Breast Suspension / Mastopexy

WHAT IS IT AND WHO IS IT FOR?

Female breasts can sag due to various factors such as excess weight, lack of bra use, age, increase and subsequent reduction in volume during breastfeeding, pregnancy, and weight changes. Candidates for this breast suspension/mastopexy surgery are women generally satisfied with the breast volume but unhappy with sagging, the position, or the size of the nipple.

There are different surgical techniques to lift the breast (pexia). The surgeon must choose the most appropriate technique for each case and, above all, the one they master the best.

SURGICAL PROCEDURE

The aim of the operation is to lift the entire breast, decreasing the volume in the lower pole, increasing it in the upper part, and achieving the proper height of the areola-nipple complex. The projection of the breast is of special importance; sagging breasts (ptotic) are very flat, so the doctor must pay close attention to this aspect. In some cases, the breast diameter is also very enlarged, and it needs to be reduced.

As this surgery is not aimed at removing volume, the surgeon must preserve most of the gland and remove the excess skin with minimal scarring. Older techniques didn’t pay much attention to scarring, resulting in considerable scars.

More modern techniques try to avoid horizontal scars whenever possible, as these scars heal worse and can be visible with low-cut clothing.

The incision outlines the area where the breast skin will be removed and defines the new location for the nipple. Once the excess skin is removed, the nipple and areola are moved to a higher position. The skin surrounding the areola is then brought down, and the breast is reshaped.

The modified Liacyr-Riveiro surgical technique, as performed by us, follows these steps:

1. Careful marking.

2. Careful anesthetic infiltration.

3. Periareolar de-epidermization.

4. Individualization of the inferior pedicled flap.

5. Flap migration.

6. Glandular and skin closure.

ANESTHESIA AND SURGERY DURATION

Anesthesia can be general or local with sedation. At Clínica Luso Espanhola, we prefer sedation with local anesthesia whenever possible because the patient will not feel pain in the immediate postoperative period. The use of modern local anesthetics such as ropivacaine, with or without vasoconstrictors, ensures a long-lasting anesthetic effect in the operated area, allowing the surgery to be performed on an outpatient basis.

In experienced hands, the procedure lasts between 2 to 3 hours. If hemostasis is done carefully, drains will not be necessary. This detail depends on the technique used during the surgical procedure. Hospitalization can range from 6 to 24 hours, depending on the general state and the extent of the intervention.

A proper dressing and specific bra should be worn for the first few days. We usually recommend wearing the bra for 3-4 weeks. The stitches should remain in place for at least 14 days for intradermal sutures.

RESULT

Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures that require less extensive incisions, performed through smaller incisions from the areola. A breast implant may or may not be inserted depending on the technique used, the patient’s preference, and the surgeon’s indication.

Although scars are an inevitable result of any surgery, the surgeon will make every effort to ensure the scar is as inconspicuous as possible. The stitches are usually located around the areola, in a vertical line extending below the nipple, and along the lower breast crease. However, scarring is a personal characteristic and varies from patient to patient. The final result is visible after 6 months.

POSTOPERATIVE CARE

After the surgery, the patient should wear a specific bra for approximately 30 days. During this period, the bra should be worn day and night, and afterward, whenever engaging in sports. Bathing or showering is only allowed after the doctor’s permission.

During the first few postoperative weeks, the patient should avoid physical exertion, as there is a risk of the breast sutures opening. After this period, the patient can gradually return to normal life, and physical activities can become part of the routine again.

The resulting scar will primarily depend on the patient’s healing quality. Each individual has unique characteristics regarding healing.

WHAT ARE THE MOST COMMON PROBLEMS THAT CAN OCCUR IN A MASTOPEXY?

Although uncommon, breast suspension, like any other surgical procedure, can present complications such as hypertrophic scarring, decreased nipple sensitivity, hematoma, suture dehiscence, infection, and skin necrosis.

Whatever the type of complication, it is important to remain calm and understanding, trusting the doctor to resolve the issue. The occurrence of any of the aforementioned problems is part of the so-called “calculated risk” that applies to all types of surgery. Fortunately, these problems are infrequent and usually do not compromise the final results permanently.

FREQUENTLY ASKED QUESTIONS

When do the scars disappear?

Scars gradually fade over several months and may take up to a year. It’s important to note that scars never completely disappear, but over time, they become much less noticeable.

Can there be loss of sensitivity?

It is a very rare complication but possible in any breast surgery.

Can I breastfeed if I become pregnant?

In principle, there should be no problem.

When can I return to work?

After 4 to 5 days, depending on the type of work and how you feel.

When can I go to the beach?

We advise waiting a month after surgery to avoid sun exposure on the scars.

When can I drive again?

Driving is allowed after 4 to 5 days post-surgery.

When can I return to physical exercise?

Patients can resume physical activity after 30 to 60 days, always with medical guidance.