-operative patients reports have already shown improved physical health, physical appearance, social life, self-confidence and self-esteem. Candidates for mastopexy surgery share certain important characteristics. They need to have appropriate skin elasticity so the skin can conform to its new, improved contours. It is mandatory for patients to have realistic expectations; they should understand not only what mastopexy can accomplish, but also the limitations of the procedures.
The degree of breast ptosis of each breast is determined by the position of the nipple-areola complex upon the breast hemisphere; ptosis of the breast is measured with the modified Regnault ptosis grade scale. Grade I: Mild ptosis – the nipple is located above the inframammary fold and but remains located above the lower pole of the breast. Grade II: Moderate ptosis – The nipple is located at the level of the inframammary fold, yet some lower-pole breast tissue hangs lower than the nipple. Grade III: Advanced ptosis – the nipple is located below the inframammary fold 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. Pseudoptosis is the sagging of the skin of the lower half of the breast and is a usual consequence of postpartum gland atrophy. The nipple is located either at or above the inframammary fold, while the lower half of the breast sags below it. Parenchymal maldistribution is the developmental deformity of the breast – the lower breast lacks fullness, the inframammary fold is very high under the breast hemisphere, and the nipple-areola complex is close to the inframammary fold.
Mastopexy techniques can differ due to the grade of ptosis, the need of breast reduction and/or breast augmentation. Differences between surgical techniques depend on the neuro-vascular pedicle for nipple-areolar complex nutrition and in the shape of the final scar. According to the maintenance of neuro-vascular integrity of the nipple-areolar complex we can consider upper, lateral, medial, inferior, oblique, vertical or horizontal pedicle. According to the final scar three main types of mastopexy procedures can be found. Periareolar mastopexy (Donut lift), featuring the cutting out of a concentric ring of skin from around the nipple-areola complex, with the final circular scar round areola. It is suitable for mild ptosis. The Vertical scar mastopexy (Lollipop lift), 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. This technique can be suitable for mild to severe breast ptosis but usually is not appropriate in cases of larger breasts. The Inverted T mastopexy (Anchor mastopexy) is the technique with a vertical scar extended also horizontally in the inframammary fold. This procedure results in more extended scarring but can solve all types and degrees of breast shape, size and ptosis.
Mastopexy procedure can be of various extents. The simple correction of mild breast ptosis is the easiest surgery with the lowest risk of complications. When surgery is double with both breast tissue reduction and augmentation it becomes more complex with higher risk of post-operative complications, potential asymmetry or non-optimal final breats’shape.
Mastopexy is always performed under general anesthesia with an average operative time of 2 to 4 hours.