MASTOPEXY (BREAST LIFT) USING LOCAL ANESTHESIA
I use a combination of the less invasive techniques of Drs. Benelli, LeJour, and Regnault (all Europeans). The Tumescent Anesthesia technique is the same as I use to perform liposuction. About ½ liter (a pint) of a very dilute anesthetic solution is pumped into the tissue. The anesthetic solution also contains epinephrine to constrict the blood vessels and minimize bleeding. I do not use a McKissock incision, which produces a large “underwire” scar. Usually I use a “lollipop” incision, which produces vertical scar below the areola, plus the scar around the areola. I fold in the tissue of the lower breast (Le Jour’s technique). I use a purse-string to close the skin around the areola (Benelli’s technique). The nipple/areola is not removed. It stays on the breast and is moved up with the breast. $4000. As with all my surgeries, local anesthesia is used. You can return to work four days later. Breast reduction can be accomplished at the same time using liposuction; fee for liposuction plus breast lift is $6400.
I have included here a before and during photo showing the Benelli-LeJour technique. Usually the circle around the nipple/areola is not as centered as seen here. It can be located wherever breast needs to be moved. The size of the areola can also be reduced if necessary. The circles are marked according to a formula: The top of the circle is the new location of the top of the areola. The bottom of the circle is 6 to 7 cm above the fold at the bottom of the breast, depending on breast size. After drawing the circle, a vee is marked at the bottom. This will reduce the circumference of the circle. If the remaining circumference is more than twice the circumference of the areola, a curving Regnault B incision is needed below the areola so take up more of the circumference of the circle. Skin is removed. Skin is undermined outside the circle. The nipple/areola stays on the breast and moves with it. The deepest layer of skin below the areola (i.e. under the vee or the bottom of the B) has most of the nerves to the nipple/areola and is not removed. Leaving this deeper derm also gives more strength when this layer is folded in with sutures to push up the breast. After the top of the vee has come together a purse-string is placed under the skin just outside the circle and pulled on to reduce the size of the circle until it matches the areola. Then many (24 or so) separate stitches are placed to align the skin edges. The purse-string ensures that there is no tension on these stitches so the scar around the areola won’t widen while healing. In this photo the anesthetic in the right breast makes it look like there is an implant present, but there is not. The patient is reclining at 45 degrees, not standing. Her left breast would sag even more standing. As it is, only the top of the vee is visible.
You can reasonably expect this surgery to move your nipples higher and take much of the sag out of your breasts. The surgery cannot be relied upon to restore fullness to the upper part of the breast. That takes an implant, which can be placed later and quite easily if it is a small implant, as it should be. If your breasts sagged of their own weight, it is not a good idea to add much weight to them. If you want large implants, you would see a plastic surgeon and have them placed (under general anesthesia) behind the muscle to help support them.
PROBLEMS & RISKS SPECIFIC TO THIS SURGERY
Loss of nipple sensation: I will attempt to spare the nerves to the nipple. Although rare, it is possible to lose some or all nipple sensation. If your nipples are an important erogenous zone, you may wish to reconsider whether to have this surgery.
Asymmetry: Pre-operative skin marking ensures the nipples will be moved to symmetrical locations, but healing may pull them to slightly different heights or make them point differently. Healing may also distort the breasts so they are not shaped exactly the same.
Undesirable shape: Even with your nipples higher and much of the sag gone, you may find the shape of your breasts is not what you hoped for, or not what you consider natural. Nipples may be too flat, curves may be uneven or unnatural, etc. It will help if you don’t form a precise image in advance of what your breasts will look like—then you will be less likely to be disappointed.
“Steps” or puckering at scars: This surgery involves joining skin edges of different length and of different thickness. A small area could need to be re-done.
Effect on mammography and breast palpation: This is only a theoretical problem. Scarring from the surgery could interfere with checking your breasts or could confuse the interpretation of a mammogram. This could delay the diagnosis of cancer. However, breast reduction, breast enlargement with implants, and breast lift do not actually seem to have had any effect on the diagnosis of breast cancer (or the chance of getting it).
RISKS OF ANY SURGERY
Hypertrophic scars or keloids: If you have ever formed a thick or wide scar, you may do the same when you heal from mastopexy. This can really spoil the result, giving you a “bride of Frankenstein” look. If you know you have this problem, perhaps you shouldn’t have this surgery. Injecting the scars with cortisone can, to a degree, prevent or treat this problem, but it isn’t always completely effective. Different areas of the body heal differently, so just because your C-section scar looks fine, that doesn’t mean scars on the breast will look as good. Likewise, if you have never had any surgery, you don’t know how you will scar. Generally redheads and those with darker skin are more likely to form thick scars, but anyone can. To summarize, this is one of many reasons that this surgery should be reserved for women whose breasts are in fairly bad shape. Then if you get a poor result you can’t be much worse off.
Skin slough: Undermining skin can (rarely) cut off its blood supply, causing it to die. The result looks like a deep burn. It will heal, but a scar will result. The risk is increased if breast or armpit liposuction is also being done.
Bruising and blood collections (hematomas): Blood leaks out of blood vessels into tissue during surgery, causing bruising. Until it and the iron it contained is reabsorbed, discoloration will be present. You should avoid iron-containing vitamins while this process is taking place because your blood can only carry so much iron at a time. Rarely, a collection of blood will need draining via a tiny cut.
Infection: The risk is low, but infection can kill tissue, causing skin slough or an abscess (a very big pimple) that can require draining. Take your antibiotics, and call immediately if you have a fever, or a hot or red area. Healing from an infection can distort the breast.
Anesthesia complications: Local anesthesia minimizes this risk, but it’s still possible to have problems with an irregular heartbeat or a drug reaction. If you are having your surgery in Dr. Roget’s office, you should know that since he does not give general anesthesia, he has not certified his office as a surgical center. The monitoring equipment in his office is less sophisticated, and you could conceivably have a problem that would have been diagnosed earlier or treated better in an approved surgical center. However, Dr. Roget’s office is very near the hospital, and the extensive experience with Tumescent Anesthesia indicates its is so safe that its use in a regular office is reasonable. In a survey of local anesthesia outpatient surgery in the state of Florida, over a three year time period there were no deaths and no hospitalizations. This was not just cosmetic surgery, but all outpatient surgery under local anesthesia.
BEFORE AND AFTER PHOTOS
Photos will be taken before your surgery and at your follow-up visit. Your face will not be in the photos.
POSTOPERATIVE INSTRUCTIONS FOR BREAST LIFT
Do not take aspirin for one week. For pain take 3 Advil every 5 hours or 2 Aleve every 8 hours. Pain medication works best if taken on a schedule for three days after surgery. Finish your antibiotic as directed. Do not apply ice packs. Cold packs are ok (refrigerator temperature).
You may resume your usual diet immediately. You may drive the day after surgery.
Bloody drainage may occur through the incisions for one or two days. One breast may drain and not the other. Sometimes there will be delayed drainage, days or even weeks later. If that occurs just put paper towels or a Kotex over the incision until the drainage has stopped. I do not need to be informed unless the drainage looks infected. The incisions do not need to be covered if they are not draining. Stitches take six to eight weeks to dissolve, so the area will be bumpy during that time.
Extensive bruising is normal. However, ongoing bleeding into the breast is an emergency. The breast will become darkly bruised and will be enlarging rapidly. Call me. Do not go to an emergency room unless you live over an hour away. I have everything at hand in the office to take care of the problem efficiently.
If a breast becomes hot and red or you have a fever over 100 degrees for two readings six hours apart, call me.
For the first week, wear only a sports bra. Wear it at night, too. Then you may wear your regular bra during the day, but should continue to wear a sports bra at night for two more weeks. Breasts may be swollen for up to three months after surgery, so it’s best to wait a while to buy new bras.
You may shower even on the day of surgery. But do not take a bath or swim for one week.
You may exercise after one week but should wait six weeks to go jogging. If you ride a horse, it would be best not to trot, canter, or gallop for six weeks. If you compete and these recommendations are not acceptable, let me know and I will recommend a special compression garment for you.
I may want to see you the day after surgery, and in any case I need to see you monthly for four months to check the scars. These are important appointments. There is no charge for follow-up and you should call if you have a question, or come in (call first) if you think something doesn’t look right.