Dr Tavakoli’s Philosophy on Breast Lift or Mastopexy
Unfortunately, gravity does tend to take its toll on breasts. Sometimes sagging happens gradually over time; sometimes it’s noticeable after weight loss or breastfeeding. For those who want to improve the positioning and shape of their breasts (without reducing the size), Breast Lift surgery is usually the best way. In some cases its best combined with a Breast Augmentation, but can also be done independently.
Dr Tavakoli performs a large number of Breast lift operations with all 4 internationally accepted techniques further refined by him over the past 12 years in private practice, including over 1000 Breast Lift cases. The issue of breast lifting is very complicated as most women do not wish to have the scars or the extra cost involved in performing the lift. Dr Tavakoli prefers to use an implant to achieve the lift however he also recognises that in situations where the skin has stretched too much and has lost its elasticity the use of an implant alone is unwarranted.
Operative Sequence Offered
Dr Tavakoli may recommend any of the following operations to you at the time of the consultation:
- Breast Augmentation alone- Patients always enquire if they can simply have an implant to correct droopiness or ptosis. This depends on the A. Severity of the drop plus B. Skin quality of patient. I categorise the patients during consultation to:
A. Green Zone: Patients have mainly deflated breasts, will do greatly with the appropriate use of implant and dual pocket dissection
B. Yellow zone: Patient has a combination of deflation and droopiness that may not fully resolve with the use of implants but she may accept slight droopiness in the postoperative breasts as long as there are no scars involved
C. Red zone, the droopiness far outweighs deflation and patient must undergo Breast lift or mastopexy in order to achieve aesthetically pleasing results
- Breast Augmentation with breast lift in one operation (single staged)
- Breast lift followed by breast augmentation after 6-12 months for Extreme droopyness and/or severe asymmetry (2 staged)
- Breast lift alone, Auto-augmentation:In selected cases where patient has droopiness with great skin and firm parenchyma Dr Tavakoli uses a modern “Internal Bra” technique based on anchoring breast tissue to the chest wall creating an “auto-augmentation look” without the need for a Breast Implant. This procedure can be coupled with Fat Grafting to the upper pole if need be. For further information on Fat Grafting please click on the relevant page.
- Fat grafting to upper pole of breast: Mastopexy performed in conjunction with fat grafting to the upper pole of breasts to create fullness.
Media about Dr Tavakoli’s Breast Lift procedures
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Dr Kourosh Tavakoli explains how a breast lift corrects drooping breasts and improves their shape and position.
What is a Breast lift surgery / Mastopexy?
Breast lift or Mastopexy is designed to improve the shape and position of the breasts without reducing their size. It is a term used for breasts which sag but are not necessarily too large. Sagging of the breasts may occur with normal development for some women or as part of aging. Pregnancy, breast-feeding, and weight loss are other conditions which increase breast ptosis (sagging). Some patients will have a better shape to their breast if an implant is used at the time of mastopexy.
It is becoming increasingly obvious to the savvy plastic surgeon given the spectrum of breast shapes and conditions that simply using breast implants alone will not always produce aesthetically acceptable results. In assessing breast geometry and design, the plastic surgeon must consider 4 crucial parameters:
- Breast Shape
- Breast Size
- Nipple-areolar Position
- Skin elasticity & Stretch marks
Breast ptosis (pronounced “toe-sis”) or droopiness is a condition that affects women of all ages. Although we tend to associate breast ptosis with old age, young girls after significant weight loss or post-breast-feeding are often faced with varying degrees of droopiness. For these women wearing supportive bra is essential in order to disguise their saggy breasts.
Although Breast Augmentation with Implants can to some extent rectify the volumetric problem in an otherwise perfectly shaped breasts, the issues relating to nipple position and excessive skin envelope cannot be addressed. This technique is best left for very, mild cases of DEFLATED breasts as shown in the case studies below.
Case Series 1 – GREEN ZONE: Deflated
YELLOW ZONE: ‘Borderline’ cases (Mild Ptosis of the breast which can be lifted with Breast Augmentation, no Mastopexy required).
Case Series 2 – RED ZONE: Clear cut droopiness requiring Mastopexy and Augmentation
Case Study 3
Case Study 4
Case Study 5
Breast ptosis can be classified according to the position of the breast and nipple in relation to breast fold:
1. Grade 1: Breast is below fold, Nipple-areola at fold
2. Grade 2: Breast is below fold, Nipple-areola is also below fold
3. Grade 3: Nipple-areola pointing to the floor
Breast lift surgery or Mastopexy is therefore designed to return breast shape to a more youthful appearance in 3 ways:
1. Move the position of nipple-areola complex,
2. Remove excess breast skin,
3. Reshape the breast tissue
Although mastopexy does not change the amount of breast tissue a woman has, it can change the shape dramatically. This in turn can affect the overall breast size and projection. However, there are many cases where breast lifting needs to be combined with a breast implant to produce a desirable breast size. The combined breast lift-augmentation is considered one of the more difficult operations in plastic surgery. It can be performed in either one stage or more commonly in two stages.
Modern plastic surgery is about creating minimal scar in return for achieving the most desirable aesthetic outcome. The prospective patient should be aware of this delicate balance prior to embarking on this procedure.
The breast lift surgery is basically performed using 4 types of incisions or scars:
TWO Types of Nipple re-positioning procedures with little effect on the breast shape but effective in aligning nipple-areolar complex:
1. Cresenteric scar (half-moon) areolar Lift: I generally do not like this procedure as it can cause the areola to become ‘boxy’ in appearance,
2. Periareolar Mastopexy where there is a Donut-shaped scar around the nipple-areola complex (Benelli-Goes): This is an interesting procedure with a huge amount of history. It has been extensively researched as a way of lifting breast tissue and proven to be unsuccessful. Its a great procedure if adopted correctly by the surgeon and executed meticulously. It is the workhorse operation in treatment of Tuberous and short fold patients. It gives direct access to breast parenchyma enabling the breast to be split in a Tongue-Groove technique. For more information on Tuberous breast please visit the designated page.
TWO Types of Breast Lift procedures that can re-shape the breast and modify the nipple-areolar position for moderate to severe droopyness (ptosis):
3. Lolly-pop (Circumvertical) scar from the areola to the breast crease (LeJour-Hammond). This is the commonest technique utilised by me in restoring breast firmness and establishing ideal nipple height. If there is extra skin at the end of this procedure I will cover the scar to Inverted-T in order to minimise breast droopiness relapsing.
4. Traditional anchor-shaped scar, inverted T-scar (Wise pattern). For severe droopyness I utilise this technique as it removes the most amount of skin ad stretch marks.
Further to the skin scarring pattern, breast tissue must be surgically contoured from an elongated shape into a more youthful conical structure. This maneuver is an integral part of breast remodelling process.
Scarring after breast lift
Most patients embarking on breast enhancement fear poor scarring that may arise from this procedure. Hence there are instances where Dr Tavakoli would initially recommend the use of Breast Implants and adopt wait and see approach. Although Dr Tavakoli is the leading minimal scar surgery expert the quality of the breast lift scar can depend on the patient’s own healing power.
Dr Tavakoli’s Breast lifting scars are usually of great quality but do take 18-24 months to fully fade. We apply the latest scar therapy technology to all our plastic surgery patients. We do not post this information on the website but its available to all our patients in the clinic.
The Breast Lift Procedure:
Patients must stop smoking for at least 2 months before and after the operation. Time off work from this procedure is usually 10-14 days for recovery and healing to take place. Smoking increases chances of bleeding, infection and long term scarring.
What happens to the circulation and sensation of my nipple? Generally, the nipple-areolar complex (brown part of the breast) is carried on some breast tissue to keep it alive. This usually preserves the nipple sensation and keeps it viable.
How long is the patient hospitalized? A Mastopexy can be performed as a day procedure under general anaesthetic, or may require 1-2 nights in hospital depending on the patient and accompanying procedures.
What kind of anaesthesia is used? A general anaesthetic is used on all Mastopexies.
Who is on the surgical team? Dr Tavakoli will always performs the operation.
What can I expect postoperatively? Discomfort, swelling, and discolouration of the breasts are to be expected for several weeks. Usually, our patients return to almost normal activity within 10 days. The scars at the incision lines typically become reddish, raised, and firm a few weeks after surgery, but after many months become pale and soft. After 12-24 months, the scars are relatively inconspicuous. The nipples and some areas of the skin may be numb or sensitive after surgery. Sensation frequently returns within a few weeks or months but may be diminished or overly sensitive.
Will the breasts start to sag again? Gravity continues to have its effect, and there is a tendency for the skin of the breast to stretch over a long period of time. Women vary a great deal in this respect. In general, the smaller the breasts, the less tendency for sagging to recur. If the breasts sag further, minor revisions may be needed to reverse the process. If Dr Tavakoli tries to lift heavy breasts without making them smaller at the same time, sagging will return much sooner. One key point to a satisfying result is having realistic expectations.
What are my limitations in activity post-operatively? You should plan to avoid activities which require much raising of the arms above the level of the head, heavy lifting and activation of the pectoralis muscles. With great care, you can drive about 7 days after surgery. Patients can usually return to work in 10 days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.
- Light walking can commence within 7 days
- Lower body exercises can commence within 6 weeks
- Light jogging and physical activity can recommence at 3 months post-op
Surgical risks & Complications may include: infection, bleeding, asymmetry, keloid scarring, and nerve damage. Damage to the blood supply of the nipple-areolar complex, although uncommon, can occur.
Case study: Bilateral lollypop mastopexy (no implant) performed to correct severe breast ptosis.