Mastopexy is the clinical term for a breast lift. It repositions breast tissue, tightens the skin envelope, and raises the nipple and areola to a higher position on the chest wall. What it does not do is add volume, and that single point accounts for a large proportion of the misunderstanding patients bring to a first consultation. Understanding what mastopexy addresses, what it does not, and what influences how long the result holds, makes the decision considerably clearer.
What Mastopexy Is and What It Does Not Do
Mastopexy addresses the position of the breast tissue and the excess of the skin envelope. It is performed under general anaesthetic and involves removing skin, reshaping and repositioning the breast tissue, and moving the nipple and areola upward. The areola is commonly reduced in diameter at the same time.
Because no volume is added, mastopexy does not restore fullness in the upper part of the breast where that fullness has been lost. Patients whose main concern is loss of volume rather than position may find that a lift alone does not address what they are unhappy about. Conversely, patients whose concern is position rather than volume are unlikely to be well served by augmentation alone. Distinguishing between the two is one of the central purposes of the assessment.
Ptosis and Pseudoptosis
Breast ptosis describes descent of the breast tissue and nipple relative to the inframammary fold, the crease beneath the breast. It is graded on a spectrum from mild through moderate to severe, based principally on where the nipple sits in relation to that fold and to the lowest point of the breast.
Pseudoptosis is a separate finding, and the distinction matters clinically. In pseudoptosis the breast tissue has descended below the fold but the nipple remains above it. This pattern is common after breastfeeding and after weight loss, and it often presents as a breast that feels empty in the upper pole with fullness sitting low. Because the nipple position is acceptable, the surgical approach differs from a standard lift, and the amount of nipple repositioning required is limited or unnecessary.
Grading is not made on appearance alone. Skin thickness, skin elasticity, the volume of breast tissue and its distribution, and the position of the fold are all assessed together, because these determine which technique is appropriate rather than the nipple position in isolation.
Clinical Factors That Influence Suitability
Suitability for mastopexy, and which technique is appropriate, depends on several factors assessed at examination.
Nipple position relative to the inframammary fold. This measurement drives how much repositioning is required and, in turn, which incision pattern is needed.
Skin quality and elasticity. Skin that has been stretched by pregnancy, breastfeeding, or weight change has reduced recoil. Poor skin quality affects both the immediate result and how well it is maintained, and patients with significantly reduced elasticity are counselled about this before proceeding.
Breast volume and tissue distribution. The amount of tissue present and where it sits determines whether a lift alone is appropriate, whether reduction is more suitable, or whether volume restoration should be part of the discussion.
Weight stability. Ongoing weight change alters breast volume and skin tension. Stable weight before surgery gives a more predictable and more durable result.
Future pregnancy and breastfeeding plans. Pregnancy and breastfeeding after mastopexy commonly change breast volume and skin tension and can reduce the durability of the result. Patients planning pregnancy are generally advised to consider deferring surgery, and this is discussed openly rather than avoided.
Smoking and general health. Smoking substantially increases the risk of wound healing complications and of compromised blood supply to the nipple, which is a specific and serious concern in this procedure. Body mass index, medications, and any history of breast disease are also reviewed.
Breast symmetry. Some degree of natural asymmetry is present in most patients. Where it is clinically notable it is documented and factored into planning, and patients are advised that complete symmetry cannot be assured as a surgical outcome.
Mastopexy, Breast Reduction, or Augmentation
These three operations address different problems and are sometimes confused. A mastopexy repositions without changing volume. A breast reduction removes breast tissue as well as skin, reducing volume, but also lifts and is generally considered where breast size itself is contributing to symptoms such as neck, shoulder, or back discomfort. An augmentation adds volume without addressing position.
Where a patient presents with both ptosis and volume loss, a combined lift and augmentation may be discussed. Combining the two carries a different and higher risk profile than either alone, because the procedures work against each other mechanically, one tightening the skin envelope and the other expanding it. Whether it is appropriate, and whether it is better performed in one operation or two stages, is an individual clinical decision made at consultation.
Incision Patterns and What Determines the Choice
The incision pattern is determined by how much skin needs to be removed and how far the nipple needs to move, not by preference.
A periareolar or donut pattern uses a circular incision around the outer edge of the areola, and is generally suited to mild ptosis requiring limited elevation. A vertical or lollipop pattern adds a line from the base of the areola down to the fold, allowing more repositioning and suiting moderate ptosis. An inverted T pattern, also called an anchor or Wise pattern, adds a horizontal incision along the fold and is used where a greater amount of skin must be removed for more significant ptosis.
Scarring is present with every pattern. A lesser incision does not produce a better result if it cannot achieve adequate correction, and attempting to limit scarring at the expense of the correction generally compromises the outcome. This trade off is discussed directly at consultation.
What Influences How Long the Result Is Maintained
Mastopexy does not stop the processes that produced ptosis in the first place. Gravity, ageing, and changes in skin quality continue after surgery, and some settling is expected. The degree and speed of change varies significantly between patients.
Factors associated with less durable results include poor skin elasticity at the outset, larger and heavier breasts, significant weight fluctuation after surgery, pregnancy and breastfeeding after surgery, and smoking. Patients with these factors present are advised of the likelihood of earlier change. No specific duration can be assured, and revision surgery is sometimes considered years later.
Recovery and Risks
Mastopexy is performed under general anaesthetic. A supportive bra is generally worn for around six weeks, and strenuous upper body activity, lifting, and vigorous exercise are usually restricted for four to six weeks, as directed by the treating surgeon. Swelling and altered sensation are expected early and settle over weeks to months. Final shape continues to settle over several months.
Risks include scarring that may be more visible than anticipated, asymmetry, changes in nipple and skin sensation which can be permanent, difficulty or inability to breastfeed afterwards, wound healing problems, infection, bleeding, delayed healing at the junction of incisions, loss of nipple or areola tissue in uncommon cases, recurrence of ptosis over time, and the risks associated with general anaesthetic. These are discussed in detail before any decision is made.
Cost and Next Steps
Mastopexy performed for cosmetic reasons does not attract a Medicare benefit. A quote comprises the surgeon’s fee, the anaesthetist’s fee, the hospital or day facility fee, and pre and post-operative costs, and a personalised written quotation is provided following consultation once the surgical plan has been determined.
The initial consultation fee is $300 and follow up consultations are $150. A referral from your general practitioner or another medical practitioner is required before a consultation for cosmetic surgery.
Dr Mark Hanikeri FRACS (PLAS) sees patients to discuss mastopexy in Perth. Assessment is individual, and the appropriate procedure, if any, is determined following physical examination.
Frequently Asked Questions
What is the difference between a mastopexy and a breast lift?
They are the same procedure. Mastopexy is the clinical term and breast lift is the common term. Both describe an operation that repositions breast tissue, removes excess skin, and raises the nipple and areola without adding volume.
Does a mastopexy make the breasts smaller?
Mastopexy is not intended to reduce volume, though removing skin and reshaping the tissue can make the breast appear slightly smaller or firmer. Where the aim is to reduce breast size, particularly where size is contributing to neck, shoulder, or back symptoms, a breast reduction is the more appropriate procedure. Which applies is determined at assessment.
How much does a mastopexy cost in Perth?
The total comprises the surgeon’s fee, the anaesthetist’s fee, the hospital or day facility fee, and pre and post-operative costs, and it varies with the complexity of the procedure and whether any additional procedure is performed. Mastopexy performed for cosmetic reasons does not attract a Medicare benefit. A personalised written quotation is provided following consultation.
How long does a mastopexy last?
No specific duration can be assured. Ageing, gravity, and changes in skin quality continue after surgery and some settling is expected. Poor skin elasticity, larger and heavier breasts, weight fluctuation, pregnancy and breastfeeding after surgery, and smoking are all associated with earlier change. Individual factors are discussed at consultation.
Should I have a mastopexy before or after planning a pregnancy?
Pregnancy and breastfeeding commonly change breast volume and skin tension and can reduce the durability of a mastopexy result. Patients planning pregnancy in the near future are generally advised to consider deferring surgery. This is a personal decision made with an understanding of the likely effect, and it is discussed at consultation.
Can breastfeeding still occur after a mastopexy?
Some patients are able to breastfeed after mastopexy and some are not. The procedure involves repositioning the nipple and areola and reshaping breast tissue, which can affect the ducts and the nerve supply relevant to breastfeeding. Patients for whom future breastfeeding is important should raise this at consultation so it can be factored into the discussion.
Further Reading
- Breast Lift Perth: https://markhanikeri.com/breast-lift/
- Breast Lift Surgery in Perth: What Is Assessed at Consultation: https://markhanikeri.com/breast-lift-surgery-in-perth-what-is-assessed-at-consultation/
- Types of Breast Lift Incisions: Donut, Lollipop and Anchor Techniques: https://markhanikeri.com/types-of-breast-lift-incisions-donut-lollipop-anchor-techniques/
- Navigating Choices: Mastopexy Breast Lift vs Breast Reduction: https://markhanikeri.com/navigating-choices-mastopexy-breast-lift-vs-breast-reduction/
- Breast Lift With or Without Implants Perth: https://markhanikeri.com/breast-lift-with-or-without-implants-perth/
- Mastopexy Breast Lift by Age: 30s, 40s and 50s: https://markhanikeri.com/mastopexy-breast-lift-by-age-30s-40s-50s/
| Written by Dr Mark Hanikeri – Specialist Plastic Surgeon, Perth WA. Dr Hanikeri holds Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery and has practised in Perth for over two decades. Consultations are conducted at accredited facilities in Subiaco and Murdoch. |
