What You Need to Know About Breast Lift Surgery

Reviewed by Walter Erhardt, MD

Breast lift cosmetic surgery (mastopexy) is a common, but complex breast enhancement procedure that raises and reshapes sagging breasts. Breast lift can be performed with or without the insertion of breast implants, depending upon the anatomical factors and needs of the patient. About 93,000 breast lift procedures were performed in 2005, according to the American Society of Plastic Surgeons (ASPS).

Initial Consultation

At the initial visit, you can expect the surgeon to take measurements of your breasts while you are upright (seated or standing). You'll talk about the desired size and shape of your breasts, and about the new position of the nipple after surgery. The surgeon should help you fully understand the extent of the changes to your body.

Discussing your expectations and goals with your surgeon helps ensure that you will achieve them. The surgeon may also discuss whether your breast lift surgery may include breast implants or breast reduction to receive a fully satisfactory outcome.

How is a Breast Lift Performed?

The breast lift surgical procedure may be performed under local anesthesia (awake) or general anesthesia (asleep), in a hospital or in an office surgical suite. Your time in surgery is typically two to three-and-a-half hours.

The degree of lift needed generally will determine the number and length of the incisions. The more lift a patient needs, the more likely the patient will need a lift with more extensive incisions. In other words, someone who needs a significant lift likely will not be a candidate for a periareolar incision, but rather the "anchor incision" (described below).

One surgical technique for breast lift involves three incisions that form an anchor shape ("anchor incision"):

• The first incision is around the areola, extending above it and creating a new position for the nipple.
• The second incision runs vertically from the nipple down to the bottom of the breast.
• The third incision runs on the underside of the breast just above the fold under the breast.

These incisions create flaps where excess skin will be removed.

Excess skin may also be removed as the nipple and areola are moved to a higher location on the breast. The nipple is normally positioned so that it will be even (vertically) with the lower crease between the breast and chest. The skin that was previously above the nipple is brought down around the nipple and sutured together under the breast. The nipple and areola remain connected to the underlying breast tissue and the associated nerve and blood supply, reducing the chances of sensation loss.

For some patients, other techniques may be appropriate that may include omitting the horizontal incision along the bottom of the breast and thus leave one less scar after surgery. For women with smaller breasts and less droopiness, a concentric series of incisions can be used, omitting both the vertical and horizontal incisions.

Implants with a Breast Lift

If you are getting breast implants during the surgery, they can be placed:

• immediately behind the breast (subglandular placement)
• behind the breast and the major muscle groups in the chest area (complete submuscular)
• behind the breast and Pectoralis Major muscle — this is the most common location for implants (partial submuscular placement)

After Breast Lift Surgery

Because skin is removed and tissue is moved around, the breasts will be bruised, sore, and swollen afterwards. You can expect to wear bandages or a surgical bra for several days. There may be some pain, but it should not be severe and it can be treated by a prescription from your plastic surgeon. After the bandages and surgical bra have been removed, your doctor may suggest that you wear an athletic or support bra until the swelling subsides. Stitches are normally removed in stages within a week or two after plastic surgery.

Heavy lifting or straining should be avoided after plastic surgery because this can cause the breasts to swell and increase pressure. You can return to work normally within a week, and to full activity within a month. Sensation in your nipples may be reduced temporarily, but sensation usually returns to normal as your breasts heal. Breast feeding is typically unhindered because the connecting glandular tissue of the nipple and areola are left intact during breast lift surgery.

Complications and Risks

As with any surgery, there is risk of complications related to infection or reaction to anesthesia. Excessive bleeding can occur. After healing, some permanent scarring will remain. When proper precautions are taken by the surgical team, complications are typically minimized or prevented.

Ask a Surgeon

For questions about breast lift cosmetic surgery, consult a board-certified plastic surgeon who has experience with breast lifts. Discuss expectations, risks, cost, and benefits with your surgeon. You may also want to talk about whether to have a breast lift alone, or in combination with breast implants.

[page updated May 2008]