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Breast Lift (Mastopexy)

What is a Breast Lift?

A breast lift is also known as a mastopexy. The purpose of a mastopexy is to raise the breast by redraping the skin and breast tissue to give you a more youthful and uplifted breast contour.

Women’s breasts change over time due to pregnancy, breastfeeding, changes in weight, aging, gravity, and a mastopexy can help regain the original shape of the breast. If more volume is needed in the breast, a mastopexy can be combined with an augmentation.

There are multiple techniques for mastopexy:

  • Periareolar (aka donut mastopexy): An incision is made around the areola and can be done with or without reshaping of the breast tissue. Risks are nipple areolar complex (NAC) widening and pleating around the NAC. This is used for patients with mild ptosis that require a lift of 1-2 cm.

  • Vertical Scar: A vertical incision is made on the breast and around the NAC (like a lollipop). This incision pattern can be used with all grades of ptosis.

  • Inverted T scar: This uses the traditional Wise (anchor) pattern which is also used for breast reductions. This is good for severe ptosis and for patients with poor skin quality.

  • Inferior wedge excision: This technique is for patients that have the proper placement of the NAC but there is extra breast tissue on the lower aspect of the breast. This incision is hidden so there are no visible scars on the breast.

  • Autoaugmentation procedure: if a patient has had significant weight loss, there may be severe droop of the breast with the majority of the breast tissue at the bottom of the breast. This results in a “rock in a sock” appearance of the breast. We reshape the breast and replace it back onto the chest wall, then redrape the skin over the breast and are able to provide a rejuvenated appearance to the breast without the use of implants.

The limitations of a mastopexy is that it will lift the breast but it will not fill out the superior pole (upper) of the breast. If a fuller look is desired, an augmentation with implant can be done at the same time as the breast lift.

Am I a Good Candidate?

A mastopexy may be a good option for you if you have breasts that droop, lost shape, have become flat and elongated, your nipples and areola point downward, or you have breast asymmetry.

When evaluating a breast to determine which technique is best for the patient, we look at many factors such as the amount of breast droop (ptosis), breast volume, anatomy, and medical history.

Ptosis is the droop of the breast. Factors that may lead to ptosis of the breast are excessive breast size, thin skin, weight loss, aging leading to loss of breast volume and skin laxity.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

Initial Consultation

During your initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

We will start by discussing your surgical goals to determine if a mastopexy is the right procedure for you. Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. We will also discuss your desired breast size and long term expectations. If you have a strong history of breast cancer in your family or you are over 40, it is recommended that you get a mammogram prior to any breast surgery. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications with generic names that end in “-pril”, “-sartan” before your surgery. If you are on metformin, you will be asked to not take it on the day of surgery. Do not eat or drink anything after midnight on the day of your surgery

Once you are at the surgical center, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make preoperative markings and discuss the markings and expected outcomes with you. They also will perform extensive checks with careful attention to detail. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

You will typically spend 1-2 hours in the post-anesthesia care unit before either being discharged to you home or to your room if you are spending the night.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

  • Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
  • Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

  • temperature greater than 100.5 F
  • bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • increasing pain that is not controlled on oral pain medications
  • increasing redness or size at the surgical site
  • your drain is not holding suction
  • if your incisions come apart
  • Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Follow-up Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

Limitation, risks, complications

The risks of breast lift surgery are bleeding, infection, changes in nipple or breast sensation, poor scarring of the skin, asymmetry, and need for revisions. If you have an implant augmentation performed at the same time, risks include implant leakage or rupture, wrong position of the implant, formation of tight scar tissue around the implant, fluid around the implant, discomfort near or around the breast implant, wrinkling or rippling of the skin over the implant. If any of these complications occur, you may need surgery to fix it. Revisions may range from simple skin adjustments in the clinic to full revision under anesthesia.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Breast Lift (Mastopexy) FAQs

Your result longevity depends on multiple factors such as the skin quality, the breast tissue quality, if an augmentation is performed, and the surgical technique used. This will be discussed with you at your consultation.

Yes! In cases where there is a significant amount of work to do to lift the breast (such as a revision case), we may do the procedure in two parts where the mastopexy is done first and the augmentation is done later.

The price of a breast lift is dependent on how much skin and breast tissue are rearranged. For example, a small mastopexy will cost less than a full auto-augmentation breast lift procedure. Coming in for a consultation with one of our surgeons will give you a better idea about pricing.

During your consultation, your surgeon will discuss your goals, lifestyle, medical history and also evaluate your body to determine what procedure is best for you. One way to determine if you need a mastopexy only or mastopexy with augmentation is to look at yourself in a bra. If in a bra, you have the volume of breast that you want, but want your breasts more lifted when out of a bra, then a mastopexy only would work for you. If in a bra you want to fill out the top of the breast more or increase the overall size of the breast, then you would benefit from an augmentation mastopexy. If you are unsure if you need a mastopexy with your augmentation, we can stage the procedures so one procedure is done and the second procedure is done at another time only if needed.

Breast lift is typically not covered by insurance until it is part of a breast reconstruction or reconstruction matching procedure.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

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