If you've ever stood in front of a mirror and wished that your breasts were firmer, higher and more youthful-looking, breast lift surgery, or mastopexy, may be right for you. A breast lift can rejuvenate your figure by restoring the lift and shape that is often lost due to pregnancy, weight loss or simply the long-term effects of gravity.

See our before and after photo gallery for examples.

Before	After
Illustrations courtesy of the American Society of Plastic Surgeons

Is a breast lift right for you?

You may be a good candidate for breast lift surgery if:

• Your breasts are pendulous, but their size is satisfactory to you
• You would like your breasts to be higher on your chest
• Your breasts lack substance or firmness
• Your nipples and areolas point downward, especially if they are positioned below the breast crease
• You have asymmetry, where one breast may be firm and well-developed, while the other is not
• You are in good health and maintain a stable weight
• You are not planning to become pregnant
• Your breasts are healthy
• You are understand and accept that breast lift surgery will leave permanent, visible scars

Who is not a good candidate for a breast lift?

A breast lift is not advisable if you:

• Have breast cancer, breast disease or other health issues
• Are pregnant or nursing
• Are planning to lose weight

When is the right time for a breast lift?

• A breast lift can be performed at any age, but Dr. Parungao recommends waiting until your breasts are fully developed.
• Pregnancy and breast-feeding may affect the size and shape of your breasts, so you may wish to postpone surgery until after having children.
• If you are planning to lose a significant amount of weight, it's best to lose the weight before having a breast lift, as weight loss can cause the breasts to sag.

How does a breast lift work?

In breast lift surgery, or mastopexy, the breasts are raised, the nipples are repositioned and the areolas, or the darker skin around the nipple, may be reduced in size. If you have lost breast volume over the years and want to add more fullness, breast augmentation may be combined with breast lift surgery to increase your breast size-a dual procedure called augmentation mastopexy. See our photo gallery for examples.

A breast lift corrects ptosis, or sagging breasts

Ptosis (pronounced TOE-sis) is the medical term for breast droop. The amount of ptosis depends on the relative location of the nipple and the inframammary fold, or the crease beneath the breast. In a normal breast, the nipple is located above the inframammary fold and on the mound of the breast. There are four degrees of ptosis in breasts that sag, as shown in the illustration.

• First-degree (mild) ptosis—The nipple is even with the inframammary fold.
• Second-degree (moderate) ptosis—The nipple, although below the inframammary fold, is still above the lowest part of the breast.
• Third-degree (advanced) ptosis—The nipple is below the lowest part of the breast, lies below the inframammary fold and points downward.
• Pseudoptosis (false) ptosis—Although the nipple is above the inframammary fold, a significant amount of the breast tissue is below the fold.

Degrees of breast droop, or ptosis

Source: A Woman's Guide to Cosmetic Breast Surgery and Body Contouring, by Allan J. Parungao, MD FACS, Steven M. Morris, MD and Jerrold R. Zeitels, MD. Addicus Books, 2006.

How is a breast lift performed?

Incisions may vary	Scars may vary
Illustrations courtesy of the American Society of Plastic Surgeons

Dr. Parungao performs breast lift surgery on an outpatient basis, using general anesthesia or IV sedation. The procedure usually takes 2-3 hours. There are several techniques for performing a breast lift. Dr. Parungao will determine the best technique for you based on the size and shape of your breasts, the size of your areolas, the extent of the sagging and whether you wish to add breast implants.

Breast lift techniques

• The Wise pattern, sometimes referred to as the anchor or the inverted T, involves three incisions. This is the most widely used breast lift technique, and allows Dr. Parungao to remove the greatest amount of excess skin from below the nipple and reduce sagging to the highest degree.

  In the Wise pattern, one incision is made around the areola (the dark tissue surrounding the nipple). Another incision runs vertically from the bottom edge of the areola to the crease underneath the breast. The third is a horizontal incision beneath the breast that follows the natural curve of the breast crease.

  After Dr. Parungao has removed the excess breast skin and shaped the remaining breast tissue, the nipple and areola are shifted to a higher position. The areola, which is usually stretched out in sagging breasts, can also be reduced in size. Skin that was formerly located above the areola is brought down and together to reshape the breast. In some cases, liposuction may be used to improve the contour, especially on the sides of the breasts.

  The nipples and areola remain attached to the underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breastfeed.

• The vertical technique, also known as a lollipop incision, works best for breasts with mild to moderate droop, where the nipple is near the breast crease. There are two incisions—one encircling the areola and the second extending vertically from the nipple to the inframammary fold. Dr. Parungao removes the excess skin from below the nipple and repositions the nipple/areola complex at a higher level. Then he brings together the remaining skin and sutures it.
• The periareolar technique, also known as the concentric, doughnut, drawstring, purse string or Benelli technique, works best for smaller breasts with mild to moderate droop.

  With this method, Dr. Parungao makes two round or oval incisions around the areola, one slightly larger than the other. Then he removes the doughnut-shaped area of skin between the two incisions. He raises the nipple/areola complex and pulls the remaining skin together around the areola. To finish, Dr. Parungao stitches the skin together, pulling it closed as if tightening a drawstring. This technique works well for smaller breasts, but may have a flattening effect if used on larger breasts.

• The crescent technique involves a semicircular incision around the upper edge of the areola and removal of a small amount of excess skin above the nipple. This method offers the least lift of all the breast lift methods—and as such, is not commonly used. However, it may be right for you if you have small breasts with very slight drooping.

How fast is the healing process?

Although everyone heals at a different rate, you can expect that your recovery will follow this general time line:

Within the first week

• You will begin to move about more comfortable and perhaps even return to (non-strenuous) work.
• Surgical drains (if used) will removed and dressings will be changed.

After several weeks

• Bruising, swelling, and normal periodic discomfort will diminish.
• The last of the stitches will have been removed.
• You can discontinue wearing a surgical support bra.
• Sensation in the nipple and areola area will gradually improve.
• You may return to most of your normal activities, including mild exercise.

After a few months

• Your breasts will start settling into a more natural shape.
• Incision lines, which initially are red or pink, will begin to fade.

What results can you expect from breast lift surgery?

After breast lift surgery, your breasts will feel firmer and appear more youthful and uplifted. The position of your areolas and nipples will be improved and your areolas will be more pleasingly proportioned.

Although the incision lines will be permanently visible, they will fade over time and are easily concealed under clothing—even most swimsuits and low-cut tops.

You can expect to maintain your new breast shape unless you gain or lose a significant amount of weight or become pregnant. If, over time, you again become dissatisfied with the appearance of your breasts, you may choose to undergo a second breast lift procedure to help restore their more youthful contour and appearance.

Breast lift surgery FAQ

Q.	Is breast lift surgery only for large-breasted women?
A.	No. Breasts of any size can be lifted. However, the results are more long-lasting for women whose breasts are smaller and lighter. Large-breasted women may be candidates for breast reduction surgery
Q.	Does insurance cover breast lift surgery?
A.	In most instances, insurance companies will not pay for breast lift surgery. However, coverage may be provided in certain cases. For example, if a breast reconstruction is performed after mastectomy, and the newly reconstructed breast doesn't match the opposite breast, an insurance company may pay for a breast lift on the opposite breast to achieve symmetry. Before surgery, your insurance company may require a letter of pre-determination. Dr. Parungao's office staff will help you with insurance matters related to the procedure.
Q.	When are implants typically used along with a breast lift?
A.	Combining breast implants with breast lift surgery may be useful, especially for patients who would like fullness in the upper half of the breast. Using an implant may decrease the amount of lifting—and the amount of scars—needed. This depends on the degree of ptosis, or breast droop.
Q.	Are there any disadvantages to combining implants with a breast lift?
A.	Yes. Adding implants to a breast lift procedure increases the rate of complications. The lift moves the breast and areola up, while the implant applies downward force due to the weight of the implant and the effects of gravity.
Q.	Will a breast lift affect my ability to breastfeed?
A.	Possibly. Whether you will be able to breastfeed following breast lift surgery depends on the amount of lifting done during the procedure. The more lifting, the more invasive the procedure—and the greater chance that your ability to breastfeed will be adversely affected.
Q.	Will I be in pain after surgery?
A.	You will have discomfort. The pain usually lasts 2-3 days. We have “pain pumps” you can use to significantly decrease your pain following surgery.
Q.	How long before I return to work or working out?
A.	Most patients are back to work within a week to 10 days after surgery, and can return to working out in about four weeks.
Q.	Will my breasts eventually sag again?
A.	Yes, gravity will continue to pull on your breasts. Also, with age, the skin loses its elasticity and thus, sags.
Q.	Will I have to wear a special bra after surgery?
A.	You will need to wear a sport bra for 2-4 weeks following your breast lift procedure.

Newsletters related to breast lift surgery

	October 2009 Has gravity taken a toll on your breasts?
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	February 2009 Wishing for a fuller, more youthful bustline?
February 2009