Information for Patients Undergoing Breast Mastopexy- Wise Pattern Uplift
Breast mastopexy surgery is becoming more common as women realise that they do not have to put up with having breasts which they perceive as excessively pendulous and empty.
Why do women request breast mastopexy?
- Previous weight gain may have caused breast enlargement, with stretching of the breast skin envelope. Subsequent weight loss or natural atrophy of breast tissue then leaves loose skin and drooping breasts..
- Some patients develop significant breast hypertrophy during pregnancy or breast feeding only to lose it all afterwards and also to lose the shape. The areola may also be excessively stretched.
- An element of breast droop affects most women with age. When the nipple position has descended to the level of the crease under the breast or lower this is termed “ptosis”. This just means breast droop.
- Loss of cleavage and upper breast emptiness
- They may still have a good bra size (ie greater than C cup) but the breasts are very droopy and empty when not in a bra.
- Because they just want firmer breasts or they want the nipple position to be restored to a more youthful position
What breast mastopexy will not prevent?
- Breast pain – tenderness that comes and goes with menstruation is normal. Mastopexy does not influence this.
- Breast cancer – all women have at least a 1:12 life time risk of breast cancer regardless of the size or shape of their breasts.
- Stretch marks. Unfortunately, once these have developed they will persist, although loose skin is removed.
How do I get referred for breast mastopexy?
You may self-refer by contacting Mr Turton's secretary, or ask your GP to write a referral letter. Breast mastopexy can be bilateral (both sides) or unilateral (one side- ie patients with congenital differences or previous breast reconstruction on the other side needing improved symmetry), so any woman with breast droop may be a suitable candidate. We realise that breast size is relative and there is always an element of subjective body image perception. We therefore strive to achieve what you want rather than any preconceived idea of perfection. However, good medical practice dictates that your GP is kept informed of any treatments you have or refers you for such treatments. Breast Mastopexy Surgery is performed by Specialist Breast Surgeons with Breast Reconstruction General Surgery and Aesthetic Breast Surgery Training, or Plastic Surgeons. A Specialist's usual clinical workload should relate almost entirely to women with breast disorders, and should have a specialised interest in this type of surgery. It is worth checking that the surgeon is a member of the relevant specialty organisation. This includes either the Association of Breast Surgeons of the British Association of Surgical Oncology (ABS of BASO) or otherwise the British Association of Plastic Surgeons. The National Care Standards Commission is a new agency set-up by the government to ensure the regulation of cosmetic surgery in private hospitals and if you approach a surgeon offering breast reduction surgery in the private hospitals within Yorkshire they will have had to fulfil the requirements to be allowed to provide this surgery. It is obviously our opinion that any surgical intervention is better carried out by local experts rather than travelling far and wide. Mr Turton is a Specialist Breast Surgeon and performs Cosmetic Breast Surgery including breast augmentation, reductions, mastopexy, correction of nipple inversion etc. He trained as a general surgeon and specialised in Breast Surgery. His Specialist training is therefore in Breast Surgery and complex Reconstructive Breast Surgery. He concentrates on Oncoplastic and Aesthetic breast surgery and this remains his special area of interest and dedication. He is an accredited member of the Association of Breast Surgery of the British Association of Surgical Oncology. He is an accredited Consultant and holds a Substantive post as Consultant Breast Surgeon at the Leeds Teaching Hospitals Trust.
You will be shown photographs of the procedure and the results, or encouraged to review them from Mr Turton's web site (www.cosmeticbreastsurgeon.co.uk). There are several different methods of performing a breast mastopexy. The commonest method results in an upside down “T” type scar but other methods for more minor breast droop may involve just a scar around the nipple. Your surgeon will discuss which method is appropriate for you and the possible advantages / disadvantages. The fullest correction of breast droop with improvement to shape and repositioning of the breast gland is possible with the wise pattern mastopexy. You may also discuss the breast surgery with our breast care nurse. The nature of the operation will be discussed in full, the position of the scars, and the way you will feel after surgery so you may decide if you really want the operation.
Mr Turton will perform a thorough examination of your breasts in the presence of a clinic chaperone. A preoperative mammogram may be recommended if you are 40 or over and have not had one in the previous year (this costs approximately £150). Please ask about this and let Mr Turton know of any risk factors such as your family history.
You will need to discuss whether you wish any breast tissue to be removed- if you feel your breasts are somewhat large as well as droopy Mr Turton may remove some breast tissue to improve the balance of your breast shape with your frame. On the other hand if your breasts are very empty, Mr Turton will perform a full glandular mobilisation, with restoration to the upper pole, and just resection of loose skin- he will not need to remove any breast tissue at all if it is not required. This can very dramatically improve a drooping breast shape.
It is not possible to guarantee the final cup size but Mr Turton can give you an estimate based on his experience. If you feel that implants are going to be needed, Mr Turton's preference is very much that you consider this 1 year after mastopexy when healing and maturation of the blood supply to the nipple has been given plenty of time. Combining augmentation with a mastopexy carries specific risks of complications which can be devastating and except in exceptional circumstances, Mr Turton will ask you to avoid this. Even if a complication is uncommon, if it effects YOU as an individual, that is devastating. Mr Turton will always try to adopt the safest approach to any cosmetic operation, and as a result has an extremely high satisfaction rate.
Following the initial consultation you will be given at least a 2 week “cooling off” period during which time you can make a final decision.
It is imperative that you completely stop smoking within 6-weeks of the surgery and for at least 6-weeks after surgery. If you cannot do this you should not undergo the operation. Most patients are 100% successful with this, and some use nicotine patches initially to help. Mr Turton will discuss this with any patient that does smoke and please always be 100% honest. The blood supply to healing tissues through the tiny capillary network at the skin edge of incisions is reduced in smokers and severely reduced whilst smoking (even passive inhalation) and for many hours after a single inhalation. This can cause necrosis (death of tissue) at vulnerable sites in the operated breast. The result can include delayed healing, serious infection, loss of breast tissue, loss of the entire nipple and areola complex needing major revisional or reconstructive surgery, but without good result. Although these drastic complications are rare and can occur in non-smokers they are more common in smokers. Do not undergo this surgery if you smoke. Give up first and then you will have placed yourself in a better position to have an excellent outcome.
Regular use of sunbeds or regular sunbathing damages skin. It becomes more vulnerable to healing complications. In particular if you smoke and use sunbeds regularly the risk of delayed healing or wound separation increase. It is therefore important not to use a sunbed in the preoperative period, but also to inform Mr Turton of previous regular sunbed usage.
Mr Turton prefers that you tell him about all medication, herbal preparations or supplements that you take. He will normally ask that you avoid the vitamin and herbal supplements in the weeks before surgery and any non essential medication. In the two weeks before surgery, if you have a headache (or hangover) or period pain, then you should have Paracetamol and avoid anti-inflammatories such as Brufen or Aspirin. These recommendations help to risk unnecessary oozing after surgery, output from the drains, and also lowers the risk of a return to theatre in the first 24-hours to evacuate a haematoma.
You will be admitted to one of the surgical wards. You will be seen by Mr Turton before the operation and a final check of any pre-operative tests or questions will be made. Pre-operative tests can include a blood test, a chest X-Ray, a tracing of your heart beat and a general medical history. A Consultant anaesthetist will visit you and talk about putting you to sleep for the operation. You will be kept Nil By Mouth (nothing to eat or drink at all) for 6-hours prior to surgery. On the morning of the operation you may still take a bath or shower. Prior to surgery you will put on an operation gown and the nurse looking after you will complete a routine checklist.
Mr Turton will see you to obtain your signature for consent and to “mark up” the breasts with the measurements for the mastopexy. The nurse will give you a tubigrip elasticated support to put on before the operation (just wear it around your waste as it will be pulled up over the breast at the end of the operation). A photograph is normally taken once the measurements have been marked (this excludes your face to protect your anonymity).
Antibiotics are given during the procedure so it is important to highlight any allergies.
You will have an infusion (drip) in your hand until you are able to eat and drink. There may be two drainage tubes, one in each breast if you have had bilateral (both sides) breast mastopexy, and one if unilateral (one side) mastopexy and these are normally in place for 24-48 hours. However, it is sometimes the case that no drains are required and women can expect to return home 1 days post op, once you are mobile and self caring. It is recommended that you wear the elasticated support dressing (tubigrip) day and night for support and comfort. Mr Turton prefers that it is not removed for washing- please take a shallow bath with the water just run up to lower waist, sponge under arms, and ask someone else to help with hair washing- this is for the first 2-weeks after surgery- it keeps your dressings dry, and removes the need for these to be changed, reduces infection and minimises discomfort.
You are encouraged to move your arms as soon as possible to prevent stiffness, but avoid raising your arms above shoulder height. Avoid lifting anything heavier than a kettle for the first 2-weeks. Avoid opening heavy doors. Avoid using a pull type cork screw or grating cheese!
The wounds are covered by steristrips and on top of these are the dressings. The dressing is designed to absorb exudates and blood. Do not be alarmed if you see blood spots on the dressing! It doesn't mean you are bleeding! The old blood that can collect that doesn't come out of the drains can seep out a little and look worrying but it will remain sterile as long as the dressings are in place. The dressing should feel dry and are only removed if obviously wet. This is very uncommon.
The dressings stay in place for around seven to ten days unless there is a problem.
Complications / Side Effects
Breast Mastopexy surgery involves a general anaesthetic and takes several hours. General risks of any operation include both chest infection (very rare) and thrombo-embolic problems (very rare- not occurred to any of Mr Turton's cosmetic surgery patients)- clots in the legs that may even travel to the lungs= Pulmonary emboli, and whilst very rare, can prove fatal). If there is any family or past history of blood clots please inform Mr Turton. Steps are taken to reduce the risks even when they are already very low: these including the use of compression stockings, and flowtrons (automatic calf compression during anaesthesia) as well as becoming mobile again early after your operation. Smokers should make every effort to give up or not have the surgery.
Only very rarely would a blood transfusion ever be required, even if a haematoma (large deep collection of blood) occurs postoperatively. Sometimes it is necessary to return to theatre to remove a haematoma.
Nipple sensation : Nipple sensation can either be lost completely or there may be some small loss or indeed increased sensation. Temporary loss of sensation occurs in about 30% or cases and can take up to 12-months to improve.
Nipple Necrosis: There is also a small possibility that the nipple may lose its blood supply and become necrotic (the skin may become non-viable and heal by scarring with loss of pigmentation) or you may even lose the nipple in extreme cases. Fortunately, this is very rare.
Skin Necrosis and T Junction breakdown: Very rarely the blood supply to the skin on the flaps used to reconstruct the breast shape is inadequate. This is a risk that would be higher in smokers. Skin loss heals by eventual scarring. The commonest place for this to occur is at the apex of the “T” incision so the resultant scarring remains hidden. However, it can rarely be extensive, and time to heal up can be delayed by many weeks in such cases, and the dead skin may require surgical removal (very rare).
Infection: Infection is readily treatable but another rare possibility despite the routine administration of antibiotics during the procedure. Any signs of spreading redness, heat, mucky discharge or a raised temperature need to be reported to your Consultant, through the ward from which you were discharged, or other members of your Consultant's team. If possible an earlier appointment to the breast clinic can be made, or a visit to the ward arranged. If there are any areas that are slow to heal, you may be given a course of antibiotics. Very very rare serious infections causing tissue necrosis are occasionally reported in the literature (necrotizing fasciitis) and are more common in diabetics.
Scarring: If you do get an infection, the scars can become a little thicker and the eventual scars you are left with may not be as fine as you expected. Even without infection some women develop thick unsightly scars due to a condition called “keloid and hypertrophic scarring.” If you have had problems with such scars before special dressings may be required to try to reduce it and you should discuss this with Mr Turton. The scars may also become quite broad with time. Hiding the scars under the breast obviously helps but does not always solve the problem. Keeping scars supported with a strip of “mepore tape” for several months after surgery can help to prevent the scar from stretching - this will be discussed at the post-operative clinic review. At the ends of the horizontal scar where it meets your normal tissue there can be a slightly raised piece of skin which is termed a “dog-ear” this is commonly apparent and usually diminishes in part over the next year. It is caused by the residual excess tissue that has not been excised as the incisions have to stop short of the breast-bone area on the inside and the arm-pit area on the outside. Additional surgery can be performed at that time to flatten it further, usually under local anaesthetic although there is likely to be a charge for this. This is also rarely needed.
Skin Sensation: In addition to alteration in the nipple sensation it is normal for the breast skin sensation to change with areas of numbness or tingling. However, it is common to have fleeting sharp sensations in the breasts for several months after this surgery. This is the normal healing process.
Haematoma (Bruising): Bruising may cause the breast to become a little discoloured and this may spread downwards on to the abdomen. The body will absorb this bruising over a few weeks but if you are worried please contact your surgeon. Rarely an operation is required to drain a haematoma. This tends to occur suddenly in the first 24-hours after surgery, when a little vessel that was previously sealed bleeds, overwhelms the drain and collects under the wound. It feels quite painful suddenly and the breast swelling is obvious. The surgeon will normally drain this out with you back under anaesthetic soon after it is recognised. Avoiding aspirin and anti-inflammatories prior to surgery helps to prevent this, as does a good normal healthy blood pressure.
Fat necrosis: Fat necrosis is a condition that can occur when breast tissue is remodelled in a breast reduction or mastopexy. It results in a small hard lump within an area of the breast that sometimes cause anxiety to a patient. The condition is benign and does not carry any risk. However, all lumps should be investigated by specialist regardless of whether a mastopexy has been performed or not.
Once discharged home, you can have shallow baths as discussed earlier. The stitches in your wound will dissolve. Mr Turton will let you know if there are any that need to be removed. The dressings are changed only when necessary, and in the early post operative stage, care is needed not to bang or knock the breasts. Mild pain killers will be required after your operation until you feel comfortable. An appointment will be made for you to come back to clinic in 1-week for a dressing change, and again at 2-weeks. Mr Turton will review you at 3-weeks after discharge. You can expect some bruising in both breasts if having bilateral mastopexy, but in the very unlikely event that a wound discharges any offensive smelling fluid, you need to be seen. You can also expect your breast/breasts to be slightly swollen. This will last approximately 6-8 weeks and, therefore, you will not always begin to see the total benefits of the mastopexy until such time and the final effect may take several months to become apparent. You can normally stop wearing the tubigrip from 3-weeks and then you can buy a sports bra. This should be worn for at least a further 3-weeks.
Mr Turton prefers to follow patients up, and routine breast check ups are given. Beyond the first post-operative consultation follow up visits are charged at the standard rate.
Note: This information is for general guidance only and represents the views and opinions of Mr Turton, Consultant Breast Surgeon. It should in no way be regarded as either definitive or representing the views of any other institution.