Breast Lift for Correction of Ptosis or Breast Reduction for Hypertrophy

Dr. Ouakil, aesthetic surgeon in Paris, provides information, prices, photos, and a blog about plastic and aesthetic surgery related to breast lifting, treatment of sagging breasts, and correction of breast ptosis. Elevating the breasts through mastopexy can be performed without implants or in conjunction with the placement of breast implants and/or lipofilling. This aesthetic procedure is carried out by an aesthetic surgeon in Paris, an expert trained by the best French and Brazilian aesthetic surgeons, with over 30 years of experience in breast aesthetic surgery. Scars may be peri-areolar (round block), vertical, or anchor-shaped (inverted T).

Breast Lift – Breast Reduction – Mastopexy – Mastoplasty – Mammoplasty – Correction of Breast Ptosis
All these terms refer to the same basic technique for elevating the breasts, which involves tightening the breast through a skin lift (requiring scars) combined with remodeling of the breast tissue.

Who is a Breast Lift for?

The breast plastic surgery procedure (breast lift) is indicated in three main situations:

Breast Hypertrophy

The breasts are too large, and the chest is overly voluminous. This condition is often acquired during adolescence and can develop during menopause. Breast hypertrophy is always associated with sagging breasts, causing aesthetic concerns as well as discomfort in daily life, clothing, and sports.

In cases of breast hypertrophy, we can distinguish between juvenile-type breasts, which are heavy and firm but sag little, and hypertrophy in older women during menopause or perimenopause, characterized by heavy, sagging breasts that have lost firmness due to fatty involution (a portion of the breast tissue is gradually replaced by fat).

Breast Ptosis

The breasts sag, which is often the case for women who have had multiple pregnancies, especially after breastfeeding, but not necessarily, or for those who have lost significant weight (often more than 20 kg). The breasts then appear flat and rest on the upper part of the abdomen. Sagging breasts can also occur in young nulliparous women without a history of significant weight loss.

Sagging breasts are almost always observed following bariatric surgery (gastric sleeve or bypass).

The goal will be to elevate the breast and, if necessary, to fill it with an implant behind the remodeled gland or in conjunction with a lipofilling procedure (re-injection of one's own fat).

Breast Asymmetry

A bilateral remodeling will help balance the two breasts. The amounts of skin, fat, and glandular tissue will differ.
This mastopexy (breast lifting surgery) is indicated as early as age 17 to prevent spinal static disorders and the development of harmful psychological complexes. Dressing will be significantly easier due to this breast symmetry.

Breast asymmetry may sometimes occur in the context of tuberous breasts or too-small breasts (hypoplasia or mammary hypotrophy).

Surgery for Breast Ptosis and Pregnancy?

Before pregnancy, breast lifting is entirely possible. However, it is advisable to postpone aesthetic breast surgery if a pregnancy is planned within the next 18 months on average. Pregnancy and breastfeeding can damage the breasts, so it is always preferable to reserve any potential surgery for afterward.

In young women without children, the aesthetic surgeon should retain a certain amount of glandular tissue to anticipate potential loss of breast volume after pregnancy. Breastfeeding may not always be possible due to the severing of some milk ducts during breast remodeling and sometimes due to sensitivity issues with the nipple secondary to breast surgery.

What are the possible scars from a breast lift?

A scar is always created, which is the scar around the areola. Indeed, the nipple always needs to be elevated. In some cases of small and slightly sagging breasts, this may be sufficient but is associated with breast implantation. This is the round-block technique with implants.

The isolated peri-areolar technique is, in my opinion, a poor intervention, as it tends to flatten the breast and leave very large areolas with a sunset-shaped scar.
In the vast majority of cases, we will need two scars: one around the areola and an additional vertical scar (from the areola to the fold) that allows for effective lifting and suspension of the breast, giving it a nice rounded shape. This is referred to as vertical mammoplasty. It is the reference technique used in 90% of cases in my practice.

If the hypertrophy is significant (95-100/E-F) or the breasts are very ptotic, the classic technique known as anchor-shaped with three scars, including an additional horizontal scar under the breast, remains the only valid option.

Can a breast be lifted solely by placing breast implants?

No, or only partially and temporarily. A breast that sags slightly and is empty in its upper part can benefit from an augmentation with an implant, giving the visual impression of having been lifted, with its upper edge appearing significantly elevated. The projection of the breast created by the implant leads to a slight real lifting effect.

However, unfortunately and quickly, especially if the breast implants are large, the skin relaxes and the breast sags again. Moreover, a truly large implant can gradually lead to even greater breast ptosis than before the surgery over time. For a good result in this case, it is necessary to perform a combined procedure, breast lifting and implant or lipofilling.

Combination of Lifting and Breast Augmentation Implants?

In the presence of empty and sagging breasts, following pregnancy (with or without breastfeeding) or after significant weight loss, the need to increase breast volume becomes evident. The placement of breast implants is entirely possible simultaneously with breast lifting.

This will be done through the incision specific to mammoplasty and will not add any additional scars. Most often, the breast implant will be placed in front of the muscle. In the case of very thin skin, a retro-muscular position may be chosen or a breast lipofilling (composite breast lift) may be combined to enhance coverage. In some cases, the remaining gland

How does the procedure to lift the breasts proceed?

Anesthesia

The procedure is performed under general anesthesia, in a semi-sitting position.

Before the Procedure

A mammogram will be systematically performed.

Hospitalization

Hospitalization for 1 to 3 days is recommended.

Upon Awakening

• The breasts will be supported: either directly in a non-underwired bra to be worn for 6 to 8 weeks, day and night, or in an initial large dressing replaced the next day by the bra.
• Rarely, two small tubes (drains) may come out from the side, connected to a bottle that aspirates the serous fluid produced by the procedure. They will be removed before discharge. The removed gland is systematically sent for analysis.

What are the postoperative outcomes?

The aftermath is somewhat painful, managed with appropriate and possibly strong medications during hospitalization. Upon discharge, pain relief medications will be systematically and preventively prescribed for several days.
The stitches are mostly absorbable and therefore do not need to be removed.

During the first 10 days, it will be prohibited to raise the arms too high, climb, lift heavy loads, and drive.

Afterward, normal activity is allowed. Sports will be prohibited for 6 weeks.

Short-term risks include hematoma and tissue suffering (poor initial healing) of the areola, which may require immediate re-intervention.

Can operated breasts be monitored normally?

Of course, after breast plastic surgery, monitoring of the breasts remains normal.

The breast tissue remains accessible to palpation and any radiological examination.

However, it will be important to inform the radiologist to handle the breasts carefully, especially in the presence of implants. It may be necessary to consult radiology offices accustomed to this type of procedure.

Are there long-term health risks after a breast lift?

No risk of disease secondary to breast plastic surgery has been reported. The specific risks of the operation include partial or total necrosis of the areola and decreased sensitivity of the nipples. These risks are exceptional and usually only occur after treatment of severe breast hypertrophy (gigantomastia). This may potentially disrupt breastfeeding.

When is the final result of mastopexy achieved?

In the vertical technique, initially, the breasts are tight and somewhat overly rounded at the top and flattened and wrinkled below.

Gradually, over 3 weeks, the breasts deflate, soften, and settle into place.

The final shape is achieved in about 3 months. In the classic technique, the shape is immediately "too pretty" like an apple, and the breast will gradually flatten from the top unless a breast implant is placed simultaneously or lipofilling is performed to fill the upper part.

Mastopexy or Breast Lift in Practice:

1. “Before” the Breast Lift

   1. You will have had 2 preoperative consultations and an anesthesia consultation.
   2. A reflection period of 15 days will have been respected.
   3. Preoperative photos are taken, with a simulation on paper.
   4. Radiological assessment: ultrasound and mammogram dated less than 2 years ago.
   5. Signing of legal documents including detailed information about your procedure, an estimate, and informed mutual consent.
   6. Coverage possible only in cases of breast reduction of at least 300 grams per side, no prior agreement necessary.

2. “During” the Breast Lift

   1. Generally under general anesthesia, exceptionally under high epidural.
   2. Outpatient hospitalization for minor breast ptosis or 24-48 hours for breast hypertrophy.
   3. Elastic compressive dressing.
   4. Drains are sometimes placed and will most often be removed before discharge.
   5. Absorbable stitches have mostly been used, but some so-called "construction" stitches with nylon thread are often present.
   6. Moderate pain is alleviated by infusion of analgesics.
   7. A supportive bra and a light dressing to be changed every one to two days will be recommended.

3. “After” the Breast Lift

   1. A rest period of a few days is planned.
   2. You will receive a detailed prescription.
   3. Swelling and bruising will form, intensify, and transform over several days.
   4. A follow-up appointment is scheduled for 8 days for a check-up and for 15 days for the removal of any non-absorbable stitches.
   5. You may experience areas of temporary loss of sensitivity in the nipple or the breast itself.
   6. Your aesthetic surgeon is available 24/7 on their mobile phone.

4. “At a Distance” from the Breast Lift

   1. It will take 2 to 3 months for the result to stabilize (softening and disappearance of edema).
   2. You will wear a non-underwired supportive bra day and night during this period.
   3. The scars will evolve over 1 to 2 years.
   4. The areola-nipple complex may slightly deform.
   5. Sensitivity will slowly return over several weeks, with localized permanent losses always possible.
   6. Repeated check-ups during the first year are scheduled.
   7. A pregnancy should be followed by a visit to the aesthetic surgeon in case of changes in the breasts, especially in the presence of breast implants.

In Conclusion

The breast lift (elevating sagging breasts), whether isolated or combined with glandular procedures (reduction of breast volume or augmentation with breast implants or lipofilling), necessarily requires scars, at least peri-areolar (round-block), vertical, and sometimes in the fold, as the goal is to reduce excess skin, elevate and tighten the breast to reshape its contour. It effectively remodels a breast that will be much more beautiful, toned, and significantly more comfortable in daily clothing, allowing, for example, to go without a bra in evening wear while restoring a naturally fuller décolletage and a reshaped overall contour. The practice of sports will also be improved.