Let's try to understand one of the most pressing topics related to women's beauty and health today. Every woman dreams of beautiful, and most importantly, healthy breasts. Yes, you guessed it right, we will talk about one of the most beautiful parts of the female body, the female breast, and specifically about the option of its surgical correction - mastopexy.
What is mastopexy? Who is it shown to? What age is optimal for such manipulation? What complications can there be with this manipulation? And we will try to sort out many other questions.
Historical reference
The development of breast lift methods is associated with the development and implementation of numerous surgical techniques. G.Letterman and M.Shurter (1978) divided all proposed surgical techniques into 4 groups:
- Interventions on the skin only - skin grafting with excision of excess skin
- Fixation of gland tissue to the anterior chest wall
- Correction of the shape of the mammary glands by applying sutures to the glandular tissue
- Elimination of ptosis by breast augmentation using prostheses.
The following surgical techniques form the basis of modern mastopexy methods:
- Fixation of the upwardly displaced mammary gland tissue with a strong suture to the dense tissues of the chest was introduced by C. Girard (1910) as a mandatory element of the mastopexy operation.
- Excision of excess skin in the lower sector of the gland with movement of the nipple and areola upward was proposed by F. Lotsh in 1923.
- Improving the shape of the mammary gland by moving upward a flap from the tissue of the lower sector of the gland and its retromammary fixation to the anterior wall of the chest. This technique was first used by H. Gillies and H. Marino (1958), which made it possible, in addition to creating a more full upper pole of the gland, to maintain the result of the operation for a longer period.
- Using approaches that prevent scar formation in the area between the gland and the sternum. These operation options were developed by L. Dufourmentel and R. Mouly (1961), as well as P. Regnault (1974).
- Elimination of slight ptosis of the mammary glands by implantation of endoprostheses was advocated by P.Regnault (1966).
- Excision of excess breast skin around the areola and improvement of its shape, using only the periareolar approach.
Pathogenesis and classification of mammary gland ptosis
The main causes of breast prolapse include:
- Effect of gravity
- Hormonal effects on gland tissue, which can lead to changes in volume (decrease or increase)
- Fluctuations in the patient's body weight
- Decreased elasticity of the skin and ligaments of the gland.
Normally, the nipple is located above the inframammary fold and is at the level of the middle of the shoulder for any woman’s height. The severity of breast ptosis is determined by the ratio of the nipple to the level of the inframammary fold. There are the following options:
- Ptosis of the first degree
- the nipple is at the level of the inframammary fold - Ptosis II degree
- the nipple is below the level of the inframammary fold, but above the lower contour of the gland - Ptosis of the third degree
- the nipple is located on the lower contour of the gland and is directed downward - Pseudoptosis
- the nipple is located above the inframammary fold, the mammary gland is hypoplastic, and its lower part is drooping - Glandular ptosis
- the nipple is located above the projection of the inframammary fold, the gland has a normal volume, and its lower part sags excessively (occurs in the long term after reduction mammoplasty).
Recovery and rehabilitation periods
Rehabilitation after a facelift for every woman is accompanied by compliance with certain rules. Moreover, they are different for each stage.
The day after a breast lift you should:
- be in hospital;
- wear a compression set of underwear;
- if there is no vomiting and nausea, then you can take food and water, but in the afternoon with the onset of evening;
- It is best to lie down or be in a semi-recumbent position if conditions permit;
- excitement is contraindicated;
- You can’t do physical activity or put your hands behind your head.
It is best to move your hands minimally.
You can take painkillers or antibiotics, or attend infusion therapy only if all these medications are prescribed by your doctor.
Indications and contraindications for surgery
In practice, the surgeon is faced with three main clinical situations that determine the tactics of surgical treatment:
- The skin of the gland is little changed, quite elastic, but the gland is lowered with insufficient or normal volume
- The skin of the gland is stretched and inelastic, but the volume of the gland is normal
- The skin of the mammary gland is overstretched, the breasts have insufficient or small volume.
Each of these situations is accompanied by ptosis of the mammary glands of varying degrees and severity. Ideal candidates for a breast lift are women with normal volume and moderate breast ptosis. If the volume of the gland is insufficient and its grade I ptosis or pseudoptosis is indicated, implantation of prostheses is indicated. A combination of endoprosthetics and breast lift may also be advisable in patients with severe breast involution, combined with degree II-III ptosis. In case of glandular ptosis of the mammary glands, it is necessary to remove excess tissue in the lower sector of the gland with mandatory retromammary fixation of the gland to the fascia of the pectoral muscles. In the presence of excess volume of the mammary glands, reduction mammoplasty is indicated. Contraindications to mastopexy may include multiple scars on the mammary glands, as well as severe fibrocystic diseases of the mammary glands. Also severe somatic status, systemic diseases and mental disorders.
Who is indicated for mastopexy?
Indications for mastopexy are various deformations of the mammary gland, such as:
- asymmetrical arrangement;
- descent of the nipple below the inframammary fold;
- areola enlargement;
- stretch marks;
- a change in the original shape and elasticity that is visible during normal inspection.
Contraindications to mastopexy
There are a large number of contraindications, these include:
- tumor diseases of the mammary gland or other organs;
- nodular and diffuse formations of the mammary gland;
- age under 18 years;
- obesity;
- planning pregnancy and childbirth in the near future;
- blood diseases;
- diabetes;
- cardiovascular pathology;
- chronic diseases of other systems and organs in the acute stage.
That is why, before deciding on plastic surgery, it is necessary to undergo a detailed examination by specialized specialists, since this operation takes place under general anesthesia and requires sufficient functional reserve for all vital organs. Mastopexy before pregnancy and childbirth is considered inappropriate, since during this period the mammary gland will change its size and shape, as a result of which repeated plastic surgery may be required after breastfeeding, and lactation function may also suffer. Mastopexy after gaining excess weight is also impractical, because with weight loss the breasts may change their shape, and repeated intervention will also be required.
At what age is the procedure done?
There is no specific age that would be the most optimal for mastopexy; there is only a clear contraindication to performing such an operation before the patient reaches a conscious age, namely up to 18 years. There are only general principles that you should decide on mastopexy if your weight is stable, there are no plans for pregnancy and childbirth, and there are no concomitant pathologies.
Stages of ptosis (drooping) of the mammary glands
Operation
There are several techniques for performing mastopexy:
- vertical lift
- V-technique.
The methods differ in the implementation of preoperative markings and methods of detachment and fixation of glandular tissue to the chest. During mastopexy, the surgeon makes incisions in accordance with the preoperative markings, then the breast tissue is mobilized to fix it above the existing level and eliminate ptosis. Sometimes it is necessary to place additional stitches directly on the breast tissue to give it shape. Excess skin is resected and plastic surgery is performed using local tissue. Sometimes there is a need to install drainage drains, which are removed 2-3 days after surgery. Postoperative cosmetic sutures (intradermal) are removed on the 12th day after surgery. During the first month, it is recommended to wear special compression garments. The mammary glands acquire their final appearance 2-3 months after surgery.
For what reasons can surgery be prescribed?
Beauty does not always push women to undergo surgical interventions.
There are a number of reasons why breast lift surgery may be indicated, including:
- congenital anatomical abnormalities;
- the birth of a child and prolonged breastfeeding;
- changes that occur in the female body under the influence of age;
- reduction in total body weight in a short period of time. Occurs mainly among those who like to go on strict diets;
- birth defects. These include asymmetry of the mammary glands.
Complications
Breast lift is a fairly extensive operation, accompanied by a large wound surface and long scars. All this increases the likelihood of developing local complications.
The following types of complications may develop after mastopexy:
- Early postoperative - hematoma, wound suppuration, wound dehiscence, marginal necrosis of skin flaps, malnutrition of the nipple.
- Late postoperative - deformation of the gland, secondary ptosis of the gland with loss of volume, deformation of the nipple or areola.
Early postoperative complications.
Early postoperative complications
Hematoma occurs no more often than in 1.5-2% of cases, most often occurring on the first day after surgery. Treatment consists of evacuation (removal) of the hematoma. With timely treatment it does not lead to significant consequences. Local infection can be a consequence of a hematoma or as an independent phenomenon. Antibiotics are prescribed to prevent it. Dehiscence of wound edges can occur either as a result of technical errors in suturing, or due to disruption of the healing processes due to insufficient immunity. Necrosis of the nipple or areola occurs rarely (no more than 1% of cases); the main reason is errors in surgical technique.
What you need to know about the pros and cons of a breast lift?
If we talk about the pros and cons of breast lift with implants, everything is very ambiguous.
Let's take a closer look. In most cases, mammoplasty is performed without any indications, with the exception of the cases described above, and the main positive feature will be the increased self-esteem of the fair sex.
The next advantage is the tightened breasts and the restoration of their appearance if surgery has been performed to remove the mammary gland. This operation is performed if cancer has been detected. As a result, the woman receives severe psychological trauma. This is where implant placement can help.
Not every woman knows that breasts cannot have the ideal shape and size. Both mammary glands have some differences in these characteristics. It is considered normal if the difference reaches several sizes. It is very difficult to come to terms with this state of affairs, conditioned by nature itself. That is why installing an implant with an adjustable volume is a completely acceptable way out of this situation.
Achieving an aesthetic result is also an undoubted advantage when performing mastopexy with implants. If there is ptosis or pseudoptosis, they tighten the skin and increase the volume that could have disappeared during breastfeeding.
Minuses
The disadvantages include the following factors, which appear in the form of complications associated with surgical intervention and temporary limitation of work activity.
Along with the already listed disadvantages, we can list a few more negative aspects after breast augmentation, for example, the appearance of scars. This nuisance occurs when incisions are made during surgery. It doesn’t matter how exactly the surgical intervention took place, the sutures remain visible. After some time they become thinner and lighter. However, in some representatives of the fair sex, the scar may begin to expand and become rougher.
DETAILS: Breast replacement
Difficulties in performing mammography are also significant disadvantages. Lifting the glands leads to complications in identifying possible tumors.
In some cases, damage to the nerve endings can occur and then the sensitivity of the nipple is lost. Here, of course, the risks are minimal, but they still exist.
Loss of ability to breastfeed. Most operations are now carried out in such a way that women can feed their children naturally if necessary. But sometimes damage to the gland ducts occurs, and then breastfeeding becomes impossible.
Modern technologies make it possible to produce very durable implants that undergo many tests, but in some cases the shell is damaged. If the saline implant ruptures, the contents will end up in the body. Fortunately, there is no harm to humans from saline solution.
