Breast augmentation and mastopexy

Every woman who is thinking about breast augmentation hopes and expects that implants will not only enlarge them, but also eliminate sagging and improve their shape. However, this is not true. We'll tell you why.

Firstly, by placing into breast tissue, e.g. silicone implant(or saline - there is no difference), the chest is already becoming heavier than it was before. That is, a factor is added here that influences breast sagging. Further, increasing the drooping breast will cause the nipple to remain in its original place. That is, it will appear higher relative to the level of the body, but relative to, for example, the level of the inframammary fold, it will remain at the same level as it was before the operation.

Breast augmentation without mastopexy

Since breast enlargement itself does not lead to an increase in the level of the nipples, that is, it does not “lift” the breasts, women undergoing breast enlargement surgery should take this into account and be prepared for the result.

Mastopexy leads to scarring on the breast itself, which may be unacceptable for some women. Therefore, they may choose breast augmentation surgery without a lift. In addition, in women with slight sagging breasts, after the installation of implants, the latter gradually go down a little, which leads to a slight rise in the level of the nipples.

Breast augmentation in cases of moderate to severe sagging

In these cases, breast augmentation surgery alone will not work, as the results will be unsatisfactory. Installing implants in such a breast leads to the fact that it will serve as a “bag” for them, and such breasts will look unnatural. This causes a protrusion to form in the upper part of the chest. When the implants are lowered in this case to avoid the formation of a protrusion in the upper part of the breast, it may occur in the lower part. This results in a so-called double protrusion.

What to do? The formation of a protrusion in the upper part of the breast or a double protrusion in the lower part of the breast can occur after breast augmentation surgery with moderate drooping, but is more typical for severe drooping breasts. However, despite this, many women may choose breast augmentation without a lift. If after this they have these changes breast shape, then you can’t do without mastopexy.

Therefore, it is often mastopexy carried out together with breast enlargement. Mastopexy with implant installation is sometimes the only option possible method full recovery breast shape and volume.

Breast lift with implant installation can be performed on women who do not naturally have big breasts lost her aesthetic appearance after childbirth, due to natural aging processes or due to sudden weight loss.

Breast augmentation can also be performed on women who have always dreamed of larger breasts and, having decided to mastopexy, came to the conclusion that breast augmentation was necessary. In a word, the reasons may be completely different, but the main thing is that at the modern level plastic surgery can be picked up best solution specifically your problem.

The meaning of the term “mastopexy” is not known to many. At the same time, all women know about the use of operations in plastic surgery to correct the shape of the mammary glands.

Indications for surgery

Mastopexy is a surgical tightening of the breast skin, changing the shape and appearance sagging mammary glands by moving the nipples with the areola to a higher position, as well as changing the size of the areola in order to make the glands more aesthetically pleasing.

The main cause of ptosis (drooping) of the mammary glands is changes in the skin and glandular tissue associated with periods of pregnancy and breastfeeding, changes (especially rapid) in body weight and the hormonal state of the body, with too large breast sizes and weight. Age-related loss of elasticity is also important. skin and fibrofatty degeneration of glandular tissue. The consequences of these reasons are:

• overstretching of skin tissues with the formation of stretch marks ( scar changes) due to the discrepancy between the volume of the gland filled breast milk, and skin area;
• replacement of glandular cells with fat cells, the elasticity of which is much lower;
• sprain mammary glands at breastfeeding, at large sizes mammary glands and decreased elasticity.

All these changes lead to a deterioration in the aesthetic appearance of the breast. In a normal position, the nipple is at the level of the middle humerus and above the skin fold located under the mammary gland (submammary fold). In relation to this criterion, three types of ptosis are distinguished:

1. True, in which the nipple and areola descend below the submammary fold.
2. Glandular- the nipple is located above the fold, and the mammary gland itself of normal volume sags very much.
3. False (pseudoptosis)- with a normal position of the nipple, the mammary gland is reduced in volume, but at the same time its lower parts sag.

In preparation for plastic surgery The choice of technique by the surgeon is determined depending on the degree of true ptosis:

• I degree - the nipple is located at the level of the inframammary fold or below it no more than 1 cm.
• II degree - the nipple is 1-3 cm below the fold, but above the lower contour of the mammary gland.
• III degree - the nipple is facing downwards, located on the lowest contour of the gland and 3 cm below the inframammary fold.

Mastopexy (breast lift) is indicated for women who:

1. The breasts sagged and lost their shape and elasticity.
2. The mammary glands are asymmetrical.
3. The chest is flat and has an elongated shape.
4. Elongated areolas and stretched glandular skin with bluish, pink or white scarring.
5. The location of the nipples is below the level of the inframammary fold.
6. Breasts are small in size and weight.

Types of mastopexy

Developed large number breast lift options. The goal of all methods of mastopexy is not to change the size, but to return the natural aesthetic shape and contours of the stretched mammary glands when they sag. The surgical technique consists of several stages:

• return of the nipple-areola complex to starting position(top);
• removal of stretched skin lower section mammary glands;
• upward displacement of the tissue of the gland itself and fixation of it to the fascia of the pectoral muscle;
• comparison of wound edges and suturing.

Of the many techniques, three are most commonly used. Each of them corresponds to a certain degree of ptosis.

Periareolar mastopexy

For I degree ptosis of the mammary glands, small breasts, pseudoptosis or elongated (tubular) shape of the mammary glands, periareolar (circular) mastopexy is used. An incision with a radius of up to 14 cm is made around the areola, after which the excess is excised. skin tissue without glandular, followed by application cosmetic stitches, which tighten the glands.

After the operation, the sensitivity of the nipples remains as it is not affected glandular tissue. Scars around the areola, almost invisible, are subsequently smoothed out even more. Circular mastopexy lasts no more than 1 hour. A particularly good aesthetic result of this operation is achieved when combined with the installation. Rehabilitation period lasts on average 7 days, but you can start working in 1-2 days.

For grade II ptosis, it is performed vertical mastopexy, in which the diameter of the removed skin flap is from 14 cm to 17 cm. The incision is made above the nipple around the areola with an extension vertically downwards by 3-5 cm or to the skin fold under the mammary gland. The operation involves a slight reformation of the glandular tissue (sometimes with its partial removal) in the area of ​​the areola, which may subsequently reduce the sensitivity of the nipple. The areola itself can be reduced (if necessary) to 4 cm. After lifting, the tissues are fixed with sutures to the fascia of the pectoral muscle.

Sutures are placed on the skin in areas favorable for healing. Depending on the complexity, the operation can last up to 2 hours. After it, minor pain persists for 2-3 days. Working capacity is restored after a week, but wearing it is necessary for 1 month. compression garments and limiting physical activity. After the operation, barely noticeable scars remain.

Vertical mastopexy with implantation of endoprostheses

Mastopexy with anchor incision

At III degree ptosis and pseudoptosis, the same incision is used as in degree II, but with the addition of a horizontal incision along the inframammary fold. But the “anchor” version of the cut is more common. It consists of incisions around the areola, along the inframammary fold and almost vertical incisions connecting them. After suturing the skin, the scar has the shape of an anchor. This operation is most effective for significant changes in shape mammary gland. The disadvantages of the method are:

• high morbidity and duration of the operation (about 3 hours);
• formation of large scars;
• long period of rehabilitation (work capacity is restored after 10-14 days);
• limiting physical activity for up to 3 months.

Breast lift using anchor incision technique

Endoscopic breast lift method

Carrying out operations endoscopic method allows you to significantly reduce the size of scars, since instead of conventional incisions, punctures are made in the submammary area. An endoscope and manipulation instruments are inserted through them. Under visual control on a monitor screen, excess glandular tissue is separated from the skin and excised. This method allows not only to reduce the size of scars, but also to make the postoperative period much easier and its duration shorter.

Periareoral mastopexy can be performed under local anesthesia. In other cases, operations are carried out under general anesthesia. The period for complete formation of breast contours occurs within a period of several months to 1 year. The positive effect of the operations may last a lifetime, but age-related or rapid weight changes may lead to the need for repeated correction after 5-10 years.

Preoperative preparation and contraindications

Preparation consists of a conversation with the surgeon, who listens to the patient’s wishes, asks about past experiences and the presence of chronic diseases. After this, the doctor examines the mammary glands, performs necessary measurements and informs about the type and principles of the operation, options for its results, possible complications and prescribes the necessary examinations. These include:

• clinical blood and urine tests;
• blood test for group, Rh factor and coagulation;
• blood test for RW, HIV and hepatitis;
• determination of glucose and urea levels in the blood;
• mammography;
• fluorography of the lungs;
• consultations with a gynecologist and mammologist.

After this, a consultation with an anesthesiologist is held, which consists of an interview and examination of the patient, familiarization with the results laboratory research, information about the type of anesthesia, preparation for it and possible complications.

At least a week before surgery, you must stop smoking, taking medications that reduce blood clotting, vitamin E and lecithin. A light dinner is possible the night before. No food is allowed on the day of surgery, and water is not allowed for 2 hours before surgical intervention.

Contraindications and complications

Surgical breast lift is not recommended if:

1. Planning a pregnancy, since the effectiveness of the operation will be insufficient or short-lived.
2. Less than 1 year after the end of breastfeeding.
3. The presence of breast tumors, nodular or diffuse mastopathy.
4. Hormonal and autoimmune diseases.
5. Blood diseases and bleeding disorders.
6. Acute somatic diseases or their aggravation.
7. Acute respiratory viral and venereal diseases.
8. Diabetes and overweight.
9. Reduced immunity.

After surgery, complications are possible such as:

1. Short-term swelling inflammatory processes, hematomas, pain and discomfort when moving.
2. Suppuration of individual areas of the skin (extremely rare).
3. Formation of rough scars. This complication occurs in 3-5%. With careful suturing, the scars gradually become smaller and lighter, but remain for life.
4. Secondary breast ptosis, which occurs mainly due to insufficient elasticity of the skin, a significant mass of glands, and also due to unprofessional surgery.
5. Breast asymmetry. However, small deviations are considered normal, since most people have them even before surgery.
6. Temporary or constant decline nipple sensitivity.
7. Reducing the size of the areola and nipple.

Mastopexy is effective way correction for prolapse of the mammary glands. Choice correct technique guarantees a high aesthetic result.

When we talk about breast surgery, we usually mean breast augmentation or shape correction. Meanwhile, another operation from the area is no less popular among girls around the world. aesthetic surgery- mastopexy (or breast lift).

In order to increase literacy in this absolutely important area, we asked a plastic surgeon to answer the main questions: about the differences between mastopexy and mammoplasty, indications for its implementation, risks, myths, postoperative period and important features.

Konstantinov Nikolay Gennadievich,
plastic surgeon.

How is mastopexy different from mammoplasty?

Both of these operations are performed on the breasts (mammary glands), but let's take a closer look. The concept of “mammoplasty” is quite broad. If we start by analyzing the meaning, then literally this is the creation of the shape of the mammary glands, the formation of the mammary glands (from the Latin mamma - mammary gland, plastica - creation, formation). This term can mean breast enlargement (endoprosthetics, lipofilling), breast reduction (reduction mammoplasty) and repeated interventions (reprosthetics, removal of mammary glands).

As for the term “mastopexy”, its meaning is narrower (with others. Greek languageμαστός means a vessel resembling the shape of a mammary gland, and “pexia” means fixation), and implies a tightening of the mammary glands to eliminate their prolapse.

What are the indications for a breast lift?

The main indication for a breast lift is ptosis of the mammary glands. There are several degrees of ptosis. In the first degree of prolapse, the nipple-areolar complex (nipple and areola) will be located at the level of the inframammary fold (the fold of skin, or groove, that is located under the mammary gland). The second degree of ptosis is characterized by drooping of the nipple and areola below the inframammary fold. In the third degree, we see that the nipple and areola are located at the lower pole (at the lowest point) of the breast hanging down. At each degree can be selected different methods operations.

How difficult and dangerous is this operation?

First of all, I would like to say that simple and safe operations doesn't happen. There are many types of mastopexy: in some cases it is a short and superficial operation (cutaneous mastopexy), and in others it is a more complex intervention with a large number risks. In any case, it is important to take this treatment seriously and approach the issue thoughtfully.

What are the complications after a breast lift?

It is necessary to distinguish between two groups of complications. The first one occurs in the early postoperative period. This may cause bleeding and hematoma formation. Rarely encountered, requires re-intervention for final hemostasis (stopping bleeding) and evacuation of the hematoma. In most cases, it does not affect the final result of the operation. Even more rare complications are complications of the inflammatory type - suppuration of the hematoma due to late diagnosis, postoperative wound. Disturbances in the nutrition of the skin and soft tissues (trophic disorders) may also occur, which manifests itself in the form of suture dehiscence, marginal skin necrosis in the area of ​​the vertical incision or in the area of ​​the areola and nipple. Each complication requires its own differentiated treatment.

The second group of complications, or, more correctly, unwanted effects operations - occurs in the late postoperative period. It can include the formation of wide scars, skin folds in the area of ​​vertical or horizontal scars, early ptosis (drooping) of the breast after surgery, impaired sensitivity of the skin of the nipples and mammary glands, breast deformation.

Will I have to have another lift in a few years?

As a rule, the operation is performed to obtain a stable result for 5-7-10 years. But there are many reasons that can prevent this. The first, and, in my opinion, the most significant is the volume of the mammary glands. Main active factor for the formation of ptosis is gravitational force(force of attraction), and the greater the volume (and, accordingly, the weight) of the breast, the faster it will fall.

As is known, even with favorable conditions The mammary glands of any woman drop by an average of 1 centimeter in 5 years - and these are the most minimal changes. It is also necessary to take into account elasticity and density connective tissue mammary glands, skin. Plus, many women’s weight changes over time: some lose weight and then the volume of their breasts may decrease, while others, on the contrary, gain weight and then the mammary glands sag with greater force.

It is advisable to approach the operation at a weight with which you are comfortable living and maintain it after the operation. If you are committed to losing weight, then I recommend performing the intervention after that.

How long and painful will the postoperative period be?

In the early postoperative period (days 1-3), pain relief is performed. As a rule, pain is not intense and is moderate in nature on the first and second days after surgery, then pain syndrome decreases. For prevention infectious complications Antibacterial therapy is prescribed.

The time spent in hospital usually does not exceed 1-2 days. In the future, outpatient removal of sutures (5-6 days after surgery) and 2-3 dressings at weekly intervals will be required. It is mandatory to wear compression garments on the chest for 4 weeks. In addition to this, it is recommended to limit physical activity and lifting weights exceeding 5 kilograms for a period of one month.

Is it true that there are more scars after a lift than after augmentation with implants?

Depending on the chosen surgical technique, scars can be of different locations and lengths. When breast augmentation with implants is used, scars may be in the armpits, in the area of ​​the inframammary fold, or along the lower edge of the areola. The length of such a scar is on average from 4 to 5 cm on each side.

When lifting the mammary glands, the approach can be circumareolar - the scar remains around the areola and, as it were, outlines it. At the same time, with a vertical lift, the scar resembles a “racket” - it is located around the areola and then falls vertically down. If ptosis is severe, then scars may remain around the areola and in the form of an inverted letter “T”, which goes down from the areola.

That is, after some types of mastopexy, scars may be subtle (around the areolas), but more often they are actually more noticeable and longer than with isolated augmentation with implants.

Is it possible to combine breast lift and mammoplasty in one operation?

When we're talking about about augmentation mammoplasty, the combination of such operations is carried out quite often. The main complaint of women who turn to plastic surgeon in such cases, there will be not only prolapse of the mammary glands, but also their desolation (reduction in volume). After a breast lift, the volume of the mammary glands does not increase and the patient remains with the volume with which she came. Therefore, to fill the upper slope of the mammary glands or to increase their total volume, a one-stage operation is performed - mastopexy and endoprosthetics of the mammary glands. But during such operations, it is extremely important to choose high-quality and maximally safe implants: in my practice, I most often use Mentor products.

Is it true that breast sensitivity disappears after mastopexy?

In some cases, a decrease in the sensitivity of the skin of the nipples and areolas may be observed. But most often, sensitivity is restored, remaining reduced in only 14-15% of women.

Is it possible to have a mastopexy before giving birth?

Why does this question arise? With mastopexy, the breast tissue is often intersected, the configuration of the mammary gland changes, which can affect the function of lactation - the amount of milk during feeding will decrease. In addition, if the sensitivity in the nipple area changes (decreases), they may react differently to the child’s touch when grasping the nipple (but such sensitivity disorders rarely occur). From all that has been said, the conclusion suggests itself that mastopexy is still better done after childbirth.

However, there is another point of view. When it comes to pregnancy after some indefinite period, and the problem with the shape of the breast is quite urgent, then women choose a more active position. Why? Any aesthetic operation is aimed at improving the quality of life (normalizing self-esteem, increasing self-confidence, the ability to behave more freely, and much more). In 3-5 years, everything will change a lot, there will be other tasks, opportunities, desires. And psychologists recommend not to put off life until later, so the choice in any case is only yours.

How is the mastopexy procedure performed?

This operation is carried out under general anesthesia(with the exception of small dermal mastopexies, which can be performed under local anesthesia). Before the operation, markings are made when the surgeon “draws” the boundaries of the mammary glands, the lines of future incisions, and tissue detachments. The duration of the operation can vary - from 30-40 minutes for skin mastopexy to 2.5-3 hours for a lift with simultaneous endoprosthetics. After the operation, the patient is transported to the recovery room, where she fully regains consciousness, and then transferred to a regular ward.

What tests need to be taken before the procedure and why may the operation be refused?

There is a standard minimum examination for elective surgery. Additionally, a consultation with a mammologist is necessary. In the presence of chronic vascular diseases ( varicose veins) an examination by a phlebologist is also necessary. Plus, it is not advisable to perform the operation during the first days menstrual cycle, more optimal time- middle of the cycle.

A refusal to perform an operation may be given due to the presence of contraindications to the operation: local inflammatory changes skin and soft tissues, acute diseases, exacerbations of chronic diseases, cancer. Before the operation, an examination by a general practitioner with a report on the identified pathology is required. The anesthesiologist will clarify in detail all the important information for him and tell you about the planned anesthetic care.