Mastopexy is the clinical term for reshaping the breast. Breast may be misshapen congenitally, as a result of pregnancy, a byproduct very large breasts yielding to gravity, and after massive weight loss. The breasts can be reshaped and made smaller (breast reduction). They can be reshaped without change in volume or they can be reshaped with an increase in volume (breast augmentation).
A mastopexy corrects a breast that is ptotic (droopy). It corrects several aesthetic problems. The nipple and areola hang too low on the chest. This is accompanied by an excess amout of skin relative to the volume. This is most commonly seen in women who have gone through childbirth. Correction requires repositioning and resizing the nipple and areola, reshaping the breast mound, and removing the excess of skin.
Whether a breast implant is used depends upon the ultimate size desired by the patient. Many women who have born children have lost some breast volume and choose a small implant to reattain volume. One benefit of an implant is that it “takes up” some of the excess skin making incisions proportionally smaller.
Because the nipple is resized and moved during a mastopexy, it is possible to lose sensibility, but it is very uncommon. Unlike a breast reduction where breast tissue is removed (and with it some of the nerve supply to the breast), no direct excision of sensory nerves occurs during a mastopexy. The likelihood of permanent loss of feeling in the nipple is very small.
Most mastopexy scars are nearly invisible given enough time. The incision extends around the areola and then vertically to the bottom of the breast. The areola is resized to about the diameter of a silver dollar. The incision from the areola to the bottom of the breast is about 3 inches. An incision in the crease along the bottom of the breast may or may not be necessary. It’s necessity and length is determined by how far the nipple and areola has to be moved and by the amount of skin that needs excision.
Breast surgery of this type takes around 2-3 hours. Patients commonly remark that they have very little pain. One lady (who had previously had children) described the discomfort as similar to the aching a woman feels in her breasts when she needs to breastfeed. There is very little blood loss. Most patients are up and about the next day with restrictions. Patients who have implants placed concurrently have more pain.
Patients who have jobs that are not physically demanding generally can return to work within a week. Other types of physically demanding employment will require longer periods of convalescence. Full physical activity, including athletics, can be resumed (on a case by case basis) at about a month with proper athletic bra support.
The areola and skin on the breast may be temporarily numb for several weeks (or even months) after surgery. There is nothing that can be done to facilitate this part of recovery. The healing process runs on its own time table. Scars will initially be red and thickened but will fade and flatten over months. Each patient is different in this part of recovery.
The dressings are supported by a bra that is provided to you in the operating room. Leave it in place until the second day after the operation (about 48 hours). Take off the bra and remove the pads that are not adherent to your breasts. Any dressings that stick should be teased off or taken into the shower for removal aided by water. Wash the breasts thoroughly but gently in the shower and blot dry.
Apply a small amount of antibiotic ointment to the incisions. Replace the dressings (a clean wash cloth will do) and support them with the surgical bra. Repeat this routine daily. Wear the bra night and day until you are rechecked in the office and given new directions. Generally patients switch to an absorbent exercise bra when the sutures are removed (about 10 days) and the draining is minimal. No underwires until given clearance by Dr. Zubowicz.
Light activity only the first two days after surgery, then gradually begin to increase from day to day. By the third or fourth day post-op you should be able to go about your basic daily activities. Soreness will persist for at least several more days. Most patients can return to desk-type work when they feel comfortable (about one week). Remember, absolutely no heavy lifting, pushing or pulling until released by Dr. Zubowicz.
Have your prescriptions filled prior to surgery, and take all medications as prescribed by Dr. Zubowicz. If you do not use the Phenergan suppositories, you may store them in the refrigerator where they will keep for up to a year.
Schedule a follow-up appointment with Dr. Zubowicz for one week after surgery. Your stitches will probably be ready to come out the following week (10 to 14 days). The sutures securing the areola are buried and dissolvable.
Do not be alarmed if your breasts are not completely round or symmetrical immediately after removing the dressings. Swelling will create temporary distortion and this will correct itself in several weeks. Any large differences in size should be reported to Dr. Zubowicz. In rare cases a hematoma (collection of blood under the skin) may cause one breast to be much larger and/or more painful than the other.
Report to Dr. Zubowicz any fever, large amount of drainage, significant asymmetry of the breasts, or inordinate pain. Feel free to ask any questions by calling 404 814-1100.