A crescent mastopexy involves excision of a small ellipse of skin from the superior aspect of the areola. This is truly not a mastopexy procedure as it does not shape or sculpt the breast mound at all. It can move the position of the areola up to 1 cm higher on the breast mound and may effectively reposition the areola in patients who have implants.
The Wise pattern mastopexy is the traditional mastopexy performed most commonly 20 years ago and it is still popular in certain circumstances today. The “inverted T” or “anchor” shaped scar is utilized to cone the breast up into a conical shape and allows removal of excess skin in both a vertical and horizontal direction. This type of mastopexy is very advantageous in patients who had massive weight loss and have significant excess skin. A potential disadvantage of this procedure is that the skin will lose its elasticity over time and the breast mound tends to “bottom out”. This type of mastopexy has a very pleasing shape on the operating table and allows plastic surgeons to sculpt the breast mound and achieve a very nice shape. Both the vertical and Wise pattern mastopexy procedures involve separating the skin envelope from the underlying breast gland and then sculpting and repositioning the underlying breast gland separate from the skin envelope. Once the breast gland is shaped, the skin is closed over the newly sculpted breast mound to create the final shape. Because of the extensive undermining of tissues with both of these procedures, the blood supply of the skin flaps as well as the nipple/areola can be compromised. For this reason, these procedures are not performed on smokers.
Occasionally, breast lift procedures are performed in conjunction with a breast augmentation and this involves manipulating the breast gland as well as placing an implant to give more projection and a larger base diameter. When a breast lift procedure is performed in conjunction with a breast augmentation surgery, it is called an augmentation mastopexy surgery. Augmentation mastopexy surgery is one of the most complicated procedures performed by plastic surgeons and always involves some type of compromise from either the mastopexy portion or augmentation portion of the procedure. In general, mastopexy procedures constrict or tighten the soft tissue envelope of the breast. Breast augmentation procedures stretch out or expand the soft tissue envelope of the breast. When these 2 procedures are performed together, there will always be a compromise of either the tightening component or stretching component of the procedure. If you are considering an augmentation mastopexy procedure, you will need to have a lengthy discussion with your plastic surgeon regarding this.
The plastic surgeon will perform specific measurements using the notch at the apex of the patient’s sternum as a fixed reference point to determine the amount of breast tissue, amount of breast skin, laxity of skin and sagginess (or ptosis) of the breasts. The ideal candidate for mastopexy surgery is a patient who has ptosis or droopiness of their breasts and desires a “perkier” breast mound with an improved shape. Some patients experience deflation of their breasts following breast feeding and these patients may require augmentation in addition to mastopexy. It is recommended that patients wait at least 6 months following breast feeding cessation before undergoing any type of breast surgery. Often times, patients may come into the office requesting breast augmentation surgery when in reality a major component of their breast appearance is droopiness or ptosis. It usually takes considerable time to explain to a patient with sagging tissues how an implant may not improve the sagging and in some cases make it appear worse. The scars for a breast lift (mastopexy) surgery can be a considerable deterrent for patients who want to improve the appearance of their breasts. Discussing how a misshapen breast is not aesthetically pleasing even if there are minimal scars and the trade off of an aesthetically pleasing shape to the breast with scars is still a difficult decision for some patients.