Why Breast Sagging Occurs
In some patients requesting breast enhancements, the tissue of the breast has become lax and saggy. The medical term for this condition is breast ptosis. This can occur with age and as a common consequence of pregnancy, nursing and/or weight fluctuations. Breasts progressively hang lower and lower on the chest with loss of upper breast projection (perkiness), elongation and flattening. In some cases, the nipples point straight down.
Binelli (Doughnut) Mastopexy
In certain cases, the scar for mastopexy can be limited to the area around the areola. This technique is called a Binelli Mastopexy after Louis Binelli, the French plastic surgeon who described it. Unlike standard breast augmentation scars that are nearly undetectable, the scar that results from Binelli Mastopexy is visible. In essence, the way the procedure is performed is by incising a circle around the areola and leaving the nipple attached. A larger circle is then fashioned and all the skin inside the “doughnut” is removed. The two circles are then brought together by placing a “purse-string” in the outer circle and then tying it. This allows the scar to remain at the areolar margin. However, because there is a mismatch between the two circles, the resulting scar widens a little bit and is visible. Also, there tend to be folds or pleats near the areola that may persist for months and rarely are permanent.
As long as the woman’s breast is not too heavy, it is the preferred technique in women with ptosis that want to be larger. One aspect of all minimal scar techniques is that they can take a while to settle and assume a normal shape. In addition to having a flat frontal area, Binelli Mastopexies can also look “boxy” for an extended period of time (six to 12 months in some instances). Therefore, you may need to be very patient with the shape and areolar pleating as the result matures during the first three to six months.
Lejour Limited Scar Breast Lift
In women who desire simply to lift their breasts into a more youthful position and contour, a technique called Lejour (after the Belgian Plastic Surgeon, Madeline Lejour) may be the best option. This technique is very different from the standard procedure involving anchor incisions, or “Binellis,” in that the final result is not determined or dependent upon the breast skin. Lejour breast lift differs in that the breast tissue itself is molded into a new cone of tissue, which is secured with internal sutures and then suspended up higher on the chest wall. The result is not determined or dependent on the overlying skin. Therefore, the scar can, in many cases, be limited to the area around the areola and down the front of the breast (from “lollipop” incisions). Also, since we are fashioning a new breast cone, the result can be more natural and tends to last longer with decreased incidence of recurrence.
Lejour Mastopexies are typically performed on an outpatient basis under general anesthesia. Most patients can return to work in 7 to 10 days and normal activity in 2 to 3 weeks. You will generally need to be seen the day following surgery, at one week and at 6 weeks after surgery.
Vertical Mastopexy with/ without Breast Implantation:
Women with more severe amounts of sagginess and skin excess can be effectively treated with a Vertical Mastopexy alone or, if needed for optimum breast shape, the addition of an implant. Dr. Hause has incorporated many techniques of breast lifting and reshaping to customize the result to the patient, rather than a one-size-fits- all limited procedure. Because of the amount of skin excess, an Anchor incision is necessary. However, this allows the most profound improvement of breast shape and position on the chest. In patients who need better upper pole fullness (perkier), an implant can be done at the same time. In certain situations when the breast tissue is mal-positioned to low on the chest, Dr. Hause developed what he calls a Remodel (Reduction) Breast Lift Augmentation. This is not a term you will find elsewhere but was developed using a combination of breast reduction, augmentation and lifting techniques to allow the maximal amount of reshaping to get the best result. In essence, Dr. Hause removes the breast tissue that is in the wrong place, places the appropriate sized implant in the right place, then molds the remaining breast and skin into the best result.
Schedule a Breast Lift Consultation
If you would like to learn more about your breast lift options, please schedule a consultation with Dr. Hause. Call (916) 646-6869 to make an appointment.