Women can be affected by breast ptosis or sagging for many reasons.

Genetics unfortunately plays a very significant role in determining how breast tissues respond to childbirth and breastfeeding and weight fluctuations. Some congenital breast tissue predispose women to breast ptosis or sagging.

Breast lift is sometimes called an “auto-augmentation” as in some patients just rearranging the breast tissues, lifting them and removing excess skin can give the impression of a larger and fuller breast.

In others where there is breast ptosis combined with volume loss, breast lift is best combined with breast augmentation procedures.

A breast lift aims to redistribute tissue where it is less desirable (below the nipple and in the outer breast) to the upper central area of the breast and cleavage area. It removes excess loose or redundant skin.

Breast lifts can be done with the following approaches:

Periareolar mastopexy– scar around the nipple
-this has less lifting capacity than other breast lifts, however involves a scar that is well hidden in most
-suitable for people with mild to moderate degrees of sagging and ptosis and large nipples
-commonly used in tuberous breast congenital breast malformation

Breast lift or mastopexy with a vertical scar
-scar extends around the nipple and from nipple to breast crease
-this has much greater lifting capacity than a periareolar lift
-suitable for moderate to severe ptosis

Breast lift or mastopexy with a vertical and short horizontal scar
-for people with more significant skin excess and a larger breast
-usually the horizontal scar can be short and central
-large scars extending the length of the inframammary crease are rarely indicated except in cases of massive weight loss

Any one of these can be combined with a breast augmentation with implants or fat transfer for extra breast volume.

Currently it is not possible to perform a breast lift without scars.

What people advertise as a “scarless breast lift” is in fact a breast lift where the scars are hidden, however still present. It typically refers to “cheating” a breast lift by placing a large implant which fills and lifts the breast with a breast implant insertion scar of 5cm in the inframammary crease under the breast. Trying to compensate for lift by filling or overfilling can mean an excessively large implant needs to be used.

Fat transfer can give some lift to the breast in cases of mild ptosis. However, even a large fat transfer does not have significant enough lifting capacity for more severe cases of ptosis.

Reunion or J plasma can achieve some breast skin tightening, however, it gives modest results and still require small scars for insertion.

Breast lift or mastopexy scars fade over time in most people.

The scar around the nipple has the potential to fade very well. In people with congenital conditions that have weak tissues around the nipples or stretched out large nipples can experience stretched scars in this region even if permanent stitches are used.

The main scars that remains visible for some time is from the nipple to the breast crease or the vertical scar.

Certain skin types may form lumpy and quite pink scars known as hypertrophic scars. These can be managed with appropriate scar therapy.

All patients are given scar management advice and if a prominent scar begins to form in the post-operative period, further scar management measures are instituted.

Augmentation mastopexy may be desired in cases where there has been volume loss post childbirth and breastfeeding or in cases of congenital breast conditions where there is minimal glandular tissue. In these cases lifting and rearranging the breast tissue will not provide enough volume.

The breast tissue is lifted and tailored around the implant. The implant can be placed either under or on top of the pectoral muscle; the choice depends on patient anatomy and overall breast volume.

In certain cases it is possible to do an augmentation mastopexy as one procedure. In other cases it may not be safe or the best decision and it is staged.

Which procedure is performed first depends on the individual patient.

There can be patients who may be satisfied with a breast augmentation alone if they have mild to moderate ptosis. In these people, a breast implant may provide enough lift and can be performed first. Sometimes patients are happy to not accept a “perfect” nipple position to avoid visible scars on the breast. They may be happy with an implant only for some years and then as the breast ptosis becomes worse over time, may decide to undergo a breast lift later down the track.

In other patients, breast ptosis may be too advanced to get an acceptable result with an implant only. In people that may have enough breast volume to be satisfied with a breast lift, this can be performed first and a breast fat graft or breast implant done subsequently if there is not enough volume.

It is important to remember the breast tissue and implant age and sag at different rates. It is usually the overlying breast tissue that fails first and can sag over a higher implant. An augmentation mastopexy is not a permanent solution to breast ptosis and how soon a lift may need to be done depends on individual patient genetics and what they perceive to be an acceptable cosmetic result.

If it has been many years since a breast augmentation, sometimes patients have enough breast tissue that removal and mastopexy can give a desirable cosmetic result.

Dr Simone will advise if you have enough breast tissue to get a desirable result from breast lifting in this situation. Many patients will not have enough tissue following implant removal. Fat transfer is an alternative in this situation.

It is advisable to wait a minimum of three months after either a mastopexy or breast augmentation to go ahead with a second stage procedure.

It is possible to perform a small fat transfer during mastopexy or breast lift to mask certain areas of implant visibility or small asymmetries.

However, to try and do a large volume fat transfer and breast lift is not recommended. During a mastopexy, tissues are maximally tightened and lifted to achieve the greatest possible degree of lift. Tight tissues do not provide a good fat graft bed as the looser the tissues, the better the fat survival.

The mastopexy or the fat graft can be done first and depends on the patient. Many patients will be happy with the tissue rearrangement and lift provided by a mastopexy alone and not need a subsequent fat graft so in most cases the breast lift is done first.

The only people to benefit from a fat graft during mastopexy are those with breast asymmetry or congenital conditions such as tuberous breast. In these cases constriction in the lower part of the breast needs to be corrected as well as sagging of the upper part of the breast. Otherwise larger fat grafts should be reserved for a second stage as fat graft survival rates and results will be superior.

Fat graft is soft and does not have the lifting capacity of a breast implant.

In patients with a small amount of volume loss and deflation post childbirth where the nipple remains in relatively good position, fat grafting can be beneficial. Post childbirth the breast tissues are loose and stretched which allows for a good amount of space for a fat graft. The greater the space in the breast, the more likely the fat graft will take well.

In patients with significant ptosis, a fat transfer is usually inadequate to give enough lift unless they are completely unconcerned with nipple position and only want extra volume. Even then, once breast tissue are stretched out and ptotic, it is best to commit to a breast lift as reshaping is required for a desirable cosmetic result, not just volume replacement. Trying to place volume in the upper part of a breast that is already sagging will tend to push the nipple down further.

This depends on individual patient factors such as genetics and the state of the breast tissues and the stability of weight post surgery. As well, how much a patient wishes to pursue a more ideal breast position ie there will be some recurrence of breast ptosis over time but it may not be severe enough to warrant surgery.

Obviously major weight fluctuations or pregnancies will negatively impact results.

Breast implants last an average of 10 years, some more. Usually the most common reason to revise an augmentation mastopexy is the breast tissue sags over the implant which typically remains higher.

There is no point gaining weight before surgery as in most people who maintain a relatively stable weight throughout their life, it is likely to gravitate back to the original weight post-surgery, and then volume will be lost from the breasts.

This is a procedure that needs to be performed under general anaesthesia in an accredited hospital facility.

Mastopexy can be performed as day surgery. Some patients will require drains and they can be managed in or out of hospital depending on patient preference.

The procedure depends on the size of the breast lift, however, around three hours is average, more if implants are combined.

Patients are up and walking the day of surgery. Most mastopexies can be performed as day surgery or with an overnight stay. 

Dr Simone Matousek works in conjunction with an anaesthetist who is focused on ensuring your post-operative pain is well controlled and minimal.  Long acting local anaesthetics are injected into the breast at the time of operation which provides good pain control. Pain with this procedure is well tolerated by most. 

There will be bruising and swelling of the breasts which can take 2-3 weeks to resolve. Smaller amounts of swelling can remain for some months.

There will only be waterproof dressings on the breasts over the nipples and scar line. Showering is permitted over these once drains have been removed (if they have been used). These remain intact until the time of your wound review at around 10 days.  Bruising varies from patient to patient but should resolve in most by 2-3 weeks.

Pain following a breast lift if variable, however, usually well tolerated. Taking regular post-operative pain relief is important in controlling this. Patients can be back to a desk job within a few days, depending on the size of the mastopexy and if drains have been used and removed.

When combined with an implant, recovery times may be longer.

Anything requiring significant lifting or physical activity can require 3-4 weeks off.

A firm bra needs to be worn day and night for six weeks.

Underwire bras should be avoided for at least one month to ensure adequate wound healing.

As gravity continues to play a role, wearing of bras as normal to maintain results is important after the recovery period.

Weight gain or weight loss after surgery will impact the results.

The wounds should be completely healed at around 2 weeks.

Gentle exercise can be commenced at this time. More aggressive upper body stretching should be avoided for 4-6 weeks, however lower body exercise is permissible.

The degree of breast ptosis now has to be severe to qualify for a Medicare item number in situations in a breast lift that is performed post pregnancy. Congenital breast conditions such as breast asymmetry also have to meet certain guidelines.

It can only be applied once in a patient’s lifetime.

Other strict Medicare criteria have to be fulfilled as well to qualify; these are listed below. In these situations, a health fund rebate may be available for the hospital stay, and part of the surgical and anaesthetic fees. There are still associated out of pocket costs with this surgery.

45558

Breast ptosis, correction by mastopexy of (bilateral), if:

(a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and

(b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and

(c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes

Applicable only once per lifetime

A mastopexy is best performed once the weight is stable post pregnancy and the breasts have reached a stable size and shape. This is usually a minimum of six months after giving birth or stopping breastfeeding.

To qualify for Medicare criteria, a patient’s youngest child has to be at least one year of age.

It is advisable to plan a breast lift or mastopexy once you are done with childbirth and breastfeeding.

In the event that a pregnancy occurs after surgery breastfeeding is possible with both breast lift and breast augmentation mastopexy.

Any breast surgery may impact breastfeeding and this impact can be unpredictable. If you have breastfed prior to your surgery, it is likely that you will still be able to breastfeed after a breast lift. However, milk production may be somewhat reduced.

The “mummy makeover” is a colloquial term used for the most common combination of surgeries to restore the body to its pre pregnancy state. It has no set components; each series of procedures is customised to fit each patient’s unique needs. Procedures can be performed during one operation, or sometimes spread out over multiple surgical sessions. Breast lift or mastopexy, breast lift combined with breast implants or breast fat transfer are all part of a potential “mummy makeover” and can be done at the same time as an abdominoplasty or tummy tuck.