Ten reasons to consider a breast lift

You might need a breast lift (mastopexy) if one or more of these ten reasons sounds familiar to you:

1. You prefer the breast shape you get when you lift your breasts upwards with your hands.
2. You want your breasts to be “perkier”.
3. Your breast size is good, but they are "too low".
4. When standing, one or both of your nipples point towards the ground.
5. When standing, one or both of your nipples are at or below the level of your breast crease.
6. You can't go braless in any kind of top.
7. Your breast skin is loose, very stretchy, hangs or sags, because of weight fluctuations, pregnancy or breast feeding.
8. You like your breast shape when you stretch your arms above your head.
9. You look short-waisted because your breasts are covering your upper abdomen.
10. If you want your nipples to be positioned higher on the breasts.

Breast implants, by contrast, do not lift the breast. They can add volume, increase roundness, give more upper pole volume, increase projection and fill up loose breast skin - but implants do not lift.

If you have one of these 10 reasons, and want the breast to be larger as well - a combination of breast augmentation and lift may be an option for you.

A new device to improve mastopexy results?

One of the frustrating problems of breast surgery, particularly breast lift surgery, is the nature of the skin. It stretches out - frequently more quickly than either the patient or the surgeon would like, leading to a loss of the uplift or shaping effect of the mastopexy (breast lift).

Surgeons have been trying various methods for years to overcome this problem, with varying success. Literally dozens of different methodologies have been published - with varying results and acceptance.

One new idea, developed in South Africa, is the "breform" internal bra system. This is a soft, polypropylene fabric material, which is shaped much like the cup of a bra. At the time of breast lift surgery, it is implanted into the breast, about one-half inch beneath the skin, and secured to various fixed locations around the breast. Supposedly, it acts as an internal support system, reducing the problem with recurrent stretching out of the skin. This concept has been described in a similar way previously, by the South American Surgeon, JCS Goes. The Breform system uses a different mesh material, and features pre-sized, pre-formed implant shapes - making it an easier-to-use modification of Goes' original idea.

And the early results reported seem promising. The breast shape seems to maintain itself much better than traditional mastopexy surgery.

Before you all get excited, though, let me state that the Breform system is not yet FDA approved - but has been used for a number of years in the U.K., Europe, and South Africa.

Concerns about this technique include:
- higher possibility of infection
- interference with mammography
- subcutaneous scarring / capsule formation around the mesh
- palpability of the mesh
- mesh exposure
- mesh malposition / asymmetry
- interference with subsequent breast surgery / breast biopsy

The proponents of this technique claim that the issues are not a significant problem with this product, but currently, their follow-up is only 4-5 years in length.

We'll have to watch this technique with interest. The surgical results certainly look attractive, and the quoted complication rates appear low. Hopefully, one day it will become an option for American women as well.

Do I need a lift, Doctor?

A common question from patients who are considering a breast augmentation is whether they would need a breast lift or not.

There are several methods that plastic surgeons use to decide whether or not there is significant droop of the breast, known as "breast ptosis". Essentially, it all has to do with the position of the nipple, compared to the position of the crease underneath the breast, known as the "infra-mammary fold".

If the nipple is positioned above the horizontal level of the infra-mammary fold when you are standing up - then any ptosis you may have is considered "mild". If the nipple has descended below the level of the crease, then the breast droop is more significant, and you may indeed benefit from a breast lift, in addition to any augmentation you might be considering.

Another easy method to check for breast ptosis involves clasping your hands on top of your head, and looking at what happens to the nipple position in the mirror. If the nipple position is still too low for your liking, then a lift operation might be beneficial.

When the amount of droop is mild, often we can use a short-scar technique for the lift, avoiding the long anchor-shaped incisions used in the classic breast lift. The benelli or "donut" lift, for example, allows us to can use one circular incision around the nipple - and get three benefits with it: use it to place the implants, make the areola smaller in size, and get a little bit of a breast lift all at the same time.

Implants & lifts - part one

One area of confusion I see frequently in our practice is the difference between when we should use a breast augmentation, and when we should use a breast lift, otherwise known as a "mastopexy". Many people think that a breast implant will lift a significantly droopy (ptotic) breast - sadly, this is not the case.

Adding an implant to a droopy breast most commonly converts it to a bigger, but still droopy breast. Some surgeons will try to "fill up" a droopy breast with a big implant. While sometimes this works, for most people, the effect is temporary - and the additional implant weight on the stretchy breast skin tends to make the droop worse as time goes by. And now, it's a much more complicated thing to fix...

For some women, who just have just a relatively minor degree of breast ptosis (droop) - an implant may work, especially if it is combined with one of our smaller breast lifts, like the "donut lift" - which involves an incision around just the areolar area. But only use an implant if you've decided you want to have a larger breast size. You can't count on them to act as an "internal bra".