Breast lift/mastopexy with or without prosthesis
Breasts are one of the most appreciated organs by human beings, a symbol of femininity and sensuality, shaping and characterizing the female body. It is normal to seek improvement in this anatomical area. It is important to know which aspect is of most concern to the woman who seeks our help in order to indicate one treatment or another.
What would you like to improve? Are they empty? Are they asymmetrical? Is it a different shape? Do you want to increase its size?
Breast lift, also known as mastopexy, is a surgical procedure designed to raise and reshape sagging breasts, restoring their youthful position and shape. It is an especially popular procedure among women experiencing changes in the shape and firmness of their breasts.
The sagging breasts that we often see in our daily lives are usually due to successive pregnancies, and even more so if the patient has been breastfeeding for a long time or to other factors such as significant weight gain and loss (especially if they occur in short periods of time).
One of the most common questions we usually get in consultation refers to sagging and empty breasts.. And this is one of the most important complexes that a woman can have and to which we provide a solution with the mastopexy.
What RESULTADO do you want to achieve?
Before/after Mastopexy WITHOUT prosthesis
B/A Case 1
B/A Case 2
B/A Case 3
Before/after Mastopexy WITH prosthesis
B/A Case 1
B/A Case 2
B/A Case 3
Self-esteem and confidence
When breasts lose their firmness and begin to sag, it can significantly affect a woman's self-esteem and confidence.
Mastopexy offers an effective solution to this problem, helping to restore the patient’s appearance and self-confidence.
During the initial consultation, Dr. Marc Illa discusses the patient’s concerns and goals in detail, carefully assessing skin quality, nipple position, and amount of existing breast tissue to determine the most appropriate approach.
Frequently Asked Questions
While mastopexy focuses on lifting and reshaping sagging breasts without changing their size, breast augmentation involves the use of breast implants to increase the volume and improve the shape of the breasts. Some women may choose to combine both procedures for optimal results.
And so much so! Its advantages are the reason why the vast majority of plastic surgeons use it in breast lift or reduction.
- It allows for VERY PREDICTABLE results unlike other techniques, which will depend greatly on how the tissues behave in the postoperative healing phase.
- It allows us to MODIFY the shape of the breast IN ALL SENSES AND DIRECTIONS, we are not limited (which could lead to a poor result)
- It is the technique that usually generates LESS VISIBLE SCARS (in the other techniques, although the scar is shorter, it is usually more visible), since the tension is less (when removing skin from the breast, tension is generated) because it falls on a longer length of scar.
In some cases we do not use the inverted T as a technique to perform a mastopexy or breast reduction, but these cases have to be very well chosen and specific. In most patients, if we want to obtain an optimal result with well-hidden scars, the inverted T or anchor is usually the best solution.
Recovery varies depending on the complexity of the surgery and the individual patient's response, but most people are generally expected to be able to return to normal activities within one to two weeks. It is recommended that strenuous activities and heavy lifting be avoided for at least four to six weeks.
Scars may vary depending on the technique used and the amount of skin that needs to be removed. Common incision options include around the areola (periareolar mastopexy), a vertical line from the areola to the breast crease (vertical mastopexy), or an anchor-shaped incision (inverted T mastopexy).
While the results of a mastopexy are long-lasting, the natural aging process, as well as changes in body weight and breast health, can affect the appearance of the breasts over time. However, many patients experience significant and lasting improvement in the shape and firmness of their breasts after the procedure.
There are several tricks that can help us achieve an aesthetically pleasing neckline.
- Choosing the prosthesis: This is the most important thing to be able to create a good cleavage. It is necessary that the width is sufficient to cover the entire thorax and thus be able to correctly occupy the entire area. The shape, level of implantation and size of the patient's previous breast must also be taken into account.
- The way in which the pectoral muscle is lifted: this is where the prosthesis is inserted and the muscle itself can help us bring the breasts together.
- Internal Bra: With the help of stitches, we fix and close the edges of the prosthesis pocket well to create an internal bra effect.
- Lipoinjection: Fat injection into the breast allows for the creation of a completely natural volume and avoids long-term aesthetic defects such as rippling (irregularities in the surface). It allows us to create a beautiful and natural neckline with the patient's own fat.
The answer is: IT DEPENDS on each case
When to decide “NOT to wait to be a mother”? This is the preferred option for patients who do not feel comfortable or identified with the shape and/or volume of their breasts at the moment. For many patients, for example at 20 years of age, it is not worth spending another 10-15 years (until the age at which they want to be mothers) with a breast that does not feel good. It is true that the breast changes over the years, with sudden weight changes or pregnancies, but retouching a breast that has already been operated on tends to be simpler. These are usually surgeries that mainly affect the skin and fat without having to touch deep areas or previous breast prostheses. Hospital admission is not usually necessary and the postoperative period is usually very bearable. For this reason, many patients decide not to wait and to operate on their breasts at the moment when they do not feel comfortable with them.
When to decide to “Wait to be a mother”? This option is best for women who only want to undergo surgery once. In this case, it is best to wait until you have had all the children you want before undergoing breast surgery. The price to pay will be spending several more years accepting the shape and volume of the breasts that you are not completely comfortable with.
It is possible that it may have an effect, but it cannot be guaranteed. The intervention involves the removal of breast tissue and the replacement of the nipple. It will depend on the type of surgery (whether more or less breast tissue is preserved under the nipple structure) and the patient's genetics (there are patients who have little mammary gland but produce a lot of breast milk, this usually depends more on how much the mother is stimulated and not so much on genetics or the amount of mammary gland left in the surgery).
However, the amount may be smaller or there may be additional difficulties due to changes in the structure of the mammary gland.
This type of surgery involves remodelling the mammary gland and, usually, also the skin of the breasts. For this reason, it is common to have alterations in sensitivity that usually last at least for the first 6 months, then they usually recover within 12-18 months.
- Minors under 18 years of age with aesthetic objectives
- Pregnancy
- Active or past breast infection within the last 6 months.
- Any uncontrolled disease
Breast mammograms can be performed without problems in women who have breast implants. We recommend that they be performed 12 months after the operation to prevent inflammation from the surgery from interfering with the interpretation of the test. As long as you notify the doctor who is requesting the test in advance so that it can be scheduled to be performed using the Eklund technique, a maneuver that consists of moving the prosthesis towards the back of the breast, leaving it outside the compression paddle, compressing only the breast tissue to perform the mammogram. There is no problem with doing other tests such as MRIs or flying (the prostheses do not explode). Being a breast implant wearer is even beneficial for breast self-palpation, since the breast tissue is more taut and distributed around the implant and allows for greater sensitivity and specificity when palpating all this tissue.
No, the quality of the materials used to manufacture the breast prostheses we work with has allowed us to reduce the risk of complications associated with these to a very low level. This does not mean that it may not be necessary to replace the prosthesis or remove it during life for some reason, but this is rare. The prostheses used years ago did recommend changing them every 10 years, but thanks to scientific advances this is no longer the case.
No type of plastic surgery is related to an increased risk of cancer. The use of breast implants has been linked to some types of autoimmune disease or some types of lymphoma, but there is no scientifically clear or proven relationship with the breast implants we currently use (it has happened with some brands of breast implants used in the past).
General anesthesia is always used to ensure patient comfort and to allow the surgeon to work with maximum precision and safety. Full intubation is not usually necessary; a laryngeal mask with mild anesthesia is usually the route of choice for our anesthesiology team. Breast surgery should not be performed with local anesthesia; it is bad practice. Throughout the entire operation, the patient's general condition and vital signs are monitored and taken care of in the utmost detail by our anesthesiology team.
One night's stay is usually the norm. It is preferable to be under medical supervision for the first few hours. Although it is not a long or risky surgery, we have been in an operating room and have received medication. In addition, intravenous medication is useful in the first few hours to maximize the patient's postoperative comfort.
We work with different brands of breast prostheses: Motiva, Silimed, Politech, Eurosilicon, Nagor… None of them are the same as the other, each brand has its pros and cons that must be assessed. We will specifically study your case to choose the breast prosthesis that is best for achieving the result you are looking for.
The answer to this question must be individualized in each case. Even so, it can be said that in most patients the recommendation is to place the prosthesis under the muscle (also called submuscular or subpectoral, since the muscle used is the pectoralis major). Among the most common ways of placing a prosthesis under the muscle, the most commonly used is the dual plane, where 50-75% of the prosthesis is covered by the muscle and 25-50% by the lower part of the mammary gland.
This placement has several advantages: the anatomical structure of the mammary gland is not touched at all, which means that sensitivity and subsequent ability to breastfeed are better preserved, and it is a cleaner surgery, which reduces the risk of infection or capsular contracture.
Placing the prosthesis above the muscle, although not very common in our normal practice, in certain patients, has certain advantages that must be assessed in each case. Above the muscle, it can be done in two ways: subglandular (directly under the mammary gland) or subfascial (under the first layer that surrounds the pectoralis major muscle).
Did you know that 7 out of 10 women do not know their correct bra size?
This is a very common question in consultations, since, as is normal, patients would like to know the exact result of their surgery. While it is true that the results of surgeries (and of any medical intervention) have a predictable part (it will depend on the type of intervention planned, the wishes of the patient, and factors that we study in the physical examination such as the quality of the tissues), there is another unpredictable part that can modify the result, such as the underlying genetics of each patient or other factors that we have not been able to identify initially. Our goal is to minimize these unpredictable factors that may affect the result we leave in the operating room in order to give the patient an idea as close as possible to what they will achieve, but it is impossible to guarantee a 100% result for this reason.
30% of consultations about breast pain are due to wearing an inappropriate bra. Wearing the wrong bra size can cause not only discomfort, but also marks and injuries, as well as speeding up the aging process of the breast. Here we show you how to calculate the correct bra size.
So… in answer to the question: What size bra will fit me? We won’t know the exact size until the swelling has gone down and we have a more or less stable result 3-6 months after surgery.
Patients would like to know the exact result of their surgery. While it is true that the results of surgery (and of any medical intervention) have a predictable part (it will depend on the type of intervention planned, the wishes of the patient, and factors that we study in the physical examination such as the quality of the tissues), there is another unpredictable part that can modify the result, such as the underlying genetics of each patient or other factors that we have not been able to identify initially.
Our goal is to minimize these unpredictable factors that may affect the result we leave in the operating room in order to give the patient an idea as close as possible to what they will achieve, but it is impossible to guarantee a 100% result for this reason.
During the first three months (more pronounced during the first month) the breasts will appear higher and larger due to postoperative edema or swelling. It may even be that one breast is more swollen than the other and therefore appears larger (there are patients who have this swelling greater in one breast than in the other and it varies depending on the week and from one breast to the other) giving a sensation of asymmetry or deformity. After three months we have fairly stable results. The result of cosmetic surgery should not be considered definitive until a year has passed since the day of the intervention.
The surgical technique is very similar and, in both, allows us to:
- Breast lift: both procedures aim to perform a mastopexy, that is, to lift the breast, giving it a more rounded and youthful shape, and to do so, the entire breast volume is remodeled.
- Symmetry: In both procedures we seek to improve the symmetry between both breasts.
- Repositioning and reduction of nipple-areola size: in both procedures, the nipple is placed in a new position, specifically at the point of maximum projection of the breast. The size is also reduced, if necessary.
Breast prostheses (not in all cases): they are used to redistribute the volumes within the breast itself and, in the case of mastopexy, they are necessary in many cases because the volume of the breast itself is usually not sufficient to achieve an aesthetically pleasing breast.
Types of prostheses
There are different types of breast implants available, each with its own unique features and benefits.
The choice of one or another prosthesis It certainly depends on the individual aesthetic goals of each patient, as well as their anatomy and personal preferences. In consultation we work closely with each patient and We carry out a complete study of the shape and consistency of the breast and the shape and size of the thorax to determine the most suitable type of prosthesis to achieve the desired results and satisfy aesthetic needs.
Where can breast implants be placed?
Under the muscle (also called submuscular or subpectoral implant)): This is the majority of our cases. Among the most common ways of placing a prosthesis under the muscle, the most commonly used is the dual plane, where 50-75% of the prosthesis is covered by the muscle and 25-50% by the lower part of the mammary gland.
Above the muscle or subglandular implant (directly under the mammary gland) or subfascial (under the first layer surrounding the pectoralis major muscle). This technique is less common, but in certain patients it has certain advantages that must be assessed in each case.
Techniques for performing a breast lift or a breast reduction
The techniques are very similar, however the basic breast is very different when it is large and drooping (reduction) than when it is only empty and drooping (lift).
There are 3 common techniques that we usually use, always depending on each case, adapting to the needs of each patient:
Postoperative
The use of prostheses in a breast reduction or mastopexy depends mainly on the patient's goals.
- If you want to achieve a more aesthetically rounded and firm breast, you should use breast prostheses. In this case, the postoperative period will be more uncomfortable because there is an initial tension in the skin due to the volume of the implant, but this improves after 3-4 days. Care must also be taken when moving the arms, especially if the prosthesis has been placed under the muscle.
- If you want a more natural look and feel. It will be an intervention without prosthesis. In this case, the postoperative period is usually very fast and with little discomfort. The downside is that the breast tends to fall more.
Using breast prostheses will normally require more care in the postoperative period, avoiding sudden movements, lifting weights or raising the arms.
It is normal to experience pain, swelling, and tenderness in the breasts after surgery. Your plastic surgeon may prescribe pain medication to help manage discomfort for the first few days.
You will notice a pain that is usually described as “soreness”, as if you had gone to the gym three or four days in a row. The pain is usually very well tolerated, especially if you follow the medication regimen that we recommend taking the first week after surgery to the letter. Most patients explain that the discomfort is greater during the first 3 or 5 days, and then it is minimal; although each person has a different pain threshold.
In most of our surgeries we do not apply a bandage. We put the post-operative bra on directly in the operating room. In surgeries that have completely remodeled the implantation of the breasts on the chest or their shape, it is likely that a compression bandage will be placed around the breasts to help reduce swelling and keep the new breasts in place. This usually happens in breast prosthesis replacements or in tuberous breasts.
The first postoperative hours are spent in the hospital's recovery area, where all vital signs are closely monitored. When the patient has fully woken up from the anesthesia (no longer groggy), the pain and dizziness are under control, and she is therefore in optimal condition, she is taken to her room with her family and friends. There, recovery begins in preparation for returning home. In her room on the ward, the nursing staff will diligently ensure that the patient is comfortable and with minimal discomfort, using the medication prescribed by our anesthesiology team when necessary. The nursing team will help the patient to tolerate the intake of liquids and solids, and walking, and thus ensure a safe return home. The next day we will come to the hospital to visit you, to check that the patient is in good general condition and that there are no complications of any kind in the areas that were operated on. We will consider the possibility of removing the drains and bandages, and if everything is in good condition, we will proceed to deliver the discharge report where we will detail all the postoperative instructions that the patient must follow and the prescriptions that she will need to give to the pharmacy in order to receive the medication that we recommend. In the first week after surgery, pain and dizziness are rare, but there are specific moments when they can appear and you have to be prepared.
In some cases, temporary drains can be inserted to remove excess fluid from the surgical area. We have to consider them our allies, since they remove the fluid that causes great inflammation if it stays inside and can even increase the risk of complications. We usually place them when the work on the breast is important (such as in tuberous breast or prosthesis replacements) or we see that there is a higher risk of bleeding than usual. It is true that they are a nuisance during the days that they are worn, but there is nothing worse than that. In many of our operations we leave them on, at least until discharge from hospital. We always leave them on longer in abdominal and back surgery than in breast surgery.
You can move your arms to do activities that do not require effort. The important thing is not to lift them or lift heavy weights. Normally we allow you to lift your arms from the second postoperative week, until the surgery is well healed on the inside and movement cannot affect it. And finally, you can lift heavy weights from the fourth postoperative week.
It depends on the type of job. Normally, we allow you to start computer work (secretarial work, IT, telecommunications, etc.) two weeks after surgery. Jobs that involve driving or a lot of movement usually start after three weeks.
We usually allow driving from three weeks postoperatively.
We recommend spending the first five to seven days postoperatively at home, after which we allow going out for a coffee or visiting family or friends. Driving or taking long walks from three weeks postoperatively. Sports such as going to the gym or running from four weeks postoperatively. Intense sports such as climbing, swimming, triathlon… from six weeks postoperatively.
Most stitches are subcutaneous or intradermal, that is, they are under the skin, they go inside. We do not normally leave external stitches (only those at the ends of the intradermal suture). If there is a need to leave an external stitch, we normally remove it after 7-15 days.
If there are no features that require a longer period of time, we usually recommend wearing the sports bra for a month both day and night.
