MASTOPEXY
Mastopexy (breast uplift) is an
operation to improve the shape of the breasts. It is not intended to increase
breast size. Breasts that have drooped due to a loss of size following pregnancy/breast
feeding can be improved by inserting breast implants. However in more severe
cases of droop it is necessary to cut away surplus skin to improve the shape
of the breasts. This produces a better shaped breast, higher on the chest wall
with a nipple in the correct position. Skin tightening procedures can be combined
with insertion of silicone implants in certain cases.
The extent of the scarring depends
on the amount of skin to be removed. At the very least it involves a circular
scar around the nipple/areola. More severe cases of droop require a vertical
extension from the nipple/areola down to the fold underneath the breast. Very
severe cases of droop require a transverse incision in the fold underneath the
breast in addition to the other scars.
The operation requires general anaesthesia
and hospital admission for one night. As the procedure requires a long anaesthetic
patients taking the oral contraceptive pill are advised to stop such medication
for at least one menstrual cycle. This is to reduce the risk of thrombosis (blood
clot) in the leg veins. Remember to take other contraceptive precautions at
this time. Patients are also strongly advised to stop smoking, not only to reduce
the chest problems that smokers experience with anaesthesia but also because
nicotine reduces blood flow to the skin which slows healing and can result in
the wound bursting.
The operation produces scarring,
which initially will be fine, bright red lines but although they should fade
to a pale white over six months or so they can stretch widely or become thickened
and irritated. Nipple sensation might be lost immediately after the operation
but this usually returns. Breast feeding after the operation is possible in
some cases but is not guaranteed.
Breast firmness will not be increased
by surgery.
Your breasts will be photographed
before the operation as part of the clinical record. These photographs remain
confidential and are kept securely.
The hospital holds a pre-assessment
clinic (PAC) which is run by the nursing staff. You will be invited to attend
one of these clinics a week or two before the operation. They are intended as
a medical screen to identify problems and carry out any necessary tests before
the day of your surgery. Sometimes it will be arranged for you to see the anaesthetist
at this clinic.
OPERATION
After the operation the wounds will
be painful (although this will be reduced by painkillers, initially by injection
and then by tablet) and you will feel tired and weak for a few days. The wounds
are not normally covered by dressings so you will be aware of some minor bleeding
along the incision lines. Thin plastic tubes (drains) will empty internal bleeding
into a plastic bottle. These drains stay in place until the day after surgery.
After removal of the drains (which can be uncomfortable) you may wear a well
fitting supportive bra. The stitches will dissolve. Adhesive paper strips are
used to reinforce the wounds. The breasts will be quite swollen and bruised
for a few weeks. Initially the breasts will be a very odd shape (rather square)
but this will improve with time as the swelling settles and the breasts become
more rounded and normal in shape.
DISCHARGE
When discharged from hospital the
breasts may remain uncomfortable if not adequately supported in a bra of the
correct size. Some patients find it helpful to wear a bra at night. However
it is not always necessary to wear a bra and many find it more comfortable without.
Strenuous exercise, running or heavy lifting should be avoided for three months.
Gentle swimming, provided that the wounds are well healed, is probably acceptable.
Before leaving hospital you will
be given an outpatient appointment but if you have any problems, worries or
concerns after discharge from hospital please feel free to telephone for advice.
I can generally be contacted on 07850 484 672 but if I cannot be reached immediately
a message can be left on my office answerphone (0208 463 0019) and I will get
back to you as soon as possible.
Your GP will be given full details
of your surgery and progress.
COMPLICATIONS
No operation on the human body is
without risk. A few of the more common problems are listed below. This list
is intended to inform rather than frighten and it does not cover every thing
that can go wrong.
1. Anaesthesia. The small risk of an anaesthetic applies as in any operation.
Smoking and the oral contraceptive pill increase this risk.
2. Wound Breakdown/infection. The wounds can heal rather slowly and may occasionally
weep or ooze blood. Larger areas of breakdown can occur particularly at the
middle of the breast fold where the scar lines join. This generally heals on
its own but sometimes requires a small skin graft. In very rare cases breakdown
and infection require an emergency operation. The risk of wound breakdown is
much greater in those who are overweight and/or smoke. Poor quality scarring
follows wound infection.
3. Stitches. The absorbable stitches sometimes work themselves out onto the
skin surface where they cause irritation. They are easily removed.
4. Sensation. Nipple sensitivity can be absent after the operation and in rare
cases this will be permanent.
6. Breast Feeding. Should you become pregnant breast feeding is not always possible.
7. Shape. The breasts in time will sag and lose their youthful shape. This is
a natural ageing process, which can be a little unpredictable after surgery.
8. Scars. The scars will stretch and may thicken. They may become darker than
the surrounding skin. Minor irregularities of the scarring sometimes require
surgical revision. Usually this can be done under local anaesthesia.
9. Nipple Loss. Very rarely the nipple skin dies either partially or completely
resulting in nipple distortion or loss and unsightly scarring. If this happens
corrective surgery may be required but can never recreate a completely normal
looking nipple. In black skin there is a risk of losing colour in the nipple
and surrounding areola.
10. DVT. There is a risk of deep vein thrombosis occurring during any operation.
Precautions are taken during the surgery to reduce this risk. You will also
be fitted with tight stockings to wear before, during and after surgery. It
is worthwhile wearing the stockings, day and night, until you are fully mobile.
08/03/05