Breast Lift – Mastopexy

Serving New York City, Manhattan

 

Breast lift surgery, or mastopexy in New York City, is performed on women who have sagging breasts. This is commonly performed after completing child bearing. The breast becomes engorged during pregnancy and then involutes after breast-feeding is completed. Like an overblown balloon that eventually loses air, the breast skin “stretches out” and often loses its elasticity, and the breast volume shrinks.  It can also happen with fluctuations in weight as well as with aging that results in weakness in skin elasticity.


There are three general skin design patterns for mastopexy. These are based upon the amount of skin that needs to be removed, the distance the nipple areola complex needs to be lifted to place it in an aesthetically pleasing position, the amount of breast tissue that needs to be removed or repositioned, and finally the volume, if any, that needs to be restored with a breast implant (see the breast augmentation section).

The three more common skin patterns include:

  • Wise Pattern Breast Lift Looks like an inverted –”T” or an anchor after final closure.
  • Vertical Breast Lift Which looks like a “lollipop” incision.
  • Circumareolar breast lift (Sometimes referred to as a Benelli breast lift) which ends up with an incision along the border of the areola.

So to summarize, the Wise pattern places incisions along the inframammary border of the breast, a vertical incision from the fold up to the areola, and an incision around the border of the areola.  The vertical lift eliminates the inframammary incision, and the circumareolar breast lift eliminates both the vertical and inframammary incision.  Dr. Wallach, a Manattan New York Cosmetic Surgeon, will commonly employ a vertical lift technique (a modified LeJour technique) that minimizes the amount of scarring on the breast using a “lollipop-type” pattern that encompasses a circular incision around the areola with a lower breast vertical incision. This eliminates the use of a transverse incision along the lower breast fold that is placed as part of a more traditional “anchor type” procedure.  The circumareolar breast lift only employs an incision around the areola.  This procedure is for a very limited patient population that does not require the nipple areola complex to move too much.

The tissue that supports the blood supply to the nipple areola complex can usually be brought on a leash of tissue commonly referred to as a pedicle from superiorly, inferiorly, medially, or laterally. This technique is usually reserved for patients with moderate breast ptosis (droop) and reasonably good skin elasticity.  For this reason, most massive weight loss patients would not be good candidates for this technique because of the poor skin quality.  But, for the majority of breast lift patients in New York, this technique is an excellent choice.  For patients with poor skin quality and with significant breast ptosis, a Wise pattern skin incision would probably be most beneficial to achieve the desired result.  Dr. Wallach will combine breast augmentation with a breast lift for those patients that desire an increase in volume as well as a lift. In many cases, Dr. Wallach will limit the incision from this procedure by using either a “lollipop-type” pattern or a pattern designed only around the areola (circumareolar), further limiting the incisions. For massive weight loss patients in Manhattan NYC, Dr. Wallach has used all three types of skin incision designs to achieve nice results for his patients.  Sometimes a breast augmentation alone can be performed to lift the breast for minor sagging.


“I believe true confidence comes from a feeling of self-assuredness from one’s inner self. However, I also believe that it is heavily impacted by a lack of confidence with one’s outside appearance as well. Plastic surgery can help improve confidence by in this way. ”


The surgical procedure usually takes between two and four hours with a recuperation time of one to two weeks. Patients wear a support bra without an under-wire or a sports type bra for about three to six weeks before they can go back to using an under-wire bra. Dr. Wallach recommends that patients avoid aerobic type exercise for at least three weeks and strenuous exercise for at least six weeks after surgery. Dr. Wallach has presented his findings on limited access surgery combining breast augmentation with minor breast sagging in several peer-reviewed journals. He has also presented talks to other plastic surgeons on his preferred techniques for breast lift surgery. Dr. Wallach has also given an instructional course to fellow plastic surgeons on his preferred techniques at the American Society of Aesthetic Plastic Surgery (ASAPS) national meeting.

If you would like more information about New York Surgeon Dr. Wallach and his success with New York City Breast Lift (mastopexy) procedures, we hope that you will not hesitate to contact our Manhattan office at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.

Breast Lift Frequently Asked Questions

Why do my breasts sag?

As a patient grows older, the breasts begin to sag. They will sag more with large weight fluctuations. Similarly, hormonal changes during pregnancy cause the breast to become engorged. After childbirth is complete, the breasts deflate. This is analogous to a balloon that is blown up to capacity. The air slowly leaks out of the balloon and the skin of the balloon becomes weaker.

If I have a breast lift operation will I have a lot of scars?

It really depends upon what the breasts look like and what the patient desires from the surgery. If the patient wants more volume and the breasts do not sag too much, then a breast implant through a small incision may be all that is required to make the breasts look better. On the other hand, if the patient wants a lift and no increase in volume, then a limited incision breast lift technique can be employed. This includes vertical breast lift operations, which limit the incisions to a lollipop appearance (a circle around the border of the areola and a vertical line from the lower border of the areola to the inframammary fold). Sometimes the incision can be limited to the area just around the areola.

What if I decide to have more children? Can I still have this surgery?

I usually instruct patients to delay having a breast lift until they have completed their child bearing. The breasts will go through the same changes as they did with other pregnancies. The breasts may or may not stay “lifted,” so it is probably best to wait.

What kind of incision will I need for a breast lift?

A breast lift can be performed using several different incision patterns. It really depends on multiple factors including: the person’s breast size and shape, the quality of the skin, and the relationship of the nipple areola complex on the breast mound, to name a few. I have performed small circumareola lifts using a Benelli procedure (many times with an implant). I also commonly use a vertical lift technique. Many times the technique is a modification of the one described by LeJour. I have taught a course on this specific technique at the American Society of Aesthetic Plastic Surgery’s annual national meeting for many years. If a patient has severe laxity and a very low lying nipple areola complex, I may choose an inverted “T” type of incision for the breast lift. I always incorporate the patient’s goals in the planning of the procedure when choosing the specific operation to perform.

Can I just have a lift around the border of my areola?

Some patients can have a breast lift procedure that encompasses only an incision around the border of the areola. Because there is a small risk of central flattening with this technique, I like to reserve this either for very small nipple areola lifts or in patients that want a breast augmentation as well. This technique is sometimes referred to as a Donut mastopexy, a circumareola mastopexy, or a Benelli mastopexy. These techniques are best for patients in which the nipple areola complex does not have to be elevated significantly, and there is little to no skin laxity.

What is a vertical breast lift?

A vertical breast lift really encompasses several different techniques. It can be referred to as a “lollipop” lift because the final incision closure looks like a lollipop. The incision is around the border of the areola and runs vertically from the base of the areola to the breast fold. Some of the more popular names of these techniques include the superior pedicle technique described by LeJour,  Lassus, a superomedial pedicle technique described by a friend and colleague Elizabeth Hall-Findley, MD, and the SPAIR technique described by Dennis Hammond, MD. In general, these techniques are good for patients who need a moderate elevation of the nipple areola complex, and that have reasonably good skin quality. One advantage of this technique is that it often avoids an inframammary incision.

Who requires a “T” incision breast lift?

An inverted “T” incision can be used for almost anyone, but it also creates the most incision lines. There is an incision around the border of the areola, with a vertical component running from the lower border of the areola to the chest fold, and then an incision runs along the inframammary fold. This technique is often reserved for those patients with severe skin and gland laxity and in those where the nipple areola complex is very low. Many pedicle variations have been described using a central, inferior, lateral, medial, or superior pedicle to preserve the blood supply to the nipple areola complex.

Will I need an implant with my breast lift?

If a patient wants to have larger breasts and have a lift, then implants will be necessary. If the patient is satisfied with the overall volume of her breasts then implants are not necessary. The technique chosen will depend upon the skin quality and the nipple areola position on the breast mound. I have often been able to do a circumareola lift in those that do not need a significant nipple areola lift and chose a breast implant to increase the volume. Many times I have used a vertical technique that may or may not require a small “T” at the fold.

If my breasts are slightly saggy can I just get breast implants?

Sometimes yes, and sometimes no. If there is some glandular ptosis (or sag) and the nipple areola is in good position, then it is possible that you might not need a lift. However, if the nipple is not in a good position that places it on the main projection point of the breast, then a lift will be necessary. Sometimes it is as simple as lifting the nipple areola only, in a donut type mastopexy or circumareola breast lift. If there is significant skin laxity then a vertical breast lift or inverted-T breast lift might be necessary.

Is a breast lift procedure the same as a breast reduction procedure?

In many cases, breast lift procedures are identical to breast reduction techniques except for the volume of breast tissue removed during the procedure. Both tighten the skin envelope, both raise the nipple areola complex as needed, and both can reduce and mold the breast glandular tissue.

Will I lose sensation in my nipple after a lift procedure?

Losing nipple sensation is very rare but can happen. Many patients have some numbness after surgery related primarily to tissue swelling. Sensation commonly improves within the first six to eight weeks as the swelling subsides. However, there are still a few patients that have permanent sensory changes to the nipple. Some studies suggest that more than 85% of patients have normal nipple sensation after one year post-surgery.

Will I be able to breast feed after my breast lift?

The ability for a patient to breast feed after a breast reduction or lift is hard to quantify. The size of the breast may not determine the ability to breast feed either. In other words, some small breasted women can successfully breast feed, while there are others who have large breasts that cannot successfully breast feed without supplementing. In general, I tell my patients that most should be able to breast feed if they were able to before surgery, but assume that supplementing with baby formula may be necessary.

Will I need drains after a breast lift procedure?

In many patients I will place closed suction drains. These can often be removed within a few days to a week after surgery, and help to remove fluid that potentially can accumulate within the breast.

What is the recovery like after a breast lift procedure?

For most patients the recovery from a breast lift is fairly straightforward. In general, patients wear a sports type bra with a front zipper for several weeks after surgery. Most can go back to work within a few days to a week. I usually allow patients to start light aerobic exercise about three to four weeks after surgery, and heavy lifting and exertion six to eight weeks after surgery, provided that they have healed without any complications.

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