Mass media depictions of cosmetic surgery often impact negatively on public perception of the specialty. Aesthetic procedures can work miracles: not only genuinely lead to remarkable physical improvements, but also revive one's self-esteem and confidence which are even more important. We should not be too judgmental about cosmetic surgery, but accept that modern medicine can improve quality of life and make us feel better, not simply treat illnesses. In my practice, patients who have undergone successful cosmetic intervention are among the most satisfied and grateful patients I have had the privilege to treat.
Breast shape, size and appearance inevitably changes over time. Pregnancy, breast feeding, force of gravity, tissue ageing and/or weight loss all ultimately affect the shape and firmness of the breasts and skin elasticity. Some ladies may be unhappy that they have lost a significant amount of breast volume and substance over time, others would simply like to have a breast lifted and tightened resulting in a more youthful breast contour. In some cases aesthetic concerns arise due to unequal development and growth between two sides so that one breast is firm and well positioned while the other is not (breast asymmetry). Regardless of exact circumstances, aesthetic surgery can address and change breast position and shape.
Operation essentially redrapes the breast skin envelope by removing the surplus skin whilst the breast (gland) tissue underneath is remodeled into a tighter cone. By doing this, nipples are repositioned at the higher level and the areolas can be reduced in size if necessary. Essentially, the skin formerly located above the areola is brought down and beneath it to reshape the breast. In situations when the breasts are too small as well as droopy, the size can be increased by placing silicone breast implants underneath tightened breast mound, but a patient should be aware that the extra weight of the implant may accelerate the return of droopiness because the breast will invariably sink downwards as time goes by. Similarly, the breasts that are large and heavy can be lifted, but the results may not be as long-lasting as when the procedure is done on smaller breasts.
A breast lift can be performed at any age, but surgeons recommend waiting until breast development has stopped. Women usually seek mastopexy when their families are complete. If you would like to have more children it might be sensible to postpone the operation as pregnancy is likely to stretch the breast again and compromise effectiveness of the procedure.
During the operation, the nipples and areolas remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast-feed later. However, I like to warn all patients of possibly compromised breast-feeding after mastopexy due to surrounding scarring and occasional surgical interference with gland ducts.
It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery.
- Plan your time off school / work / sports.
- Allow at least few weeks after surgery before considering a travel
An operation is performed under general anaesthetic and takes between 2-3 hours depending on the complexity and severity of the problem. Drains are usually inserted on each side and these will normally stay in for 1-2 days so overnight stay in the hospital is advisable.
The wound will be dressed with the surgical tape and these can stay in place for two weeks. You will need to wear a sports bra day and night for the first 6-8 weeks. After discharge from hospital patient should be involved in light normal daily activities and gradually and sensibly return to usual activities over a period of 2-3 weeks, once the wounds have healed satisfactorily. You should however refrain from strenuous physical exercise including swimming for at least one month.
Mastopexy can be carried out by a number of different methods. The scar lines after the surgery depend on exact surgical technique used and this is determined by individual factors, patient’s preference, the size and shape of the breasts and extent of tissue sagging. There can be up to three scar lines corresponding to surgical incisions used – one around the areola, another running vertically down from the areola to the crease underneath the breast and the third one extending horizontally, beneath the breast which follows the natural breast curve. Like most plastic surgeons, I like to leave as few scars as possible so will only use incisions that are absolutely essential to achieve an aesthetic goal. However, reducing incisions and scars at all costs should not compromise the final aesthetic appearance of the breast. Although scars are not invisible, they are eventually very fine and rarely cause concerns postoperatively.
I tend to explain to the patient which the exact technique I am planning to use during consultation and after physical examination, but I appreciate a surgical freedom to implement minor modifications if at all necessary, pending exact intra-operative findings.
Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible, precautionary measures to minimise risks and complication rate. Please note below the commonest complications associated with breast uplift:
- Bleeding and haematoma (including need to return to theatre to evacuate large blood clot in approximately 3-4% of patients)
- Infection (3% of patients)
- Delayed wound healing
- Widened or hypertropic scars
- Fat necrosis
- Skin numbness
- Alteration in nipple sensation, size and position (minor adjustments can be made at a later time)
- Asymmetry (minor adjustments can be made at a later time)
- Clots in the legs/lungs
It can take several months (2-3) for swelling to disappear, scars fade and soften and breast finally settle. Naturally, breast size can still change postoperatively either in response to hormonal changes or fluctuations in body weight. The scars are initially pink, can be a bit lumpy and/or itchy, but over the course of 6 months, they mature nicely and become hardly noticeable white lines. Although scars are permanent and quite extensive, in my experience, they rarely pose problems in the long term. Postoperative infections can delay healing process and prolong remodelling of the scar tissue.
In general, mastopexy leads to significant improvement in appearance and psycho-logical wellbeing and predictably highly satisfied patients. Essential to that however, are realistic expectations, thorough and honest consultation, surgical expertise and above all, mutual trust.
Examples in the gallery below illustrate what can be realistically achieved. If you wish, I would be happy to show you more illustrations of pre/post operative results during our consultation.
This page provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
|Hospital stay||One night stay|
|Surgery time||2 hours|
|Wound healing||2 weeks|
|Shower / Bath||from week 1|
|Time off work||2-3 weeks; those involved in manual activities might need more then 4 weeks|
|Sports and exercise||from week 4|
|Full recovery||4-6 weeks|
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me