Posted by Dr. Hardesty
Breasts “sag” or “hang” because the “skin bra” is larger than the breast tissue. Over time, the weight of breast tissue can continue to stretch the skin and acts like a “rock in a sock.”
Some women develop breasts that sag, but more often the cycle of expansion and contraction of breast tissue (during pregnancy and/or after weight loss) results in a permanent stretching of the skin. The once full and rounded breast can take the shape of a bowling pin. Technically, the “viscoelastic elastic” properties of the skin have been irreversibly altered. An analogy is like a pair of pantyhose that have lost their elasticity. Unfortunately, there are no known reliable non-surgical techniques to significantly shrink the skin.
These changes in the skin bra trust result in a common appearance of the breast:
- Flat upper pole of the breasts
- Pendulous lower pole of the breast
- Larger than desired areolae
- Nipples pointing downward
Some or of the above preclude or limit wearing certain garments: backless dresses, bathing suit choices, going braless, etc. In addition, these changes are a constant reminder of “aged” or “granny breasts.” The only real solution is to reduce the skin bra and reshape — “mastopexy.”
A mastopexy, or breast lift, involves shaping the breast, repositioning the nipple areolar complex (NAC) and — when needed — reducing the NAC size, as well as by removing excess skin that causes the sag of the breast. The nipple is left connected to the breast tissue.
Each of the below techniques involves a progressive removal of excess skin and builds on each other to lift and contour the skin bra to the desired breast shape.
Depending on how much excess skin exists and the desired breast shape, there are three main procedure types:
1. Peri-areolar — A doughnut-shaped scar around the NAC; the primary result is elevation of the NAC.
2. Vertical — A lollipop-shaped scar; elevation of the NAC and shaping the breast in a horizontal plane.
3. Inverted “T” — An anchor-shaped scar; elevation of the NAC and shaping the breast in both a vertical and horizontal plane.
Depending on your desires, the shape and the look of the breasts, your chosen plastic surgeonwill decide what type of mastopexy is required. I request that patients bring in photos of “ideal” or “model” photos to better help me understand your needs, wants and desires.
Breast size will not significantly change because skin is only resected (cut).
The nerve to the nipple areolar complex is directly under complex and is rare to be disturbed by removing the excess breast skin during a mastopexy. The surrounding breast skin may have some short-term numbness but usually returns.
Upper Pole Fullness
Current mastopexy techniques will not often maintain over the long-term the upper pole fullness patients desire. So, a small breast implant can be placed to create the upper pole contour and will not increase size substantially.
The trade-off for improved contour and shape is scars. Scars are always a concern. However, there are various postoperative “anti-scar” programs to optimize, reduce and treat scars. In my experience, if the desired goals of shape and NAC positioning is obtained — and proper compliance to our postoperative anti-scar program — the patients rarely complain about the scars.
Breast shape is dependent on the skin bra and the individual viscoelastic properties of the skin. Surgical alterations of the skin bra are referred to as mastopexy. Depending on the excess quantity and quality of the breast skin as well as the desired shape, different incisions will need to be made. To obtain long-term upper pole fullness of the breast, a small breast implant is often placed that will minimally affect the breast’s actual size.
The more specific you can communicate your desired breast appearance, the more likely you will achieve the desired result — bring nude model photos to refer to during your consultation.
The Staff of Imagine Plastic Surgery serving many of the communities of the greater Inland Empire including but limited to Riverside, CA and Inland Empire, Redlands, Rancho Cucamonga, Ontario, Corona, Upland, and Chino Hills.
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