Mastopexy

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

Overview
Mastopexy or breast lift surgery refers to a group of elective surgical operations designed to lessen the degree of breast ptosis (the "droop" of the breasts). Many patients opt for mastopexy alone. When breast implants are placed as part of the procedure, it is known as a breast augmentation.

The shape of a breast is determined by its skin, its volume and by its connective tissue. Mastopexy procedures may change any of these by reshaping the skin 'bra', by adding volume with implants, or by altering the structure of the breast tissue.

Procedure
The full breast lift involves an incision along the crease underneath the breast, incisions around the areola, and a vertical incision between the areola and the base of the breast. This incision is sometimes called an "anchor incision" because of its shape. It is also sometimes called the Wise pattern, after Robert Wise, who described this incision and its use for breast reduction. This approach allows maximal change to the breast, with elevation of the nipple, as well as a redesign of the conical shape of the breast.

Scarring
The scar is in three distinct locations that each have a characteristic pattern of healing. In the peri-areolar area, scarring is partially concealed by the change in color at the transition from breast skin to the pigmented skin of the areola. The vertical incision from the areola to the crease may be hidden in shadow. The inframmary portion of the scar, along the fold created by the breast is often the thickest of the scars, but it may be hidden in the inframammary fold.

Procedure
Modified breast lifts use fewer incisions than the full procedure. A popular form of the modified breast lift is the Benelli breast lift, otherwise known as the concentric mastopexy. This uses only an incision around the areola.

Scarring
An advantage of this procedure is that there is less scarring, with scarring only around the areola. A drawback is that there can be less change made to the breast's shape, and scars are prone to scar hypertrophy or stretching of the scar. Benelli procedures are frequently performed along with breast augmentation in order to overcome the inability to produce a more conical breast with the anchor or Wise pattern incision. This procedure is criticized because of the tendency to flatten the breast.

Length of effects
In most cases, aging breast tissue will not maintain the shape that the mastopexy initially brought. Usually, gravity will eventually cause ptosis to return to some degree. Surgeons may choose to take into account the design of the mastopexy, and choose to make a more pronounced change which will be apparent for the first month or two after surgery. The design may relax into the desired position as the skin redrapes for two months post-operation.