By: Jeffrey Wisnicki, M.D., F.A.C.S.

The shape of a woman’s breast is a result of many factors – some constant, some changing over time.  Genetics and early developmental influences always play a key role and some women may have uneven, tubular-like, or “saggy” appearing breasts from puberty.  Later on, pregnancy and breast feeding may enlarge and then deflate the breasts, sometimes leaving a less than desirable contour.  A similar effect may occur after massive weight loss following a diet program or gastric bypass.   As the aging process continues, the supporting tissues continue to lose elasticity and strength and the breast may succumb to its own weight.  Unfortunately, there are no exercises which will improve the situation.

If larger breasts are desired, a woman may be a candidate for breast implants.  If the degree of breast sagging (called ptosis) is limited, then augmentation mammoplasty may also provide just enough lift to obtain a good result.  The volume added by an implant helps the breast project out and up.  Mastopexy, if required, may be performed with or without the addition of implants.  There are different kinds of mastopexy depending on the effect being sought.  A crescent lift removes skin just above the nipple/areola to bring it higher.  It is a limited lift with a limited scar that generally blends well with the pigmented areolar skin.  Similarly, a circumareolar or donut mastopexy results in a scar confined to the periphery of the areola.  This approach will also provide a limited lift, but may also be useful in improving the shape of a tubular breast.  A vertical incision or lollipop mastopexy extends the scar around the areola down to allow for greater lift of the breasts.  Severe breast sagging may benefit from extending the incisions horizontally along the breast fold.  With severe breast asymmetry, a different technique may be used on each side.

When breast sagging accompanies marked enlargement (as it often does) and a reduction is indicated, then the uplifting is included as part of the reduction procedure.  In fact, many mastopexy procedures were initially designed based on a breast reduction approach.  Reduction is only performed if desired.  In all these procedures the nipple and areola are brought up to a higher or “perkier” location and the areola is reduced in diameter if needed.

What will the scars look like?  The answer is always “That depends”.

Surgical technique is certainly important.  However, even the best surgeons can’t always fight genetics and ethnic background and these are often critical

contributing issues in the visibility of scars.  Postoperative treatments with topical scar gels, steroids, and lasers may be utilized if necessary to help scars fade.

Recovery after a breast uplifting procedure is typically not any longer than after a breast augmentation nor does it usually add time to the recovery period if performed together with implant placement.  Most women are back to work within a week if their job does not require any exertional activity.  They will, of course, have to ease up on their exercise routine for a few weeks after surgery.  But these procedures will accomplish for them in a few hours what no amount of exercise can.