Breast lift

As time passes age takes it toll on the body; pregnancy, nursing and the general loss of elasticity start to show on a woman's breasts. Breast lift, or mastopexy, is a procedure to raise the breasts and reduces the size of the areola. The procedure also gives the surgeon an opportunity to reshape the breast.

There are a variety of techniques available to lift the breast; however patients' main interest is "what will my final scar be". In the traditional lifts, a T shaped or anchor incision was performed but as techniques have evolved we have been able to minimize scaring, in some patients placing the scar just around the areola. Dr. Mendieta has been working on a technique that further limits the scaring by way of a "suture suspension technique" (the scar is only in the upper areola and a small scar near the clavicle).. This is a revolutionary technique that Dr. Mendieta has pioneered and is perfecting. However not all patients are candidates for these types of limited scar options, in the majority of cases a lollipop or L shaped scar is required. What patients do not know is that it is not just about the external scar but also about reshaping the gland internally. This reshaping allows the breast to look perkier, lifted and often appear as if they have implants (but they don't). To find out about these techniques please tour our web site and to find out about your particular case visit Dr. Mendieta for your personal consultation.

II. Breast lifts procedures:

(a) The latest in breast lift techniques - learn about this new procedure.

(b) Circumareolar breast lifts with vicrly mesh with minimal scaring.

Please click below for general information on breast lifts procedures.

• Who Needs Breast lift Surgery?
• What are my different options with breast lift surgery - what type of scars will I have?
• How to prepare for the surgery.
• The surgery.
• Circumareolar breast lifts with or without vicrly mesh with minimal scaring.
• Risks and Complications after a Breast Lift Operation.
• Recovery period after your breast lifts surgery.
• Your new look.

With the new advances in plastic surgery women now can enjoy the look and feel of being feminine, sensual and sexy again. I am referring to the facts that in the past women feared undergoing the breast lift surgery because of the ugly long permanent scars.

Many of the evolving breast lifts procedures offered today attempt to minimize the amount of scaring on the breast. Depending on your particular anatomy and goals, we can now offer a technique that is only performed by a handful of surgeons across the country. In this procedure we lift the breast with only a single scar that goes around the areola and therefore completely eliminates the other sometimes-disfiguring scars. The ability to offer these techniques will completely depend on your anatomy, skin quality, breast size and your surgeon's experience.

Who Needs a Breast lift Surgery?

Over time, a woman's breasts begin to sag and the areolas become larger.

With aging or extreme body changes (i.e. pregnancy, breast feeding, weight loss) the breast looses volume, the skin looses its elasticity and gravity takes over, causing the breast to sag. There are several options available to improve the breast appearance. Mastopexy or breast lift is a surgical procedure by which we can lift and reshape the sagging breast restoring it to a more youthful appearance. Women will seek breast lift for a variety of reasons, in the majority of cases, it is because pregnancy and nursing have left them with stretched skin and less volume in their breasts. The best candidates for a breast lift are those women who have realistic expectations, and are seeking an improvement not perfection. During a breast lift we have the ability to try and improve any size differences that may exist in your breast, reduce the size of the areola and even reduce the size of the breast. If you desire larger breast then it can be combined with a breast augmentation.

You must always remember that gravity is always working against us, so the bigger your breast, the more they will want to droop or sag again. (No surgery can permanently delay the effects of gravity). The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.

Breast lifts do not affect the ability to have children; however, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, Mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.

What are my different options with breast lift surgery- what type of scars will I have?

The most important part of this evaluation will be your consultation. It is at this time that the breast shape, degree of droopiness (ptosis), and the skin quality will be evaluated. These three elements are the most important factors that will determine the type of lift and the extent of scaring you will require. In order to understand your options better, it is important to understand the history of breast lifts and the different philosophies that have evolved over the years.

Breast lift techniques have been developed following two major Philosophies:

1. What is done to the skin (The extent of scaring)

2. What is done to the breast gland itself?

In the traditional way of thinking we felt that the only way you could reshape the gland was to tighten and pull the skin in order to create support, contour and shape. The skin was like a brazier. This philosophy would encourage most of us to use the traditional anchor T-shaped scar because it was through this type of incision that we could manipulate the skin to contour and reshape the breast. The Brazilians and Europeans challenged this thinking because they felt that the skin was very elastic and like any elastic structure it could stretch. (i.e., much like when you gain or loss weight the skin stretches). Therefore, if we depended on the skin to maintain shape, it may not last since the skin would eventually stretch and create early recurrence of the ptosis. It was their feeling that most of the reshaping should be done in the gland itself, and that the skin was merely used as a cover for the work done. This way, we don't depend on an elastic structure to maintain shape, and we would have a longer lasting and better result. With this new philosophy, we no longer needed the big scars, since the skin was only being used as a cover, and any excess skin, we felt, would retract and mold to the contour of the new breast. (Much like your skin molds to your body when you loose or gain weight). This is how the limited scar techniques evolved and have become more of our focus today. We began to focus on limiting the extent of the scars and began to concentrate more on reshaping the gland itself.

It is important to note that not all surgeons subscribe to this philosophy, and therefore they may not believe or are not comfortable with the limited scar techniques. For those of us that did take an interest in this philosophy, we noticed several things, and that was that most of the work that was being done from the Brazilians and European countries were on women that had small to medium size breast. While this limited scar techniques worked great in small to medium breast, it fell short on, medium to large breast, and in patients with very poor skin quality. The reason why, was because, these women with very droopy or large breast just had too much skin, and in women with poor skin quality, the skin had lost its ability to retract. Although the skin did retract somewhat in both of these scenarios, it was just too much to ask for and the skin would then overhang. Therefore, in these patients we needed to make longer scars in order to remove the excess skin that exist, otherwise the breast would look too wrinkled and with poor shape.

The moral of the story is that not everyone is a candidate for the limited scar techniques and we need to evaluate your skin quality, amount of droopiness (ptosis) and size of your breast in order to make recommendations.

Although we have certain guidelines to help us evaluate the degree of droopiness, there is still some room for interpretations as to the skin quality and size of the breast. Also the surgeon's philosophy, expertise, training, and preference will influence his decision as to what is best in your case. Given all these variables, It now perhaps makes more sense as to why you may hear so many different suggestions from different surgeons as to the best option for you.

In terms of scaring there is the circumareolar lift, (scar is only around the areola), the vertical scar lift, (the scar is around the areola and a vertical scar on the breast), The L- shaped scar (scar around the areola, a vertical scar on the breast and a horizontal scar that only extends to the outer part of the breast), and the traditional anchor or inverted T-shaped scar.

How to Prepare for the Surgery.

Every plastic surgeon has his own ritual and recommendations. Depending on your age and family history, we may require you to have a mammogram (breast x-ray) before surgery (Especially, if you are over the age of 35 or have a family history of breast cancer). You will also receive specific instructions on how to prepare for surgery, including guidelines on eating and drinking, medications and certain vitamins to avoid before surgery, as well as post operative care sheets. We have found it helpful for patients to do the following Things that you will need before your surgery:

• Ice packs or frozen peas (you will need these for the next 48 hours)
• You will need to purchase a Sports bra, which you will wear for about 2 weeks for comfort.
• The night before your surgery you can take a Valium 10 mg this will make you sleep like a baby. Also the night before surgery we recommend taking a zantac 300 mg, this will sometimes help with preventing nausea after your surgery.
• Don't eat or drink anything after midnight (when you brush your teeth in the morning don't drink the water).
• The morning of surgery wear something very loose that is easy to take off and on, don't wear any jewelry, you can shower but done place any creams, lotions, deodorants or perfumes.
• Arrange for someone to drop you off and pick you up after surgery. Arrange for someone to stay with you for a couple of nights.
• You will have tape around your incision site, which will be removed when your sutures are removed at about day 5-7. Don't worry you will be able to shower the day following surgery; it is ok for the tape to get wet.
• The following day you will come to the office for a follow up visit and massage.

Where your surgery will be performed.

Breast lifts is a procedure that is most commonly performed in patients that are in good to excellent health, and therefore it can be done in either office based surgical centers, ambulatory surgical centers, or Hospitals. Most of our breast lifts are in our own office based surgical center; this affords a very relaxed atmosphere with more patient privacy and comfort. The exceptions obviously would be if the patient has any major medical problems or the patient desire it to be done in the hospital.

Types of anesthesia.

The operation can be performed in various ways, either under local with IV sedation, nerve blocks with sedation or General anesthesia. It is Dr. Mendieta's preference to use General anesthesia since it is extremely safe and the operation is only about 2- 3 hours.

The surgery.

As we have stated, breast lifts can have a circumareolar scar, a vertical scar, and L- shaped scar or the traditional Inverted T- Shaped scar. The determination of your particular scar length will depend on the size of your breast, your skin quality, the degree of ptosis (how droopy they are) and finally on your surgeons experience, training and philosophy. On the average Mastopexy usually takes two to three and a half hours. It is more commonly performed as an outpatient surgery and you should able to return to work in about one week. Our basic goals in breast lift surgery are to restore the breast to a more natural and youthful shape. This will involve repositioning the breast gland and placing the nipple areolar complex at a higher position. This is why the operation involves scars since the incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position.

Incisions outline the area of skin to be removed and the new position for the nipple.

Skin formerly located above the nipple is brought down and together to reshape the breast. Sutures close the incisions, giving the breast its new contour.

Depending on what technique is used, the skin is then closed leaving either, a circumareolar scar, vertical scar, L- shaped scar or Inverted T-shaped scar.

After surgery, the breasts are higher and firmer, with sutures usually located around the areola, below it, and in the crease under the breast.

Circumareolar breast lifts with or without vicrly mesh with minimal scaring.

Those patients with small to medium sized breasts, relatively good skin quality and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the "doughnut (or concentric) Mastopexy," in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed. This technique leaves a single scar that only goes around the areola, therefore completely eliminating the other sometimes-disfiguring scars. This procedure has the expectations and the assumption that the skin will re-drape, and re-contour to the new breast, and therefore we are not depending on the skin to reshape the breast. In order to obtain a nice result it requires a great deal of glandular re-contouring. This means that we have to shape the breast by molding the gland itself from the inside. Surgeons will have different techniques or preferences on how to shape the gland. One such pioneer in glandular reshaping was Dr. Sampaio'Goes, it was his philosophy that perhaps we could maintain shape and support for a longer period of time by using a mesh. A mesh is a piece of material that is either absorbable or non-absorbable and it is used very often in hernia repairs or in repairs of weak fascial tissues in the body. This mesh would act as an internal bra, sort of speak, lending the breast more support and shape, therefore offering longer lasting results.

Dr. Ruth Graz who does not use mesh to maintain support offered other philosophies on glandular reshaping, she uses the bodies' own tissues. She uses the pectoralis muscle to create a sling by which the breast is supported internally to maintain superior breast fullness for a longer period of time. This particular technique is excellent since it offers the breast the appearance almost as if you had implants placed. These two techniques are the latest in breast lift surgery and have offered some very nice results. You must remember that not all surgeons perform this technique because they are not familiar with it, have no experience with it or do not adhere to the philosophy. Therefore, until these procedures gain familiarity, they are only performed by a handful of surgeons across the country.

Since we are trying to limit the amount of scaring and we are closing the skin in a circle, you can expect some wrinkling around the areola. This wrinkling will settle down and improve greatly over the next 3 months. Rarely will it require a scar revision to reduce the wrinkling; this determination would not be made until 4-6 months after your surgery. Usually the bigger and droopier the breast, the more wrinkling you can expect.

Dr. Mendieta has learned these techniques during his travels to France and Brazil and has been able to help many women restore their self-confidence and self esteem. To find out if you are a candidate for these techniques, please contact us.

Risks and Complications after a Breast Lift Operation.

Any surgery always has a possibility of complications or a reaction to the anesthesia. Even though these complications are rare we need to mention them so you have a full understanding.

A breast lift is not a simple operation, but it is normally safe when performed by a qualified plastic surgeon.

• Infection - This is very uncommon after a breast lift, but if it were to occur it would happen around day 7-10 after your surgery. This is usually resolved with antibiotics.
• Hematoma - This is a collection of blood, this is very uncommon as well, and if it were to occur it usually happens within the first 24 hours. You would notice one breast much larger and tender than the other and it would require a re-operation to control whatever might be bleeding or oozing.
• Wound Breakdown - This occurs more commonly in smoker. This is when a separation of the healing tissues occurs creating an open wound. This may occur, but if it does it is just a matter of letting the body heal itself. It will resolve without any problems, however it may require a scar revision at a later date after all the tissue has healed.
• Scaring - This is perhaps the biggest issue in breast lifting. We try to leave as small as scar as possible however the extent of scaring will depend on the size of your breast, the amount of lift needed and your skin quality. Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. If you are a poor healer you can develop wide scars, hypertrophy scars or keloid scars. There are a few things that may help with healing like silicone patches, steroid injections, vitamin E, and pressure. The type of scars you develop will depend on your healing process. (Poor healing and wider scars are more common in smokers.)
• Areolar loss - This is perhaps the rarest of complications but the most dreaded. It is extremely rare. This happens when there is not enough blood supply to the nipple and areola and it necrosis, or dies. It is a particular concern in patients that have had previous major breast surgeries, especially with smokers and women that have extremely large breast. As stated this is extremely rare and very unlikely.
• Loss of breast-feeding ability - This is possible whenever any breast surgery is performed, however it is very rare with breast lifts since the breast ducts are usually left intact.
• Cancer - There is no higher incidence of breast cancer in patients that have a breast lift. We recommend obtaining a mammogram before your breast lift of reduction, especially if you are over the age of 35 or have a family history of breast cancer.
• Skin discoloration - Although rare, after a breast lift you may see some skin discoloration of the breast itself and sometimes even the areola.
• Stretch marks - This is not really a concern with breast lifts or Breast reductions, since we are not increasing the volume of the breast. If anything we are reducing the volume. Stretch marks can be seen when you are combining a breast lift with a breast augmentation.
• Recurrence of ptosis - This is a very common problem, after several years the breast may begin to droop again. Although it will not be to the extent it was before surgery, what you will notice is that you loose some of the superior pole fullness. This is why some of the newer techniques focus on maintaining more fullness superior by glandular reshaping.
• Asymmetry - One breast may appear larger of different than the other. This is not really a complication but a fact of life. Each half of the body is very different than the other; therefore you can never have exactly the same breast. Expect some asymmetry in your breast and areolas.
• Fat necrosis - If some of the breast fatty tissue does not receive enough blood supply then that part of the breast will develop an internal necrosis or tissue death. When this occurs in the fat it is called fat necrosis. This is very rare in breast lifts. If it occurs, the body may reabsorb the tissue but you will go through a period of feeling hard lumps in the breast. Sometimes they don't disappear and we need to remove them.
• Nipple position, different size areolas - Because the breast is never symmetrical, you will always have one breast that is different from the other. At first this difference will be very noticeable since your breast are swollen. Once the swelling subsides, then you wont notice the difference as much but it will always be present (no one has symmetrical breast).
• The procedure can also leave you with unevenly positioned nipples and different size areolas. If the difference is too great sometimes you can improve the difference with a scar revision surgery, but they will never be exactly alike.
Recovery period after your breast lifts surgery.

Remarkably this operation is not very painful, your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications. Expect to have some wrinkling around the areola especially if the minimal scar breast lift is performed, this should improve and will take about 3 months.

Although you will be up and walking the next day, most patient are able to return to work in about one week, some patients recuperate remarkably well and have been able to return earlier, however the average is about a week. In order to resume any exercise programs or any heavy lifting, it may take 3-4 weeks, depending on how well you heal as an individual, the average is about one month. After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings.

Within a few days, a soft support bra will replace the bandages or surgical bra. You'll need to wear this bra around the clock for three to four weeks. The stitches will be removed after about 7-10 days.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful to keep the moisturizer away from the suture areas.

There are some creams that can be used to help with healing (i.e. Scar guard, silicone, vitamin E, etc); these you can start using after the sutures are removed.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

Your new look

At first the upper part of your breast may seem very high and very full and, it can have a funny appearance, this occurs because your breast is swollen and it will take about 2-3 months for the breast to settle and take its nice natural shape. You may also notice that one breast is higher or larger than the other, this is quite normal since one side may swell more than the other, (if you notice your before pictures you will see that your breast were not symmetrical to begin with). It will take about 3 months for you to become accustomed to your new look and not notice the differences as much. You may experience wrinkling around the areola and this will improve over time, it may take up to 3 months as well. Most patients are very happy immediately after their surgery. It is those patients that have unrealistic expectations and are not willing to wait for the healing process that become dissatisfied and anxious. Remember it takes about 3 months for all the swelling to go away and the breast to settle into their new positions.

We will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that Mastopexy scars are extensive and permanent. They often remain lumpy and red for months, and then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

You should also keep in mind that a breast lift won't keep you firm forever - the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again.