Aesthetic surgery of the breast encompasses a spectrum of options from mastopexy to mastopexy-augmentation. Reducing the discrepancy between skin envelope and breast tissue can either be addressed from “outside-in” with skin redraping, from “inside-out” with parenchymal augmentation, or a combination of the two. Mastopexy aims to create a beautiful breast by primarily addressing the shape and differs from augmentation where the primary goal is to alter the size of the breast. The two procedures are, however, not completely discordant and can actually complement one another as they address different parts of the breast (skin vs tissue).
The preoperative consultation is an opportunity to understand the patient’s goals and anatomy, and help the patient navigate a treatment choice that will help them achieve a beautiful appearing breast. Patients is are asked if they are bothered by the shape or size of the breasts or both. This can help differentiate between the need for a mastopexy, augmentation, or mastopexy-augmentation. However often the patient’s complaints may not match their physical exam. Objective assessment (with precision measurement) by the plastic surgeon needs to be made in the context of a patient’s goals to optimize the outcome that they are seeking. History includes a summary of previous surgeries, existing asymmetries, and a breast health evaluation. This includes past history of breast cancer, abnormal mammograms and desire for future breast feeding. Patient’s weight history is documented including any major changes or surgical weight loss.
Grades of breast ptosis:
Periareolar / Donut Mastopexy and final scar location:
Circumvertical / Vertical / Lollipop Mastopexy and final scar location:
Wise pattern / Anchor Mastopexy and final scar location:
Mastopexy – Augmentation:
Augmentation of the breast can be combined with mastopexy in a single or two-staged fashion using autologous breast tissue (auto augmentation), silicone implants or your own fat.
Post Operative Care:
Limit exercise for 4 weeks
Take antibiotics and analgesics as prescribed
Encourage hydration – 8 glasses of water a day
No smoking (active/passive)
Wear sports bra 24×7 for support for 2 weeks
Silicone sheeting postoperatively for 3 months for scar reduction