Mastopexy

Authors: Mia Demant, MD, Magnus Balslev Avnstorp, MD and Mia Steffensen, MD

Definition

Mastopexy means breast lift by removal of excess skin and tightening of the surrounding tissue to reshape and support the new breast contour with or without augmentation.

Breast lift vs. Breast reduction

Breast lift surgery builds on the same principles as breast reduction. However, when performing a breast reduction, relatively more glandular and fatty tissue is removed than excess skin. In contrast, relatively more excess skin is removed than glandular and fatty tissue when performing a breast lift.

Indications for surgery

To be a candidate for mastopexy at a public hospitals in Denmark, there are the following requirements:

• Severe ptosis of the breasts affecting physical activity – often related to age, former hypertrophic breasts, or massive weight loss (> 15 BMI points)
• Skin irritations, macerations, intertrigo, and fungal infections in the IMF
• Significant breast asymmetry
• Adjustment of breast size to the contralateral breast after this has been reconstructed due to disease

Contraindications

• Smoking
• BMI > 25
• Age < 18 years

Pre-operative assessment

• All women ≥ 35 years of age must have normal mammography, that is no more than 6 months old
• Any palpable breast lumps must be examined by mammography and ultrasound before surgery
• Volume-deficient mastopexy candidates often require breast implants, hence correct size of these must be planned/ordered

Choosing the appropriate technique

There exist a variety of mastopexy incision patterns and techniques (1,2). The appropriate technique is determined by the degree of breast sagging and size, positioning of the NAC, and the excess and quality of the skin. Some treatment options are listed below:

Vertical scar mastopexy: Corrects moderate sagging and provides more extensive reshaping (mostly used in private clinics).

Inverted-T mastopexy: the most effective option for grade II to III ptosis associated with severe excessive skin – e.g. massive weight loss patients. The most common pedicle of choice is the superomedial or superior. However, the inferior pedicle may be used in addition to giving the breast more volume and projection.