Breast Lift (Mastopexy)

The degree of sagging, or ptosis, of the breast is determined by the relationship of the nipple and areola to the remainder of the breast tissue and the crease below the breast (inframammary crease). Physicians have devised a rating scale where Grade I ptosis refers to a breast where the nipple is pointing forward and is located above the inframammary crease beneath the breast. Grade II ptosis implies a breast where the nipple is still pointing forward, but it has settled below the inframammary crease. Grade III ptosis implies a breast where the nipple and areola have fallen below the inframammary crease and are pointing downward towards the floor.

A youthful breast is one with little to no ptosis, such that the nipple and areola are located above the inframammary crease. There are many different operations described to 'rejuvenate' the tired breast and make it look more youthful. This operation frequently includes adding an implant at the time of the breast lift to achieve a more youthful appearing fuller breast (an augmenation-mastopexy).

The surgery required to lift a breast involves removal of some of the stretched out skin, which does result in additional scarring on the breast beyond what is required for a straightforward breast augmentation. Numerous techniques have been described to achieve a mastopexy, and because of his experience with this procedure, Dr. Zimmerman has been able to develop a protocol by which the least amount of scarring required will occur, based on the degree of ptosis of the breast. In mildly ptotic breasts the scars may range from a curvilinear scar on the upper border of the areola (Crescent Mastopexy), or a scar encircling the areola ( Doughnut or "Benelli" Mastopexy). More ptotic breast require more extensive resection of the stretched out skin and more degree of lift in the form of a Vertical Mastopexy, or to the Anchor or Keyhole Mastopexy performed with very ptotic breasts A carefully detailed consultation along with explanations of the anticipated results and scars are essential before proceeding with this procedure.

On occasion, one can get away with not lifting the breast in mild cases of ptosis, by slightly lowering the position of the implant. But it is a misconception that the placement of an implant will cause the breast to lift. The implant should be positioned so it is fairly centered below the nipple and areola, and trying to do this with a ptotic breast will result in undesirable results. It is also a misconception that the nipple and areola are completely removed. This is usually only done in the reduction of very large, and extremely pendulous breasts.