Breast lifts are the most challenging aspect of female breast surgery. If you want a lift, it means something must be dropping, and the medical word for droop is ptosis. As a point of interest, the “p” is silent in the word “ptosis”.
Correction of breast ptosis can be done by a varied number of techniques depending on the amount of droop, cause of droop, and the surgeon’s experience.
A well know system for defining breast ptosis is:
0) Zero degreee ptosis or pseudo ptosis when the nipple is in the right place, and the breast tissue hangs below the bottom of the breast where it touches the breast wall know as the inframammary line.
1) First degree ptosis is when the areolar, the pink or brown part around the nipple, is below the inframmary line but the nipple itself is above. This can be corrected by several techniques including biplanar masopexy, benelli masopexy, or even a very large implant if that is the patient’s desire.
2) Second degree ptosis is when the nipple itself is below the inframammary line and most, if not all of the areola. If this is true, an actual breast lift is mandatory and no implant alone can correct this problem.
3) Third degree ptois is when the nipple areola complex is below the inframammary line by a couple of centimeters, and in this situation, sometimes the nipple points at the ground. Third degree ptosis almost always requires a standard anchor masopexy.
Biplanar masopexy or internal masopexy is when an implant is placed in the sub pectoral space, but release is done in the plane between nipple and the pectoralis muscle, then a large piece of stickey plastic is connected to the skin, pulling the nipple and skin upward for several weeks securing a higher position of the breast tissue and the nipple while the implant stays correctly at the inframammary line.
Large breast implants, by themselves, cause correction in some minimal or Zero degree ptosis just because the volume of the implant causes the nipple to move up along and arc created by the anterior projection of the breast implant away from the body. Then high profile saline or silicone implants that exist today give the best change of correction of minimal ptosis using only a breast implant.
The benelli mastopexy or circumareolar mastopexy is a technique invented by Dr. Louis Benelli of Paris, France. I had the privilege of lecturing with Dr. Benelli for twelve years on the mainland, and I also won a prize for the best videotape in plastic surgery for my scientific presentation on the benelli mastopexy (streaming video). The benelli mastopexy can be done with or without implants. The surgery leaves the incision only at the edge of the areola and is good for a minimal or moderate ptosis.
Normally, there are four problems associated with breast droop or ptosis. The breast tissue hangs on the chest wall, the nipples normally below the inframammary fold, the areola is too large, and there is no fullness in the upper quadrant. Mastopexy alone can correct the first three, but an implant is required to get the desired fullness in the upper quadrant.
The standard mastopexy with or without implants will correct breast ptosis in an excellent fashion. There is a vertical scar from the areola down to the fold, and a horizontal scar in the inframammary fold. In breast ptosis surgery, as in all cosmetic surgeries, it does not matter how much you take away but the appearance of what you leave is what counts. I do not believe the surgery ends when the patient leaves the operating room. I feel the surgeon is responsible to assist the patient in getting the best conceivable scar post operatively. To that end, a great number of permanent internal sutures are used on the breast to take the tension off the skin closure. The less the tension on the skin, the finer the scar. Unfortunately, there are very few people who get a bad scar no matter what the surgeon does, due to their own genetic predisposition. The good news is that most people do not have this genetic predisposition to scarring. Taping the breast scar post operatively decreases the thickness of the scar, the redness of the scar, and the length of time until the scar is mature and as favorable as it will be.
A unique breast lift that I invented falls between a breast reduction and a breast augmentation, and I call it the Suction Reduction Augmentation Lift. It is not for every breast, and it is not for every patient, but in the surgery, the surgeon does, through a 1/4” hidden incision, a suction breast reduction where all the fat and much of the grandular tissue is removed by liposuction, very similar to the technique used for male gynocomastia. It takes about six months for this suction reduction to get to the point where the breast can be augmented. During that time, the areola gets smaller with the weight off the breast tissue, the breast and nipple move up, often significantly, therefore correcting the first three problems in the ptotic or droopy breast. Of course, the patient has to put up with small breast for about six months, but then a transaxillary sub pectoral breast augmentation can be done, giving a beautiful lift with smaller areola, the breast no longer is hanging on the chest wall, and fullness in the upper quadrant along with minimal to no scarring as the suction incision and armpit incision are so small and well hidden that this becomes almost a scarless lift augmentation. As I said, this lift is not for every breast and not for every patient, but it is a great variation for the right breast and right person.
