Mastopexy
lifting the breasts

Mastopexy and mastopexy with reduction are the most common operations for sagging breasts. Why lifting with an implant is less common and carries more risk.

After pregnancy, breastfeeding, weight loss or simply with age, the breasts lose their shape and the nipple descends. The operation to lift them is called mastopexy, and the choice of method depends on what the problem is — loose skin, excess volume or lack of volume.

What is assessed at the examination

The degree of ptosis (sagging) is determined — where the nipple is in relation to the inframammary fold — and how much skin and glandular tissue there is. Whether the patient is planning a pregnancy is also discussed.

1. Mastopexy — the most common option

Excess skin is removed, the tissue is reshaped and the nipple is moved to a higher position.

• Periareolar incision — only around the areola; suitable for mild ptosis.
• Vertical incision — around the areola and downwards to the inframammary fold.
• Inverted T or anchor-type incision — for more pronounced ptosis, with an additional incision along the fold.

The more pronounced the ptosis, the longer the scar. It is the price of a good shape and it matures over about a year.

2. Mastopexy with reduction — for larger breasts

If the breasts are heavy and large, then besides the skin, part of the glandular tissue is also removed. The result is lifted and smaller breasts, often with relief of pain in the neck, shoulders and back.

3. Lifting with an implant — less common and riskier

The combination of mastopexy with an implant is much less common and is used in selected cases — for example moderate ptosis with a lack of volume in the upper pole. The risk is higher because the two goals work against each other: lifting tightens, while the implant adds volume and weight.

• The weight of the implant can stretch the lifted tissues and lead to sagging again.
• The risk of poor nipple position, asymmetry and the need for a repeat operation is higher.
• Sometimes the operation is divided into two stages.
• An implant on its own does not lift the breast — if there is excess skin, it remains.
• The risks of the implant itself are added to those of the operation.

Recovery

• A sports bra day and night for about 4–6 weeks.
• Return to non-physical work — about a week; no heavy physical effort or sport for 4–6 weeks.
• Swelling and bruising — up to 2–3 weeks; the final shape settles over several months.

What cannot be promised

• No scars — they are unavoidable.
• A permanent result — gravity keeps acting, and changes in weight and pregnancy alter it.
• Perfect symmetry.
• Preserving the ability to breastfeed in 100% of cases, although it is often possible.
• No change in nipple sensation — a change is possible, usually temporary.

When it is better to wait

If you are planning a pregnancy, if your weight is not stable or if you smoke. Nicotine significantly increases the risk of loss of skin and nipple (necrosis).