Edited by Dr Masino Scutari
Lift it and change its shape: a complete overview of traditional techniques and the latest news.
Pregnancy, sudden weight loss, aging, but also simply a constitutional problem due to the type of skin. Breast sagging is a problem shared by women of all ages, and it is not related, as many think, to excessive breast volume. Even women with very small breasts can have breast sagging which, in medical terms, is called ptosis and which, to be corrected, requires a surgery called mastopexy.
Breast lift is an "operation whose technique has considerably evolved in recent years. Once the incisions were consistent and left very visible scars; today thin incisions, confined to some points of the breast, leave almost invisible scars. Before hospitalization. treatment and general anesthesia were indispensable; today a few hours in day hospital and local anesthesia are realities that allow to speed up surgery and convalescence.
In this overview we will talk about the traditional techniques to "lift" a breasts that have collapsed and about a new surgical technique: that of the "muscular bra".
Establish the degree of subsidence
How to calculate the degree of breast ptosis? Many women resort to the "pencil test", ie insert a pencil in the inframammary groove: if it falls it means that the breast is high and firm, if it remains in its place it means that the breast is relaxed. In reality, to calculate the exact degree of ptosis, the distance between the inframammary sulcus and the final part of the breast is measured (see fig. 1). If the distance is 1 to 2 centimeters, the ptosis is mild; if it goes from 2 to 4 centimeters the ptosis is medium; if it exceeds 4 centimeters (up to 10 centimeters) it is high. Depending on the type of breast failure, the surgeon determines the type of incision to make.
Mild PTOSIS: up to 2 centimeters
For slight mammary sagging, an incision is made around the areola of the nipple (see drawing A) and through this the mammary gland is brought back upwards, anchoring it with special sutures inside the pectoralis major muscle. It is then necessary to pay particular attention to the external structures, which, in order not to leave wrinkled scars, must be done well, so that the skin is not too tight.
A disadvantage of this type of incision is that it is not possible to make the sinus tapered and well projected forward.
This must be said in advance to the woman, so that she can eventually decide on a periareolar incision (around the "areola), accompanied by a" vertical incision.
MEDIUM PTOSIS: up to 4 centimeters
For sagging of 3-4 centimeters, an incision is made around the areola of the nipple and a small vertical cut that goes from the areola of the nipple to the inframammary sulcus (see drawing B). the surgeon then isolates the portion of breast tissue (fat and mammary gland) that has descended into the lower part of the breast, and extends it vertically, anchoring it to the pectoralis major muscle with special sutures. The aim is to fill the upper part of the breast that has emptied, making the breast tall and firm.
The excess skin flaps are then removed and the particular suture (the skin is rejoined vertically and around the nipple areola) allows a good projection of the nipple.
The areola is usually redefined (if the contours are blurred) or reduced (if it is too large). An enlargement of the contours of the nipple areola can be caused by the traction of the skin to which the breast is subjected during pregnancy or during weight gain.
HIGH PTOSIS: more than 4 centimeters
In the most serious cases, breast sagging, ie when the ptosis exceeds 4 centimeters, it is recommended to resort to an "L" incision (see drawing C). this includes: the area around the nipple areola, a small vertical cut from the nipple areola to the inframammary sulcus, and one along the side of the inframammary sulcus towards the armpit (the fold that separates the breast from the Chest).
After practicing general anesthesia, the incisions are made, then the mammary gland is lifted and anchored to the pectoralis major muscle.
After removing the excess skin, the areola of the nipple is repositioned which, thanks to a particular rejoining of the skin (the sutures must not stretch the skin too much), is projected upwards.
If the breast, in addition to being sagging, is also abundant, a portion of breast tissue (gland and fat) can also be removed, thus also carrying out a reduction intervention. When removing a part of the gland, the surgeon naturally takes care not to compromise the functioning of the milk ducts (the channels that allow the passage of breast milk), so that the possibility of breastfeeding can remain intact. With this technique, the breasts can be lightened from 300 to 900 grams.
Often in these interventions the size of the areolas (ie the brown areas surrounding the nipple) is also changed: generally women prefer to reduce it.
Cosmetic surgery can last from 2 to 4 hours; hospitalization in the nursing home is 24 hours.
Convalescence, Preliminary Exams, Costs
Immediately after the surgery, the scars are reddish and evident, but within a few weeks they settle. For at least a month after the surgery it is good to wear a supportive bra (those for sports are ideal), do not make too much effort nor practice sports.
The breast takes on its final appearance after about 3 months from the operation, and the scars almost completely disappear within 6-10 months (it depends on the skin's healing capacity).
Only in about 10 percent of cases can the scar leave small folds or cords, which can however be corrected with a small operation under local anesthesia, to be done at least 6 months after the first.
The tests to do before undergoing surgery are: blood and urine analysis, electrocardiogram.
Second part "
