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Cosmetic breast surgery
Definition:
Surgical procedure to alter or revise the size or shape of the breasts.

Alternative Names:
Mastopexy; Mammoplasty; Breast size reduction; Breast lift; Breast lift with reduction; Breast lift with augmentation

Description:
Breast revision surgery can be done in an outpatient surgical facility or in a hospital. General anesthesia is often used, although local anesthesia may be used to numb the area around the breasts.

For a breast reduction, some of the breast tissue is removed and the nipples may be relocated higher on the breasts for cosmetic reasons. The operation can take up to 6 hours and is done under general anesthesia.

During a breast lift, incisions are made along the natural creases in the breast and around the dark skin surrounding the nipple (areola). A keyhole-shaped incision above the areola is also made to define the new location for the nipple. Skin is removed from the lower section of the breast. The areola, nipple, and underlying breast tissue are moved up to a higher position. The nipple is moved and incisions are closed with sutures. The procedure usually lasts about two hours, depending on the extent of the surgery.
Indications:
If you are considering mammoplasty, consult a plastic surgeon and discuss your expectations about looking and feeling better, keeping in mind that the desired result is improvement, not perfection. Emotional stability is an important factor. Breast surgery can renew your self-confidence and improve your appearance, but the rest is up to you.

Mammograms or breast X-rays may be required before the surgery. The plastic surgeon will perform a routine breast exam.

Mastopexy is typically performed to lift sagging, loose breasts. The size of the areola, the dark pink skin surrounding the nipple, can also be reduced.

Breast reduction may be recommended for:
  • enlarged breast (macromastia)
  • cystic breast infections (polycystic mastitis)
  • pain from weight of large breasts which is not relieved by a supporting bra
  • pigmented bra-strap groove
  • striae (scar-like lines) on the breasts
Breast reduction is not recommended if these conditions exist:
Risks:
In addition to the general risks of surgery and anesthesia, there are risks of large scars with prolonged healing time, uneven position of the nipples, sensory loss, and inability to nurse a baby after surgery. The emotional risks may include feeling that the breasts look imperfect, or the desired reactions of others are not adequate.
Expectations after surgery:
The likely outcome from reduction surgery is very good. The appearance and lifestyle activities are significantly enhanced. Also, the pain or skin symptoms (such as striation) disappear. A special supporting bra may be required for a few months to reshape the breasts.

After a breast lift, a bulky gauze dressing is wrapped around the breasts and chest following surgery, or a surgical bra may be used. Pain is controlled by medication and will subside in 2-4 days. An overnight stay for breast reduction usually is needed to control pain and nausea. The dressing will be replaced by a soft bra within the first week, which must be worn for several weeks. Generally within a few days the swelling and discoloration around the incisions will subside. There may be temporary loss of sensation in the breast skin and nipples after surgery. This condition will improve with time. Within two weeks of surgery, sutures will be removed.
Convalescence:
During convalescence, limit physical activities in order to prevent stretching of the scars. Some activity may be allowed in a day or two following surgery. The plastic surgeon will recommend a schedule for resuming your usual routine (usually about 8 weeks). To permit proper healing, avoid overhead lifting for 3 to 4 weeks.

Scars are permanent and often remain highly visible for a year following surgery, then fade to some degree. Every effort is made to place the incisions so that scars are as inconspicuous as possible, and the scars should not be noticeable even in low-cut clothing (incisions are usually made on the underside of the breast).
Review Date: 11/19/2001
Reviewed By: Thomas T. Jeneby, M.D., Division of Plastic Surgery, University of Pennsylvania Medical Center Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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