Risks and limits of surgery
Do I need a breast lift or a breast reduction?
When I see you in my clinic, I will assess you carefully to check both the size of your breasts and the amount of drop that has occurred. If in a well-fitted supporting bra you are happy with the size of your breasts then you do not need a breast reduction rather a breast lift alone will suffice. If you feel that your breasts are too large then a breast reduction is the correct procedure for you, particularly if accompanied by other symptoms.
Do I need impants as well as a uplift?
When I assess you in my clinic, I will ask you how you feel about your breasts when you are wearing a well fitting bra that properly supports all the breast tissue. If you are happy with them under these circumstances, then abreast uplift will ususally suffice. If you still feel that ther is not enough fullness in the upper part of the breast or that the sixze is too small, then you are likely to need implats in addition.
I am worried about the scars from a breast uplift
Over the many years that I have been carrying out breast uplifting, my experience is that women are more than happy to accept the scars given the great benefits that the operation offers. As far as possible I use techniques to minimise the impact of the scars. The horizontal scar in the breast fold is generally tucked away out of vision. I take time using a fine buried suture technique to close the wound around the areola and the vertical scar to minimise the impact of this scar. After surgery, it is important that you follow my instructions for managing your scars. Essentially you should massage your scars once healed twice a day with a moisturiser and firm pressure to reduce the chance of thickening of the scars. If you are in a sunny environment it is important that you put a layer of sunblock over your scars to prevent them from becoming reddened or pigmented. These measures should be carried out for a period of 12 months and in most patients scarring from this operation is very acceptable.
What happens if I become pregnant?
Pregnancy may enlarge your breasts again and tend to undo the effects of the operation. It is sensible to time your surgery with this in mind.
I am losing weight. Will this affect my breast uplift?
It is important with most cosmetic procedures that your weight is stable before you embark on them. Many women who are losing weight will find that they lose a good deal of that weight from their breasts. In contrast, other women find that weight loss does not affect their breasts at all. My advice to women in the first category is that you should complete any weight loss programme prior to embarking on a breast uplift. This has advantages in that excess skin can be removed and the breasts lifted to an optimum degree once you have completed your weight loss. If you are in the second category in which weight loss does not affect your breasts, then the timing of the operation is less critical. I would advise however again, that if possible you do lose whatever weight you are planning to lose.
Will I be able to breastfeed after breast uplifting?
The technique that I use in the vast majority of women is one in which the skin is lifted from the breast tissue and the nipple and areola remain attached to the breast tissue., thus the breast ducts and nerves to the nipple and areola are also preserved. This means that this operation has in my view the least effect on the breasts and if you were able to breastfeed before, the chances are you will be able to breast feed after this operation. Similarly, if you had good nipple sensation before, it is likely you will have a good nipple sensation after. It is important to note however that in some patients the breasts can become hypersensitive presumably because the breasts have been lifted and there is less pull on the nerves.
Are there any complications from this type of surgery?
Breast lifting, like all operations, carries a risk of complications and I will go through these with you in detail at your consultation.
In many women, the breasts drop with age due to loss of elasticity of the skin, stretching of the fibrous bands which support the breasts internally, the effects of gravity and the weight of the breasts themselves. This process may be accelerated following pregnancy where further stretching of the breasts occurs, as they fill with milk. The result is that the breasts lie below their normal level and there is a loss of shape.
As well as the loss of bust, women report difficulties in buying clothes and underwear that fit due to the position the breasts restricting the type of fashions that they can choose. Many depend on a bra to give them any shape and droopy breasts may rest on the abdomen with emptiness in the chest region and a false impression of abdominal obesity.
In addition to these factors, there are significant psychosocial factors associated with loss of the bust which may be improved following breast uplifting.
A breast uplift is for women seeking to lift droopy breasts without reducing their size.
If you seek to lift your breasts and reduce their size, then a breast reduction is the correct operation for you.
Often women come to see me wishing to both lift their breasts and enlarge them. In this situation, breast implants are inserted at the time of the breast uplift. This gives more fullness to the upper part of the breast than can usually be achieved with a mastopexy alone. Breast uplift and enlargement (also called mastopexy with augmentation) can be carried out as a single stage or in two separate stages. The decision making around this is complex as there are a number of pros and cons. If this is something that you are considering, I will guide you through the process at consultation.
There are many different techniques of breast uplift. In practice, however, there are only two major differences between the various operations. The most common approach is where the nipple and areola are preserved on an internal mound of breast tissue, this is shaped and repositioned and excess skin removed. This approach has the advantage that it is often possible to preserve the nerve supply (and thus the sensation) as well as the breast ducts (therefore the ability to breastfeed) to the nipple areola. The second approach is used far less commonly and is generally reserved for patients whose breasts are extremely drooping. In this approach the nipple-areolar complex is removed as a graft, the breast reshaped and the nipple areola grafted back into the correct position on the newly shaped breast.
Breast uplift is usually carried out under general anaesthetic and takes two to three hours. At the end of the procedure, I put a small silicone tube (surgical drain) into each breast and I usually leave this in place for 24 hours. The typical hospital stay is for one night. The scars from a breast uplift vary according to the technique used. In the technique that I use most frequently, the scar circles the areola and passes vertically down to the breast fold and runs along the whole length of the fold. If you have less excess skin it may be possible to reduce the scars.
Breast uplift, combined with enlargement or reduction techniques, can also be used to correct or improve major asymmetries of the breast.
When I see you in my clinic I will make an operative plan for you based on your general build, the size of your breasts and the amount of droopiness to your breasts taking into account your aims and personal preferences. Once we have established this plan I will go through all aspects of the procedure with you including recovery time for healing return to work, childcare, and exercise. I will also go through potential complications and risks specific to you if you have any medical conditions.
In preparation for your surgery, it is helpful to have loose pyjamas or a large T-shirt to wear for your post-op stay.
On the day of your operation, I will meet you with my anaesthetist and we will go over your operation again and I will mark out your breasts in preparation for your surgery.
Once your operation is complete you will be taken to the Recovery Room where most patients wake up gently and are generally comfortable. As breast uplifting does not involve entering any body cavities the discomfort following surgery is moderate rather than severe. Nevertheless, you will be supplied with strong painkillers as required. Once you are fully awake, you will be encouraged to get up and gently walk around.
The following day I will remove your drains and preparations will be made for your discharge from hospital. Your breasts will have dressings in place but at this stage, I do not usually ask my patients to wear a bra. A loose T-shirt or top is ideal for the first week.
I ask my patients to keep their wounds dry and the dressings undisturbed for the first week. After this, I will see you in my clinic and remove all the dressings and inspect your wounds. From this time onwards you can start to shower and apply a small amount of Sudocrem cream to your wounds. This acts as a barrier.
At this stage, you can start to wear a bra and I recommend that you acquire a supporting bra that is soft with no wires. This should be comfortable around the chest and slightly larger than your anticipated breast size to accommodate the swelling. During your first week at home, it is important that you take plenty of rest but keep mobile. The simplest way to achieve this is walking both indoors and outdoors. You should avoid any heavy lifting and any vigorous activities including the gym. It is important to note that this operation has a significant impact on your ability to carry out shopping, household duties and childcare, particularly in the first two weeks. After a week to 10 days, you may drive for short essential trips and following two weeks you can usually build up to your normal pattern of driving. If your work is office based or requires light duties only you may find you are able to return to work at 10-14 days. If your work involves any degree of heavy manual work I recommend that you take at least four weeks off.
During your recovery time, I will keep a check on your progress in my clinic initially at one week then again at two weeks after your operation. This is followed by a four-week appointment and then one at three months to check how things are settling down. Following your breast uplift, you should notice a more balanced shape to your body, and easier fitting for clothes. You may also find that exercise and sporting activities are more easily carried out.