Breast Lift Surgery (Mastopexy)

Definition and Purpose

Breast lift surgery (mastopexy)is a surgical intervention performed to restore the breasts (breasts) that have sagged over time for various reasons into an upright and fit appearance. Factors such as aging, the influence of gravity, the processes of pregnancy and lactation, frequent weight gain and loss can lead to sagging of the breasts, reducing the elasticity. This condition causes the breasts to appear in a lower position, even if there is no large change in breast volume, the fullness shifts from the top to the bottom, and the nipples (heads) look down. With breast lift surgery, excess skin tissue is removed and the breast tissue is shaped and the nipple is moved to the higher position it should be. Thus, the breasts acquire a more lively, erect and youthful appearance. During this operation, there is no significant reduction or increase in breast volume; only the existing tissue is repositioned. (However, breast augmentation or breast reduction procedures can also be combined with prosthetics simultaneously with mastopexy, according to the patient's need.) As a result, breast lift surgery provides women with improvement in body proportions, self-confidence and aesthetic satisfaction in choosing clothes.

How Is It Done?

Breast lift surgery can be performed with different incisions depending on the degree of sagging. The surgeon determines the technique that is suitable for the patient's breast structure. The most common incision techniques are:

• Periareolar (Donut) Mastopexy: With mild sagging, only the areola (the dark ring around the nipple) makes a circular incision around the areola (the dark ring around the nipple), removing excess skin and tightening around the areola.
  
  
• Vertical (Lollipop) Mastopexy: In moderate sagging, a vertical incision is additionally attached to the circumference of the areola, which descends down from the areola to the underbreast line. The trace becomes in the form of circular and vertical lines, similar to a lollipop.
  
  
• Reverse T (Anchor) Mastopexy: In case of advanced sagging and pronounced excess of skin, in addition to the above incisions, another horizontal incision is made in the under-breast fold. Thus, a trace pattern in the form of an inverted T or anchor is formed.
  
  

The surgery is performed under general anesthesia, in a sterile operating room environment and approximately 2-4 hours lasts (depends on the scope of the operation performed). After the surgeon makes the planned incisions, he moves the ring of the areola surrounding the nipple to the desired new position. The nipple and areola are usually not completely dislocated; together with the tissues on it, they are shifted up in blocks so that blood circulation is maintained. Then, the excess skin tissue under the breast is removed by measuring it, and the breast tissue is folded and shaped with stitches, almost like an “inner bra”. This process gives the breast its new shape, while at the same time giving some verticality and projection (prominence). If the areola is enlarged in diameter, it is made into a smaller ring by removing a piece of skin from around the areola to reduce it aesthetically.

After all these shaping processes, the breast skin is collected at the upper pole and joined together at the lower pole, closing the incisions. As a result, the nipple was moved to the higher level, which it should be, and the nipple took on a firmer and more upright form. The breast is usually put on an elastic bandage or surgical bra for support purposes. If necessary, small silicone drains can be placed next to both nipples to prevent the accumulation of blood or fluid in the operating area; however, the use of drains is not a requirement in every case, it depends on the surgeon's preference and the course of the surgery.

Who is it suitable for?

Breast lift surgery is a suitable option for women who experience significant sagging in their breasts and want to correct it. The characteristics of suitable candidates are as follows:

• Those with sagging and loss of form in their breasts: This is an indication of sagging if the nipples are lowered below the nipple line or face down and not straight across. At the same time, the upper part of the nipples may have emptied, the fullness may have descended to the lower part. Those who are disturbed by this type of appearance are candidates for mastopexy.
  
  
• What Changes Breasts After Pregnancy or Weight Loss: During pregnancy and lactation, the breasts can grow and shrink, causing the skin to lose elasticity. Similarly, sagging due to loss of volume in the breasts is common in people who lose a large amount of weight. If these people are individuals who have completed family planning or at least do not contemplate a new pregnancy in the next few years, they are considered more suitable in terms of surgery (because a new pregnancy can cause the breasts to sag again).
  
  
• Those who are satisfied with breast volume but are dissatisfied with their shape: Some women do not complain about breast size, they just want it to look more erect and plump. Mastopexy is ideal because in this case it corrects the shape without greatly changing the volume. If the person wants both an erection and an augmentation, installing a silicone implant in the same session may be an option.
  
  
• Good General Health Status: Candidates who have severe chronic illness, no health problems that would prevent surgery, who are able to remove surgical anesthesia. Surgery is not planned without regulation, especially since uncontrolled diabetes or serious immune problems can affect wound healing.
  
  
• Those with Realistic Expectations and Good Motivation: Candidates who know that there will be a noticeable improvement as a result of surgery but that scars will remain, accepting that these scars will fade over time. Also, people who can afford the postoperative process (use of a support bra, restrictions on the recovery period, etc.) are psychologically ready for this change.
  
  

In the preoperative examination of the candidates, the surgeon measures the quality of the breast tissue, skin elasticity, degree of sagging and nipple-wall distance, assessing the benefits that the surgery will bring. If the person plans to have children in the future, they should inform the doctor about this; although surgery is not a hindrance, subsequent breastfeeding processes can again affect the shape of the breast.

Possible Risks and Complications

Breast lift surgery is usually a safe procedure, but as with all surgical interventions, it carries certain risks. It allows patients to understand these risks and seek prompt medical attention when needed, allowing for successful management of possible problems. The main risks are:

• Scar: After mastopexy, scars will inevitably remain on the breast. The form of permission is related to the technique applied (only around the areola, it can be areola+vertical or inverted T-shaped). These scars may be pink-red in color and noticeable in the first months, but over time they fade and become more indistinct. It is possible that some people (especially those with a genetic predisposition) develop hypertrophic or keloid scars, and the scars become thicker, fluffy. Good care of the marks, the use of silicone gel or tape and protection from the sun improve the quality of the trail.
  
  
• Sensory Changes: During surgery, nerves may be strained or sensitivity in areas close to the incisions may be affected. As a result, loss of sensation or vice versa, excessive sensitivity can develop, especially in the nipples and around the areola. In most patients, this condition is temporary, and within a few months the normal feeling returns. But rarely, there may be a permanent loss of sensation, especially when serious dislocation of the nipple is required, especially with very large sagging. Although this risk is low (usually < 5% permanent drowsiness), prior information should be given.
  
  
• Breastfeeding Ability: In the breast lift operation, no comprehensive treatment of the mammary glands is performed; mainly the skin and subcutaneous tissues are removed. For this reason, most patients can also breastfeed after surgery. However, during surgery, some of the milk ducts may be cut off, or operations around the nipple may affect the flow of milk somewhat. This risk should be considered for those who plan to become a mother in the future. Generally, breastfeeding ability is more likely to be preserved in mastopexy compared to breast reduction surgery.
  
  
• Asymmetry and Shape Dissatisfaction: If, due to the natural asymmetry of the human body, before the operation there were breasts of slightly different sizes or shapes, then after surgery, complete symmetry may not be achieved either. The surgeon makes the necessary measurements to ensure symmetry; for example, he tries to balance it by removing a little more skin from a breast. Even so, slight differences may remain in the healing process due to different swelling or scarring in a breast. In some cases, the patient may find that the breasts are small or different in shape than expected (mastopexy does not add volume, there may even be a very minimal loss of volume, since the skin is removed). In such cases, if there is an obvious problem, options such as a minor correction or implant application can be considered at the earliest 6 months after surgery.
  
  
• Complicated Wound Healing: Because the area under the breast is a non-airtight area, especially in patients with a T-shaped incision, there may be small skin openings or late improvements at the T-intersection. This is caused by the tension that gets on the tissues and mostly heals spontaneously with local wound care. This risk is significantly increased in smokers, so smoking patients are advised to stop smoking for at least 4 weeks before surgery.
  
  
• Infection: As with any surgery, the risk of infection also applies to mastopexy, but its rate is low. Symptoms of infection in breast tissue surgeries include increased swelling, redness, temperature, discharge, and fever. Antibiotics are usually sufficient for treatment, but if an abscess has formed, a little drainage in that area may be required. With clean surgical technique and prophylactic antibiotics, the risk of infection is reduced to a minimum.
  
  
• Bleeding (Hematoma): In the first 24 hours after the operation, blood accumulation (hematoma) may form in the tissue. In this case, sudden stiffness, swelling and pain in the breast appear. If a pronounced hematoma is detected, the patient is taken back to the operating room and the accumulated blood is drained and the source of bleeding is checked. For this reason, most surgeons keep the patient under observation on the first night and sometimes prefer to use drains.
  
  
• Nipple/Areola Necrosis: It is one of the most serious complications, although it is very rare. If the blood supply that feeds the nipple is severely impaired (especially with very large sagging or excessive smokers, the risk increases), partial or complete permanent damage (tissue death) to the nipple or areola tissue can occur. This condition may require re-surgical interventions and long-term wound care and can be difficult to fix aesthetically. Fortunately, in the hands of experienced surgeons and with appropriate patient selection, this risk is less than 1%. Not smoking and practicing the surgeon's techniques that will preserve tissue nutrition almost completely prevent this complication.
  
  

Your surgeon will take the necessary precautions before and during surgery to minimize all these risks. Following your postoperative instructions (rest, bra use, wound care, etc.) will speed healing and reduce the likelihood of complications.

Healing Process

Recovery after breast lift surgery is usually quick, but it can take several months for your body to fully recover and the breast tissue to take on its new shape. Here is the general course of the recovery period:

• First Day and Discharge: Immediately after surgery, the breasts will be bandaged and you will wake up dressed in a surgical bra. Mild chest pain and a feeling of tightness are normal when the effect of anesthesia passes; it is controlled with painkillers administered intravenously. If the drain is plugged, some bloody liquid may accumulate in it, which is to be expected. Most patients are discharged the day after surgery by pulling the drains. After discharge, it is recommended not to drive, but to rest at home.
  
  
• First Week: In the process of rest at home, pains decrease day by day. The first days there may be a pulling sensation in the breast with arm movements; avoid raising your arms too high, carrying heavy objects. Use pain relievers prescribed by your doctor regularly. If there are large bandages on the breast, they are usually removed after 2-3 days, leaving thin bands and a surgical bra in their place. The surgical bra supports the breasts, both reducing edema and preventing overstretching of the suture lines, which is why it is very important to use it for the duration indicated by the doctor (usually 4-6 weeks, night-day). By the end of the first week, most of the stitches can be removed (if the self-melting seam was not used). The permission to take a shower during this period depends on the surgeon's preference; usually a short warm shower can be taken after 3-4 days, but it is necessary not to rub the suture lines.
  
  
• The first 2-3 weeks: Bruising and swelling may be mild in the breast. Some patients do not have any bruising, while others may experience yellow-purple discoloration, especially in the lower parts, which pass within 2 weeks. A significant part of the swelling goes down in the first 3 weeks, but it will take several months to resolve the remaining slight edema for the breasts to take their final shape. From the second week, the patient can return to light daily activities if he feels well. If the desk head has a job, it can usually start working after 7-10 days. But the least for heavy lifting, high-tempo exercise, movements that require lifting arms up a lot 4-6 weeks should be expected. During this process, the support bra continues to be worn even at night.
  
  
• Between 1-3 Months: After 1 month after the operation, the stitches are completely healed. If your doctor approves, you can start wearing more normal bras, but models without balms and soft supports are preferable. Scars during this period are pink and slightly fluffy; it is important that they are protected from the sun (one should not go to the solarium, sunbathe or at least apply cream with a high protection factor on the scar). At the end of 6-8 weeks, full aerobic exercises, running or light weight work can be started. The new form of the breasts begins to look more and more natural; the tension initially felt in the upper parts is replaced by a soft tissue.
  
  
• Long Term: From surgery 6 months then the nipples have largely taken their final shape. Traces are still visible, but faded; for full ripening, a process of up to 12-18 months is prescribed. At the end of this period, the scars in most patients take the form of a thin line in the color of the skin. The results of breast lift surgery are long-lasting; however, some sagging may reappear in later years, as the effect of gravity and the aging process will continue. Especially avoiding weight fluctuations, keeping the skin hydrated and continuing to use well-supported bras prolong the life of the results. Breasts that have had once had an erection will never sag as much as before surgery, but it is a possibility that patients should know that a second small lift may be required after 10-15 years.
  
  

Breast Lift at Central Hospital Istanbul

Central Hospital Istanbul provides its patients with the highest standards of breast lift operations with specialized plastic surgeons in breast aesthetics and modern surgical facilities. Before the surgery, detailed consultations are conducted with our patients, so that the patient's complaints are understood, expectations are listened to and the breast examination determines the optimal surgical plan. Our surgeons explain in detail which technique (lollipop, inverted T, etc.) to be used according to the degree of breast sagging of the patient and the quality of the skin, inform the patient about the location and appearance of the scars that will form after surgery. If necessary, combinations such as autologous filling (remodeling of breast tissue) or implant insertion can be planned for use at the time of surgery, such as autologous filling (remodeling of breast tissue) to be used at the time of surgery.

Surgeries in our hospital are performed in fully equipped, sterile operating rooms. Using the most up-to-date and safe methods during the operation, our surgeons focus on maintaining blood circulation in the breast and minimizing the risks of complications. For example, by giving preference to safe pedicels (nutritious connections of the tissue) when moving the nipple to the new place, the bleeding of the nipple is preserved. During the operation, our anesthesia team constantly monitors the patient's comfort and safety, and effective pain control protocols are applied at the end of the surgery.

At Central Hospital Istanbul, postoperative care is a stage that is given as much importance as the surgery itself. Our nurses are meticulous about everything from the first night position of our patients undergoing breast lift surgery to drain care, pain relief applications to vital findings monitoring. Before discharge, our patients are given detailed information on how to use special surgical bras, what to look out for at home, and the use of medications. In addition, guidance is given on the correct timing for recommendations such as massage or cream application to the surgical site.

Our patients are called for regular check-ups after surgery and their recovery processes are closely monitored. In the first week, first month, third month and sixth month check-ups, our surgeon evaluates the new shape of the breast, examines the condition of the scars and answers the patient's questions. In these checks, scar reduction methods such as silicone bands or laser therapy may be recommended if necessary.

As a team at Central Hospital Istanbul, we stand by our patients in every step of the breast lift surgery process. From the pre-operative information and preparation period to the recovery phases after surgery, we aim to provide our patients with a reassuring, transparent and supportive experience. The satisfaction of our patients with the new silhouettes they see in the mirror and the positive reflection of this change on their quality of life is the most valuable measure of success for us.