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MASTOPEXY (Breast uplift)

Mastopexy is the medical term for a "breast uplift" operation. Many patients find that with the passage of time, children, and breast feeding that the shape of their breasts changes adversely. This is made worse by gravity, often leading to soft, droopy breasts. True mastopexy operations do not change the volume of the breast tissue but produce a more desirable shape. There are several different mastopexy operations described, however, essentially all are operations which mould the existing breast tissue into a better shape higher on the chest wall. Subsequently, the loose skin is tightened and then re-draped around the new breast with repositioning of the nipple. It is sometimes possible to combine a breast uplift operation with a breast augmentation using implants, but this can increase the risk of complications and this will need to be discussed carefully with your surgeon before proceeding.

Before the operation

There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill you should continue to keep taking it, and inform your surgeon and anaesthetist in the hospital. If you smoke it would be advised to stop for a month before and at least two weeks after, as this will improve wound healing and your post-operative recovery. It is a good idea to bring a soft sports bra (without wire), the same size as you would normally wear with you to the hospital. In addition, it would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The surgery

You will come into the hospital on the morning of surgery. Your surgeon will draw on your breasts with a pen to help with the planning of the procedure. The operation is performed under general anaesthetic and takes about 2 to 3 hours. Normally no breast tissue is excised. After breast reshaping the skin is re-draped, the nipple repositioned, and the incisions closed with dissolvable stitches. There will be a light dressing over the breasts and usually a drain is not required.

Post-operative follow-up and after care.

You will need to stay in hospital overnight after the operation. The following day, all being well you can go home with some painkillers. It is import to leave the dressing alone and wear the sports bra day and night. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. After about 2 weeks. You will be guided to massage the scars twice a day with simple moisturiser. It is important to rest and take it very easy for at least 2 weeks after the operation. You will be advised to take 2 weeks off work and it is essential to avoid all sexual activity during this period. The sports bra needs to be worn day and night for a month in total as it helps to mould the breast into shape. Vigorous sport such as jogging or the gym should be avoided for 6 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you.

Possible complications

All operations carry a risk of complications, although in breast surgery serious complications are rare. It is impossible to perform breast uplift surgery without putting scars on the breast. There are always scars around the new nipple, which extend down to the natural fold under the breast in a straight line. Occasionally, a small horizontal scar may be required to avoid unsightly bunching of the loose skin. Sometimes scars on the breast may be red and lumpy for a few months, but these usually settle down by themselves. Some patients do get unfavourable scars despite very neat stitching at the time of surgery. We do not fully understand why some patients scar better than others and it is impossible to predict which patients are going to generate poor scars. Fortunately, most scars improve with time and this process of scar maturation may be helped by silicone gel pads.

The risk of infection post-operatively is between 2 and 5%, and usually responds to antibiotics.. A haematoma is a collection of blood under the skin and if significant may need to be drained by returning briefly to the operating theatre. This is ususual (also about 5%) and does not affect the final outcome. Precautions are taken to avoid both of these problems developing by giving antibiotics at the time of surgery and by careful surgical technique.

Many patients will notice that they have reduced sensation in the nipple. This is likely to be permanent and is related to small nerves being divided during the operation. Breast uplift surgery usually makes it impossible to breast feed successfully, although this is not always the case in some patients. Patients who are overweight, or smoke heavily, or are diabetic may have problems with slow wound healing. If this occurs, the wounds are left to close on their own, helped by applying regular clean dressings. Very occasionally problems with wound healing may involve the nipple area causing the skin of the nipple to undergo necrosis or rarely total nipple loss.

As discussed under “Asymmetry” in “General Complications”, no two un-operated breasts are truly identical in size and shape. Likewise no two breasts will be truly identical after breast uplift surgery, although great care is taken during the operation to match the size and shape of both breasts. Perfect symmetry is always the aim but never achievable. It is important to remember that the final appearance of the breasts may take several months to develop and with time the shape continues to improve as a result of internal re-modelling of the breast tissue. However surgery cannot remove gravity and some degree of recurrent sag is inevitable.

Plastic & Reconstructive Surgery

FACTS AT A GLANCE

SURGERY TIME
2 hours

HOSPITAL STAY
1 night

ANAESTHETIC ASSESSMENT
Possibly

PRE ADMISSION TESTS
Yes

SLEEPING POSITION
Sleeping on back recommended for 2 weeks.

REASONABLY MOBILE
1 day

WASHING
Shower after 1 day. Bath after 2 weeks.

DRIVING
2-3 weeks

SPORT & EXERCISE
6-8 weeks

SEXUAL ACTIVITY
After 4 weeks, restricted at first

FULL RECOVERY
6 weeks

TIME OFF WORK
2 weeks

BRAS & GARMENTS
Sports bra worn for 8 weeks