Breast Higher and Harder: here's how to get it

By Dr Masino Scutari

Lift it up and change its shape: a complete overview of traditional techniques and the latest novelty.

Pregnancy, sudden weight loss, aging, but also simply a constitutional problem due to the type of skin. Breast relaxation is a problem that is common to women of all ages, and is not tied, as many think, to excessive breast volume. Even women with very small breasts can have a breast failure which, in medical terms, is called ptosis and which, to be corrected, requires surgery called a mastopexy .

Mastopexy is an operation whose technique has evolved considerably in recent years. Once the incisions were consistent and left very visible scars; today thin incisions, confined in some points of the breast, leave almost invisible scars. Before admission to the nursing home and general anesthesia were essential; today a few hours in day hospital and local anesthesia are realities that make it possible to speed up surgery and convalescence.

In this overview we will talk about traditional techniques to "lift" a breast that has given in and a new surgical technique: that of the "muscular bra".

Establish the degree of yielding

How to calculate the degree of mammary ptosis? Many women resort to the "test of the pencil", that is they insert a pencil in the under-breasted groove: if this falls it means that the breast is tall and firm, if it remains in its place it means that the breast is relaxed. In reality, the distance between the inframammary fold and the final part of the breast is measured to calculate the degree of ptosis exactly (see fig.1). If the distance goes from 1 to 2 centimeters the ptosis is mild; if it goes from 2 to 4 centimeters the ptosis is medium; if it exceeds 4 centimeters (up to 10 centimeters) it is high. Depending on the type of breast failure, the surgeon determines the type of incision to be made.

SLIGHT PTOSIS : up to 2 centimeters

For the slight mammary yields an incision is made around the areola of the nipple (see dis.A) and through this the mammary gland is brought upwards, anchoring it with special stitches inside the pectoralis major muscle. We must also pay particular attention to the external structures, which, in order not to leave wrinkled scars, must be done well, so that the skin is not too tight.

A drawback of this type of incision is that it is not possible to make the breast conical and well projected forward.

This must be said in advance to the woman, so that she can possibly decide for a periareolar incision (around the areola), accompanied by a vertical incision.

AVERAGE PTOSIS : up to 4 centimeters

For 3-4 cm sagging, an incision is made around the nipple areola and a small vertical cut that goes from the areola of the nipple to the inframammary groove (see dis.B). the surgeon then isolates the portion of breast tissue (fat and mammary gland) that has descended into the lower part of the breast, and extends it vertically, anchoring it to the pectoralis major muscle with special stitches. The aim is to fill the upper part of the breast that has emptied, making the breast tall and firm.

The excess skin flaps are then removed and the particular suture (the skin is rejoined vertically and around the nipple areola) makes a good nipple projection possible.

The areola is generally redefined (if the contours are blurred) or reduced (if it is too wide). An enlargement of the contours of the nipple areola can be caused by the traction of the skin to which the breast is subjected during the period of pregnancy or during a weight gain.

HIGH PTOSI : more than 4 centimeters

In the most serious cases the sagging of the breast, that is when the ptosis exceeds 4 centimeters, it is recommended to resort to an "L" incision (see dis.C). this includes: the area around the nipple areola, a small cut in the vertical direction that goes from the nipple's areola to the inframammary groove, and one along the underside of the inframammary groove towards the armpit (the fold that separates the breast from Chest).

After practicing general anesthesia, incisions are made, then the mammary gland is raised and anchored to the pectoralis major muscle.

After having removed the excess skin the nipple areola is repositioned which, thanks to a particular reunion of the skin (the sutures must not stretch too much the skin), is projected upwards.

If the breast, in addition to being drooping, is also abundant, it is also possible to remove a portion of breast tissue (gland and fat), thus also performing a reductive intervention. When removing a part of the gland the surgeon naturally takes care not to compromise the functioning of the galactophore ducts (the channels that allow the passage of breast milk), so that the possibility of breastfeeding remains intact. With this technique the breast can be lightened from 300 to 900 grams.

Often in these interventions the size of the areolas (or the brown areas surrounding the nipple) is also modified: generally women prefer to reduce it.

The cosmetic surgery procedure can last from 2 to 4 hours; admission to the nursing home is 24 hours.

Convalescence, Preliminary Exams, Costs

Immediately after the operation the scars are reddish and obvious, but within a few weeks they settle. For at least a month after surgery it is good to wear a restraining bra (those for sports are ideal), do not make great efforts or practice sports.

The breast takes on its final appearance about 3 months after surgery, and the scars disappear almost completely within 6-10 months (depending on the skin's ability to heal).

Only in about 10 percent of the cases can the scar leave small folds or cords, which can however be corrected by a small operation under local anesthesia, to be done at least 6 months after the first one.

The tests to do before undergoing surgery are: blood and urine tests, the electrocardiogram.

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