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Breast Lift (Mastopexy)
The degree of sagging, or ptosis, of the breast is determined by the
relationship of the nipple and areola to the remainder of the breast
tissue and the crease below the breast (inframammary crease). Physicians
have devised a rating scale where Grade I ptosis refers to a breast where
the nipple is pointing forward and is located above the inframammary crease
beneath the breast. Grade II ptosis implies a breast where the nipple is still
pointing forward, but it has settled below the inframammary crease. Grade III
ptosis implies a breast where the nipple and areola have fallen below the
inframammary crease and are pointing downward towards the floor.
A youthful breast is one with little to no ptosis, such that the nipple and
areola are located above the inframammary crease. There are many different
operations described to 'rejuvenate' the tired breast and make it look more
youthful. This operation frequently includes adding an implant at the time of
the breast lift to achieve a more youthful appearing fuller breast (an augmenation-mastopexy).
The surgery required to lift a breast involves removal of some of the stretched out
skin, which does result in additional scarring on the breast beyond what is required
for a straightforward breast augmentation. Numerous techniques have been described to
achieve a mastopexy, and because of his experience with this procedure, Dr. Zimmerman
has been able to develop a protocol by which the least amount of scarring required will
occur, based on the degree of ptosis of the breast. In mildly ptotic breasts the scars
may range from a curvilinear scar on the upper border of the areola (Crescent Mastopexy),
or a scar encircling the areola ( Doughnut or "Benelli" Mastopexy). More ptotic breast
require more extensive resection of the stretched out skin and more degree of lift in
the form of a Vertical Mastopexy, or to the Anchor or Keyhole Mastopexy performed with
very ptotic breasts A carefully detailed consultation along with explanations of the
anticipated results and scars are essential before proceeding with this procedure.
On occasion, one can get away with not lifting the breast in mild cases of ptosis,
by slightly lowering the position of the implant. But it is a misconception that the
placement of an implant will cause the breast to lift. The implant should be positioned
so it is fairly centered below the nipple and areola, and trying to do this with a ptotic
breast will result in undesirable results. It is also a misconception that the nipple
and areola are completely removed. This is usually only done in the reduction of very
large, and extremely pendulous breasts.