What is mastopexy surgery?

Mastopexy surgery, commonly known as a breast uplift, is an operation to remove extra loose skin from the breasts, and to lift and reshape them, to make them look more youthful.

Why have a breast uplift?

Breasts naturally droop with age, after pregnancy and breastfeeding, and after weight loss. This is because the skin and fibrous ligaments in the breast become stretched so the breast tissue is not supported. It is not possible to recreate the fibrous support of the breasts, but they can be reshaped by removing extra skin, remodelling the breast tissue and moving the nipples up to the best position on the new breasts. Other options are to reduce the size of the areola (the darker skin around the nipple), or to have the breasts enlarged at the same time.
Having a breast uplift can make the breasts firmer and higher. After a breast uplift you may be more comfortable socially and personally. The best results are with women with small, saggy breasts, but breasts of any size can be lifted.The results of a breast uplift may not last as long with heavy breasts.

What will happen before my operation?

You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. They will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor. Your surgeon will examine your breasts, and may take some photographs for your medical records. They will ask you if you want to have someone with you during the examination, and ask you to sign a consent form for taking, storing and using the photographs. The surgeon will measure your height and weight to make sure that it is safe to do an operation. If you are overweight, or planning to become pregnant, your surgeon may suggest delaying your operation.

How is the surgery performed?

There are different types of uplift. The best type of uplift for you depends on your breast size and the result you want. Different types of uplift make different scars on the breasts. Whichever type of uplift you choose, the scars should not be visible when you wear normal clothing, bras and bikini tops.The most common type of uplift, with a cut around your areola and vertically under your breast, is shown below. Sometimes there is a cut in the crease under the breast to make an anchor shape. Extra skin is removed from underneath the breast, the breast is reshaped into a tighter cone and the nipples are moved to a higher level. The size of the areola can also be reduced.
If your breasts are small as well as droopy, you can have them enlarged with silicone implants. Having breast implants is the only way to significantly increase fullness above the nipples, but their weight can make the breast droop again over time.

Choosing a surgeon

If you decide to have a breast uplift, only go to a surgeon who is properly trained and is on the specialist register held by the General Medical Council. They will talk to you about what is possible for you or might give the best results. Members of several different organisations do cosmetic surgery, so your general practitioner (GP) is the best person to advise you on who to see. You should talk to your surgeon before your operation about when and how to pay. Nobody needs an urgent breast uplift. If you are not given time to think about it, you should look elsewhere.

How can I help my operation be a success?

Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this.
If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications. Do not worry about removing hair near where cuts will be made, but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible.

What is the alternative treatment?

A simple alternative to a breast uplift is to wear padded bras. If you don’t have too much loose skin and your breasts are not droopy, a breast enlargement using silicone implants may be a good option for you. If your breasts are droopy and too large for you, a breast reduction may give you the result you want.
Many women want a breast uplift when their families are complete, so if you are planning to have more children, you should consider delaying your surgery until after that. Although there is no risk of a breast uplift preventing you from getting pregnant in the future, and breast uplifts do not usually interfere with breastfeeding, being pregnant is likely to stretch the breast again and reduce the final result of the procedure. Most surgeons delay surgery for six to 12 months after breastfeeding has stopped, so the breast has had time to settle back to its original shape.

What are the main risks and complications of a breast uplift?

As with all operations, there are risks involved in having a breast uplift. Although the risks are unlikely, it is important to weigh them up against the potential benefit of the surgery. Discuss each of them with your plastic surgeon to make sure you understand the potential complications and consequences.

Complications associated with the surgery

• Scars There will be scars from the surgery. These will usually be red at first, then purple, and then fade to become paler over 12 to 18 months. Occasionally, scars may become wider, thicker, red or painful, and you may need to have surgery to correct them.
• Bleeding Heavy bleeding is unusual but possible, and you may need a blood transfusion or another operation (or both) to stop the bleeding. Any bleeding usually happens immediately after, or soon after, surgery. Before the surgery your surgeon will discuss any medicines that increase your risk of bleeding, and it is important to control high blood pressure.
• Infection If you get an infection of the wound you may need antibiotics or another operation. This can affect the final result of the surgery. If you have discharge from your nipple, it is important to tell your surgeon about it before the operation, as this can increase the risk of infection.
• Swelling, bruising and pain There will be some swelling and bruising of the breasts after the operation, and this can take weeks to settle. There may be long-term pain, but this is uncommon.
• Seroma This is where fluid collects in the breast. That fluid may need to be drained by having a needle through the skin, or by having another operation. This can affect the final result of the surgery.
• Healing problems The edges of the wound can come apart, particularly at the ends of the scar. Usually this problem can be put right by dressing the wounds, but you may need more surgery to remove the tissue that hasn’t healed. Smokers are more likely to have healing problems.
• Extrusion This is where deep stitches poke out through the skin. These can easily be removed.
• Loss of blood supply to skin, fat, breast tissue or the nipple Some areas of skin, fat, breast tissue or the nipple may die (called necrosis) if the blood supply has been lost during surgery. This may mean that you need another operation, which can affect the final result of the surgery. There may be lumpiness or an uneven surface in an area affected by necrosis. Occasionally, fat may harden, which may interfere with mammograms in the future.
• Increased or reduced sensation After the surgery, most patients will get some alteration in the sensation in their breasts, most commonly numbness near the scar and either increased or reduced sensation in the nipples. In rare cases, the change in sensation may be permanent. Rarely, reduced sensation can cause problems with breastfeeding.
• Asymmetry This is where the breasts are not symmetrical. There may be irregularities at the end of the scars. These may improve with time, or you may need a small operation to correct them.
• Damage to deeper structures Although rare, the surgery can damage deeper structures, including nerves, blood vessels, muscles and the lungs. This damage may be temporary or permanent.
• Unsatisfactory result Sometimes, patients are not satisfied with the result of their breast uplift. This may be to do with the look or feel of the breasts, or the shape of the breasts not meeting expectations. It is very important that you talk to your surgeon, before you have the surgery, about the size and shape you want, and whether this can be safely achieved with a good outcome.
• Change over time The appearance of your breasts will change as a result of ageing, pregnancy or other circumstances not related to your surgery, such as putting on or losing weight. You may need further surgery or other treatments to maintain the results of the breast uplift.
• Allergic reaction Rarely, allergic reactions to tape, stitches or solutions have been reported. If you have an allergic reaction you may need extra treatment.

Risks of anaesthetic

Allergic reactions You could have an allergic reaction to the anaesthetic.

• Chest infection There is a small risk of chest infection. The risk is higher if you smoke.
• Blood clots Blood clots can form in the leg (called a deep vein thrombosis or ‘DVT’). These cause pain and swelling and need to be treated with blood-thinning medication. In rare cases, part of the clot breaks off and goes to the lungs (called a pulmonary embolus or ‘PE’). The risk of this is higher if you smoke, are overweight or are taking the contraceptive pill.
• Heart attack or stroke A heart attack or stroke could be caused by the strain surgery places on your heart. You will be assessed for the risk of this before your surgery.
• Death As with all surgery, it is possible to die as a result of the operation.

What to expect after the operation

Breast-uplift surgery is usually carried out under a general anaesthetic (so you would be asleep) or a regional anaesthetic (where the whole area is numbed with injections). The operation usually takes about 90 minutes. You might be given antibiotics to keep the wound clean. Also, you may have drainage tubes in the breast to drain away any fluid or blood. These tubes will be taken out when the fluid or blood has stopped draining, usually before you go home. You might go home the same day, or stay in hospital overnight. If you do go home on the same day, a responsible adult should stay with you for the night. Your chest will feel tight and your breasts and the ribs below your breasts will be sore. Simple painkillers should be enough to keep you comfortable.

Dressings

You will have some dressings on your breasts. You will need to wear a well-fitting bra with no underwiring for a few weeks after the operation.

Recovery

You will be out of bed on the same day as your surgery, and doing light activities after two weeks. You should be back to normal exercise in six weeks. Most patients take at least two weeks off work after the operation, depending on their job. Your breasts will be sore and swollen for a few weeks after the operation. Do not lift heavy things for several weeks, and avoid sex for at least two weeks. With all activities, start gently. Do not drive until you feel safe and are comfortable wearing a seatbelt. Check your insurance documents if you are not sure.

Seeing the results

At first your breasts may seem too high and the skin too tight. It can take several months for the swelling to settle, and many months for the final result to appear. Most patients are pleased with the final result, but some find their new shape difficult to get used to. This may happen to you. You may have more or less sensation in your nipple, and this can change over time. Over time you may notice that, although your bra size does not usually change, you may need to buy bras of a different cup size or shape.

Your aftercare

To protect your body, and get the best result, look after yourself.

• Avoid vigorous activities after your operation.
• Protect your wounds as you are told to.
• Putting on weight or being pregnant will affect the results.
• Maintain a healthy weight and level of exercise.

What to look out for

Bleeding after surgery can cause swelling, a change in colour, and pain, usually just on one side. The signs of an infection are pain, redness, swelling and pus in the wound, and you may also have a temperature. A blood clot in the leg can cause swelling and pain in the calf. If the clot goes to the lung, you might be breathless or have pain in your chest. If the wound is not healing well, it may be sore and weep. If you have any worries after your operation, speak to a doctor or go to A&E.

Disclaimer
This document is designed to give you useful information. It is not advice on your specific needs and circumstances. It does not replace the need for you to have a thorough consultation, so you should get advice from a suitably qualified medical practitioner. We – The BAAPS and BAPRAS – have no liability for any decision you make about the surgery you decide to have.