THE BEST CANDIDATES FOR BREAST LIFT

A breast lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for mastopexy are healthy, emotionally-stable women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted.

Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), but pregnancy is likely to stretch your breasts again and offset the results of the procedure.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.

Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

PLANNING YOUR SURGERY

In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient--and every physician, as well--has a different view of what is a desirable size and shape for breasts.

The surgeon will examine your breasts and measure them while you're sitting or standing. He will discuss the variables that may affect the procedure--such as your age, the size and shape of your breasts, and the condition of your skin--and whether an implant is advisable. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breast.

Your surgeon will describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. He will explain the anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

PREPARING FOR YOUR SURGERY

Depending on your age and family history, your surgeon will require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, avoiding smoking, and taking or avoiding certain vitamins and medications.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Your breast lift may be performed in a hospital, an outpatient surgery center. It's usually done on an outpatient basis, for cost containment and convenience. If you're admitted to the hospital as an inpatient, you can expect to stay one or two days.

TYPES OF ANESTHESIA

Breast lifts are usually performed under general anesthesia, which means you'll sleep through the operation. In selected patients--particularly when a smaller incision is being made--the surgeon may use local anesthesia.

THE SURGERY

Mastopexy usually takes one and a half to three and a half hours. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast.

The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions.

If you're having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall.

AFTER YOUR SURGERY

After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts may be a little bruised, swollen, and uncomfortable for a day or two, but the pain shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.

Within a few days, the bandages will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to six weeks, over a layer of gauze. The stitches will be removed after three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

GETTING BACK TO NORMAL

Healing is a gradual process. Although you may be up and about in a day or two, don't plan on returning to work for about a week, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to call your surgeon.

Your surgeon will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

YOUR NEW LOOK

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, genetics, pregnancy, aging, and weight fluctuations will eventually take their toll again.

Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.

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