BREAST LIFT | MASTOPEXY
The effects of gravity, pregnancy, and breastfeeding, and loss of breast volume with age, resulting in sagging of the breasts. This is known medically as mammary ptosis or breast ptosis. Certain measurements are taken into account when evaluating breasts for ptosis.
These measurements include:
- Mid-clavicular to the nipple, that is from the collar bone to the nipple
- Mid-clavicular to the inframammary fold, meaning the collar bone to the fold under the breast
- The inframammary segment, that is the distance from the nipple to the fold under the breast
- Sternal notch to the nipple, meaning the distance from the top of the sternum to the nipple
There are different degrees of ptosis as well as different types based on these measurements, and for each there are different types of breast lifts designed to correct that specific type and degree of ptosis.
TYPES OF BREAST PTOSIS | SAGGING BREASTS
Grades of Ptosis:
- Grade I: This is when the nipple has slightly dropped but is still at the level of the inframammary fold.
- Grade II: This is when the nipple has dropped to the level of the inframammary fold.
- Grade III: This is when the nipple has dropped below the inframammary fold but is still pointing forward.
- Grade IV: This is when the nipple has dropped below the inframmary fold and is pointing down to the ground.
Some authorities simplify grades of ptosis as Mild, Moderate, and Severe. But the above is a more accurate classification.
Types of Ptosis:
Nipple Ptosis: This is when only the nipple/areola complex sags, resulting in a lengthy distance between the clavicle (collar bone) and the nipple, but a normal distance between the clavicle and inframammary fold. This is the most common type of ptosis and the basis of most classifications, resulting in what is commonly referred to as Grade I, Grade II, Grade III, and Grade IV ptosis.
Inframammary Fold Ptosis: This type of ptosis results in lowering of the inframammary fold and an elongated inframammary segment, meaning lengthening of the nipple to inframammary fold distance in the face of a normal distance between the collar bone and the nipple. This type of ptosis is also referred to as Glandular Ptosis or Parenchymal Malposition.
Inframammary Segment Ptosis: This type of ptosis, also known as Pseudoptosis, is when the distance between the collar bone and nipple, as well as the distance between the collar bone and inframammary fold, is within the normal range, but there is the lengthening of the distance between the nipple and the inframammary fold.
Combination Ptosis: There are different variations to mammary ptosis and any combination of the above is possible.
For each of these types and degrees of ptosis there are different procedures available. In most situations, breasts have lost volume along with the development of ptosis. Therefore a breast implant is also required to compensate the volume loss. Performing a breast augmentation along with a lift is a controversial area and the success depends on the type of lift and the experience of the surgeon.
The types of breast lifts that are commonly used are as follows:
DOUNT-LIFT OR PERI-AREOLER MASOPEXY
This is a procedure in which an asymmetrical donut shaped part of the skin around the areola is de-epithelialized (the surface of the skin is removed, leaving behind the germinal layer or dermis), and repair is carried out, usually with a strong “purse-string” to hold the two circles together. This procedure originally was developed in the 1980’s as a “Crescent Lift”. Gradually it evolved as the Donut Lift. The main advantage of this procedure is that it only leaves a scar around the areola. A Donut Lift is suitable for breasts with Grade I or II ptosis.
VERTICAL LIFT OR LOLLIPOP VERTICAL MASTOPEXY
This form of breast lift is suitable for breasts with Grade III Ptosis. It is done by combining the donut lift with a vertical limb that is done to reduce the width of the inframammary segment. As the name implies the resulting scar looks like a lollipop. Both the peri-areolar scar and the vertical limb usually heal nicely and inconspicuously.
FULL ANCHOR LIFT OR FULL ANCHOR MASTOPEXY OR WISE PATTERN MASTOPEXY
This type of lift is done to correct Grade IV Ptosis. It involves the peri-areolar and vertical incisions, as well as a horizontal incision to remove the excess tissue in the inframammary segment. Again, as the name implies, the resulting scar looks like an anchor. In this situation, the peri-areolar scar is hidden in the skin/areola interface, the vertical scar usually heals nicely and inconspicuously, and the horizontal scar is usually hidden in the inframammary fold and invisible.
As mentioned previously, all of these types of lifts can be combined with an implant to compensate for volume loss. However, there are situations where an experienced plastic surgeon will recommend staging the procedure, meaning performing the mastopexy, allowing a few months for healing and settling to take place, and then placing the implants. The reason being that experience has shown in certain situations, for example when a full mastopexy is required, combining the implants and mastopexy at the same time can result in a higher incidence of complications and revision surgery.