When you have a breast lift surgery (mastopexy), the nipple/areolar complex (NAC) usually needs to be repositioned for better proportions and balance. This can be done in any of four ways and before your procedure, you can discuss these with Dr. Angelchik.
A crescent-shaped area of skin is removed just above the areola and the incision is closed at the areola’s upper border. This technique can lift the NAC by two centimeters (about one inch), but doesn’t reshape the breast very much. It is good for minor sagging, often in conjunction with an implant to provide volume and shape.
Periareolar (Donut) Mastopexy
A circular strip of skin around the NAC is removed (a process called de-epithelialization, as it removes only the skin’s top layer, the epithelium). An inner circle is also made on the areola at its desired diameter. Then the outer edge of the circular strip is tightened in to this inner circle. Permanent sutures in the deep skin layer maintains the areolar diameter and shape.
A Donut Mastopexy provides more tightening and shaping than the Crescent Mastopexy, but also tends to flatten the breast centrally. This gives you less projection. An implant is usually used to create projection, but some flattening may still be evident, particularly early after surgery.
Factors to consider when choosing this operation are:
- Less scarring than a vertical or inverted-T mastopexy (see below)
- Some scalloping of the incision edges (which tend to improve with time, but may not be 100% eliminated)
- A modest amount of lifting only
- Breast flattening
- A tendency of the areola or periareolar scar to spread, which in about ten percent of patients may require a revision
- Asymmetry or non-perfect circular shape of the areola.
If you understand and accept these factors, this can be a suitable choice for some mastopexy candidates.
A vertical incision along the central breast axis is made, as well as one around the NAC at the new desired diameter. The vertical incision will usually extend to the inframammary fold (breast crease) or slightly below it.
The goal is to lift the breast and give it a more projecting conical shape. There is more tightening, projection, and lifting than in a Donut Mastopexy, but you will have a longer scar. As the lower pole of the breast relaxes, the breast shape will take several weeks or perhaps months to settle into its new form.
If an implant is inserted for volume and shape, the soft tissue envelope of the breast (and muscle if the implant is below it) needs time to accommodate the implant. This will extend the recovery period further. NAC problems are less frequent than with the Donut Mastopexy.
Inverted T or “Anchor” Mastopexy
This is the classical inverted-T incision pattern used for breast reduction and lifting procedures. If you have severe breast ptosis, many surgeons feel an Anchor Mastopexy provides the best and longest-lasting lift.
A long transverse scar is made in the breast crease and more skin is removed to further tighten the loose skin envelope. Many women are deterred from this procedure by the scars which are essentially identical to those of a classical breast reduction. This procedure can be combined with an implant also. Because of the more extensive dissection of the skin, wound healing problems and skin slough may be more common although they are usually minor.
To schedule a personal consultation with Dr. Angelchik, please call or email our Phoenix, Arizona office today.