Mastopexy - Cosmetic Breast Augmentation

Mastopexy, or breast lift, is designed to improve the appearance of sagging or ptotic breast. While the incidence of breast ptosis is difficult to estimate, the frequency of mastopexy clearly is increasing. The American Society of Plastic Surgeons reported a 509% increase in procedures from 1997 to 2005.

The etiology is varied and can be due to several components but gravity seems to be a common factor. Younger patients are more prone to ptosis if breast size is excessive or if the skin is thin. Ptosis in middle-aged patients usually is due to postpartum changes; the breast skin is stretched during lactation or engorgement, and afterward the breast gland atrophies, leaving loosened skin. Finally, in postmenopausal patients, further atrophy, gravity, loss of skin elasticity due to age, and weight gain are factors in creating breast ptosis.

In most instances, breast mastopexy has no true medical indication and is performed primarily for aesthetic reasons. The main exception to this is in postmastectomy reconstruction, when performing a mastopexy often is essential to achieving symmetry.

While descriptions of reduction mammoplasty were reported as early as Paulus of Aegina (625-690 AD), not until the late 19th century was emphasis placed on correcting ptosis of the breast. Much of the history of mastopexy parallels breast reduction, both attempt to alter the shape of the breast and skin envelope, and elevate the breast.

Wise (1956) defined the preoperative geometric marking system most commonly used today. Gonzalez-Ulloa (1960) first advocated mastopexy with augmentation for ptosis with hypoplasia or atrophy. Benelli (1990) reported the use of the periareolar round block or purse string mammoplasty. Hall-Findley (1999) used a medial-based pedicle modification of the vertical scar approach first described by Lassus (1970) as superior pedicle and popularized by Lejour (1994) with the use of breast liposuction.

Mastopexy presents one of the greatest challenges to the breast surgeon but previous techniques have drawbacks. Although breast implants may provide the upper pole projection patients often desire, they present specific risks and complications.

There are four main types of breast lift, and the common names of them are based on the shape of the incision and resulting scar. The more sagging a patient has, the more likely that she will need more extensive and longer incisions to achieve a desirable result. With any of these techniques, the nipple and areola complex can be shifted to either side as well as up, if necessary, for the most aesthetic appearance. A breast lift does not involve removal and replacement of the nipple. The nipple and areola remains attached to the breast, and only the surrounding skin is removed. A summary of common techniques follows:

Superior Crescent Mastopexy - For patients with mild sagging, excess breast skin in the upper half of the breast, requesting no more than 2cm of nipple/areola lift and a normal amount of skin in the lower half, a semi-circular incision is made on the upper border of the areola. A crescent shaped piece of skin is removed, and when the skin edges are sewn back together, the nipple and areola are raised slightly (1 to 2 cms). A crescent mastopexy is best for women with only mild breast ptosis (sagging).

Donut Mastopexy - Also called a Benelli mastopexy or circumareolar mastopexy since the incision is around the areola, a donut mastopexy removes a ring of skin from outside the areola. Sutures are then placed around the areola and the skin is tightened like a purse string to lift the breast. Puckering of the skin may occur, and usually resolves on its own within a few months. The donut mastopexy is also useful for women with a projecting nipple/areola complex (sometimes called torpedo or missile shaped breasts), and can also be used to reduce the size of the areola at the same time. However, one less satisfactory result is that in the normal shaped ptotic breast there is a flattening of the areola and peri-areolar skin, reducing the overall projection of the breast.

Lollipop, Teardrop or Vertical Mastopexy - As the name implies, the incision for a lollipop mastopexy is made around the areola and then down the center of the breast to the inframammary fold. This technique is used for mild to moderate breast ptosis, with no more than 3 cm of nipple/areola lift is required. As with the circumareolar or donut lift, the size of the areola may be reduced at the same time.

Anchor Mastopexy - Also referred to as a Wise pattern (or sometimes Weiss pattern) mastopexy, full breast lift, or inverted-T incision, the anchor mastopexy is considered the traditional technique for breast lifting, elevation of the nipple/areola over 3cms is achievable as well as removal of excessive laxity of skin in the lateral and lower poles . The incisions are made around the areola, down the center of the lower portion of the breast and then across the breast in the inframammary fold. Like the donut and lollipop incisions, the areola can be made smaller at the same time. The resulting scar is in the shape of an anchor. Although the Wise pattern or anchor mastopexy used to be the standard, it is now usually reserved only for those with moderate to severe breast sagging.

Useful Resource Links:
http://knol.google.com/k/american-society-for-aesthetic-plastic/breast-lift-mastopexy/3jun2v9qwaac0/6
http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/
Breast_Lift.html