Breast Lift Surgery: Getting the Best Result from Mastopexy

From an Artistic Standpoint
Surgery of the human female breast is true surgical sculpture. The breast is the major visual identifier of the female sex, and as such should be re-created to optimal dimensions at the time of surgery. So, what constitutes optimal? For centuries, artists have painted the human figure, and sculptors have sculpted the female figure. The female breast has historically played a prominent role in art work. Human proportion and anatomical design are key to identification of the ideal, and only when we have identified the ideal, can we seek to recreate it surgically.

The surgeon must have artistic skills to do the best work on the breast, which will show in his surgical results. Placement of scars, position of the nipple and avoiding an unnatural look are all important in achieving a natural appearance in a breast lift (mastopexy). If one considers the breast to be a combination of a dome and a cone, the nipple should protrude at the apex of the cone. Operations which do not do this fail in the art department.

The Nipple -- How Big and Where to Put it
Next is the position of the nipple. There are a number of well-known measurements of proportion, which when properly applied, will tell the surgeon exactly where the nipple should be on the patient's chest. For example, a line drawn from the umbilicus (navel) to the Acromian Process (the bony prominence on the shoulder) will invariably pass through the ideal nipple position. Add two more dimensions, an equilateral triangle, and the surgeon can locate the perfect position! If the surgeon just makes a guess as to the location, it will flaw the result, guaranteed!

Next, consider nipple size and shape. Some nipples are tiny while others are huge. Some are round while others are oval. Some have flattened papilla and others protrude. So, what is normal and what is ideal? Ideally, the nipple is a circle of pigmented skin with a central raised papilla, which protrudes enough, but not too much. The ideal nipple diameter is 4.5 to 4.7 cm. That's just over 1¾ inches; something artists know and surgeons should know.

What about relocating the nipples surgically? Some women have nipples which are too far in, and other women have nipples that are too far out. So what is ideal? The breasts normally diverge at 45 degrees from the midline plane of the body, with the nipples at the apex of the cone/dome as we have observed. The closer we come to this, the better the breasts will appear. This means that if one breast is viewed in profile, the other will be seen in the full round. You can verify this if you buy a magazine with photos of nudes -- yes, such magazines are available -- or take a life drawing art course and see for yourself.

Cleavage
What about cleavage? Cleavage is a function of whatever pushes the breasts together. Clothing, padded bra, arms, hands, dependent position, etc. When a woman lies down on her back, is there any clevage? Nature induced clevage only occurs in woman with a Pectus Excavatum (caved-in chest). In such a breast configuration, the nipples may appear as "owl eyes" or "cross eyes". This can be a problem when wearing a bikini. Operations which place the nipples too far in will have the same problems.

Pre-Operative Preparation
While there are a multitude of breast deformities that the surgeon will encounter over years of practice, keeping the artistic parameters in mind, the surgeon can use his skills to make corrections of deformities, and strive for the ideal. A few principles must be recognized, however, in order to stay out of trouble. Paramount is the cessation of smoking. The next is accurate, pre-surgical measurements and planning. The third is carefulness of technique. The careless use of external, cross-hatching "baseball" sutures, or staples, will result in ugly, telltale scars. Such scars around a nipple will never look normal.

Putting it All Together
The goal of breast lift (mastopexy) surgery is to lift the sagging, drooping (ptotic) breast in order to make "perky breasts" like you may have had in your younger days. The mound of breast tissue must be advanced upward, based on its blood supply, from the underlying muscle. The overlying skin is raised, and is the redraped around the mound in such a fashion as to reproduce the ideal shape ("skin brassiere"). Excess skin (and only skin) is removed, and the closure is done with hidden sutures underneath the skin. With the breast tissue thus carefully raised to a new position, all elements must bond together and heal in the new shape.

Options -- The Bad, and the Ugly, and the Good
Some breast lift procedures lead to an abnormal looking "bottoming out" effect, where the nipple ends up too high and the mound drops down below. This is BAD! Other procedures can give you a broad, flat nipple with wide scars. This is UGLY! Another procedure puts the nipples in the wrong location, and leaves a long, bunched up scar beneath them. Again, this is UGLY!

We freely admit that these procedures are quicker to perform. However, if you want the best possible appearance, these are not for you! Consider the ideals of anatomic design and how to best achieve them. After all, these are your breasts -- two of your greatest assets -- and with breast lift surgery, you've only got one chance to get it right. Be GOOD to them!

To learn more about breast lift surgery (mastopexy) visit our website at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/breast-lift-surgery/.