WHAT DOES THE SURGERY INVOLVE?
Time, gravity and breastfeeding all have an effect on the shape of the breast gland. The breast gland may shrink within a stretched skin envelope leaving an empty looking breast with the nipple at its lowest, pointing downwards. The shape and attractiveness of the breast is determined by three factors: the volume of the breast gland (its distribution and shape), the surface area of the breast skin and the position of the nipple relative to the breast mound.
The surgical options for this procedure are determined by one or more of the above factors. For only slightly droopy breasts simply increasing the volume of the breast by inserting a breast implant may be all that is required – this has the advantage of minimal scarring. For extremely droopy breasts a great deal of tightening of the breast skin is required and this can produce scars similar to those in a breast reduction. In the majority of cases however it is necessary to do something in between. Reducing the breast skin surface area and increasing the volume of the breast selectively in the upper part of the breast gland using a breast implant is the most common type of augmentation mastopexy (uplift with implants). The scars produced by this procedure are in a similar position to those of a breast reduction but often not as extensive. The factors which determine the ideal procedure of choice in breast uplift surgery or mastopexy are very personal and are explained to prospective patients on an individual basis. Surgery is carried out under general anaesthesia and in-patient stay varies from one-two nights. Drains are not always necessary and a soft dressing is applied in the operating theatre which should be left in place for two weeks. All stitches used are dissolvable and do not require removal.
WHAT ARE THE SCARS LIKE?
These can vary from a fine line scar around the circumference of the nipple (periareolar scar) to a periareolar scar joining a vertical scar, four-five cm long down the front of the breast. In extreme cases the scars produced may be similar to those seen after breast reduction surgery with the scars running along the skin crease under the breast (inframammary fold) and vertically from this fold to the areola (ring of colour around the nipple) and then curving around it. Usually the scars are somewhere in between those of a breast augmentation and a breast reduction and they usually heal nicely with little redness and start to fade within a few weeks but, as with any scar, it may take several months to look its best. Generally Mr McDiarmid uses his own modification of the central mound technique as he feels it is the safest and produces the best scar quality when the incisions are closed using his own high circumferential tension technique.
HOW PAINFUL IS IT?
This varies depending on the choice of procedure but usually the majority of the discomfort settles within 24 hours. Patients are offered a short course of pain killers on discharge from hospital.
What happens after surgery?
Patients are usually ready to go home after one or two nights in hospital. The soft dressing covering the breasts should be left dry for two weeks following surgery and it is advisable to restrict your level of activity during this time. After two weeks the dressings covering the breasts are removed in the clinic and patients can return to normal bathing and showering. Three months after the surgery a further appointment is made so that we can check that the scars are settling down and take post-operative photographs.
WILL I BE ABLE TO BREAST FEED AFTERWARDS?
This largely depends on the technique used to carry out the surgery and should be discussed on an individual basis. Generally, yes if the technique used is less invasive, and no if it is more involved.
WHAT ABOUT NIPPLE SENSATION?
This largely depends on the technique used to carry out the surgery and should be discussed on an individual basis.
WHAT COULD GO WRONG?
Complications are very rare and their likelihood largely depends on the technique used to carry out the surgery so should be discussed on an individual basis.
Infection and bleeding are possible complications of any operation. A single dose of intravenous antibiotics is given to all patients undergoing breast uplift surgery at the induction of anaesthesia as this has been shown to drastically reduce the infection rate in breast surgery. The scars can occasionally become red and itchy and may require further treatment to help them settle. Asymmetry and problems with the new breast shape are very unlikely to be an issue as Mr McDiarmid performs the surgery on both sides himself.
The ultimate size of the uplifted breast is determined by the contact area of the breast base on the chest wall. It is never possible to produce a pert B-cup breast if the previous breast base was very large as the minimal volume of breast tissue spread over a large surface area would produce a breast with very poor projection and an unaesthetic result. The ultimate cup size is determinable within reason and this is discussed in detail at the consultation.
Very occasionally the circulation to the nipple may become impaired and part or all of one of the nipples may be lost. This occurs extremely rarely in older patients or smokers undergoing massive breast uplifts. Breast uplift is one of the procedures in plastic surgery where stopping smoking is an imperative for successful healing.