Mastopexy

In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding.

[1][2] The usual mastopexy patient is the woman who desires the restoration of her bust (elevation, size, and contour), because of the post-partum volume losses of fat and milk-gland tissues, and the occurrence of breast ptosis.

Moreover, additional to tissue prolapse, postpartum diminishment (involution) of the voluminous milk glands in the breast aggravates the looseness of the suspensory ligaments, and of the inelastic, overstretched skin envelope.

Mastopexy corrects said degenerative physical changes, by elevating the (internal) parenchymal tissues, cutting and re-sizing the skin envelope, and transposing the nipple-areola complex higher upon the breast hemisphere.

Laurence Anthony Kirwan published an alternative classification system for ptosis of the primary or non augmented breast that is meant to be better suited than the Regnault scale for planning surgery.

Pseudoptosis usually occurs when the woman ceases nursing, because the milk glands have atrophied, and so reduced the volume of the breast, thus the sagging of the breast-envelope skin.

[13] Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications.

The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the result, before making any surgical incisions to the breast.

[14][15] The contraindications for mastopexy are few: aspirin use, tobacco smoking, diabetes, and obesity are medical and health conditions associated with increased incidences of nipple necrosis.

Pre-operatively, the patient and the surgeon decide upon the appropriate surgical technique (superior, medial, or inferior pedicle) that will achieve the best degree of breast lift.

Nonetheless, in breast-lift surgery, the primary consideration is the tissue viability of the nipple-areola complex, so that the outcome is a functionally sensate breast of natural size, contour, and feel.

The proper topographic locale for the nipple is determined by transposing the semicircular line of the inframammary fold to the face of the breast (anterior aspect), thereby configuring a circle, wherein the nipple-areola complex is centred.

After determining the nipple locale, the surgeon delineates the remaining skin incisions of the correction, while maintaining the inferior limit of the vertical-incision at a distance above the pre-operative inframammary-fold, which precaution avoids extending the surgical scar to the chest wall after the lifting of the breast and the inframammary fold.

Therefore, the application of the superior pedicle approach affords the surgeon greater procedural flexibility in determining the incision site for emplacing the breast implant, but it limits the possible degree of elevation of the nipple.

Post-operative surgery scars upon the breast hemisphere can alter the way that the woman conducts her breast self-examination for cancerous changes to the tissues; thus exists the possibility that masses of necrotic fat might be mistakenly palpated as neoplasm lumps; or might be detected as such in the woman's scheduled mammogram examinations; nonetheless, such benign histologic changes usually are distinguishable from malignant neoplasms.

A complication of the Anchor mastopexy is the tension-caused wound breakdown at the junction of the three limbs of the incision, yet the scars usually heal without undergoing hypertrophy.

Afterwards, the surgical incision lines are infiltrated to the breast skin with a local anaesthetic mixture (lidocaine 1.0% and epinephrine 1:100,000) that constricts the pertinent vascular system to limit bleeding.

Again, the supine patient is elevated to a sitting position so that the surgeon can ascertain the size, shape, and symmetry, or asymmetry, of the corrected breasts.

[2] During the initial post-operative period, the plastic surgeon examines the patient for occurrences of hematoma, and to evaluate the histologic viability of the breast-pedicle skin flaps and of the nipple-areola complex.

Breast contour irregularities occurred when the tissues of the inferior part of the incision are gathered to avoid forming a scar at the inframammary fold.

That the B technique mastopexy yields improved aesthetic results with a breast-skin pedicle created with a curvilinear incision (an inverted, upper-case letter-B).

The consultation includes detailed, pre-operative, post-operative, and healing-stage photographs that illustrate the nature and extent of the mastopexy incisions and the resultant scars.

With the patient laid supine upon the operating table, the surgeon performs a free-hand, curvilinear delineation of an inverted, upper-case letter-B pattern to the breast.

The vertical and horizontal component-incisions of the B mastopexy are created with a tapering, curvilinear incision that begins from the lower margin of the areola to the lateral crease of the breast.

In the combined mastopexy–augmentation procedure, wherein the breast prosthesis is emplaced to a submuscular implant pocket, an anaesthetic tumescent solution is injected along the marked incision line.

After establishing anaesthesia, the surgeon de-epithelializes each edge of skin by undermining it 3 to 4 mm (0.12 to 0.16 in), with a razor scalpel, thereby facilitating the closing of the surgical wound without tight sutures.

If the mastopexy includes simultaneous breast augmentation with submuscular emplacement, the surgeon observes that the pectoralis major muscle is divided from the sternum and the ribs.

The key suture is emplaced at the junction where the apex of the vertical incision meets the nipple-areola complex—because it is the skin area of the breast subject to the greatest tension(s).

[24] Furthermore, advocates of the B technique mastopexy report that it usually does not require secondary correction, because it allows for the better transposition of excess lateral tissues of the breasts by means of curvilinear incision (inverted, upper-case, letter-B) to the skin envelope.