Mastopexy/Breast Lift after Implant removal

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MASTOPEXY “BREAST LIFT”

Typically in Dr. Chun’s practice, Mastopexy is often performed in conjunction with the implant and capsule removal surgery. The implant removal surgery reduces the breast volume and therefore creates excess loose skin in most patients. This causes post-removal cosmetic deformities in some patients. Mastopexy prevents this by removing the excess skin, creating a tighter skin/soft tissue envelope, and reshaping the breast. It also reduces/repositions the areola(the nipple is never detached!). The anchor mastopexy is typically used. It has a circular scar around the areola, a vertical scar from the areola to the breast crease, and a horizontal scar along the breast crease. In certain specific patients with tight/elastic skin and small implants may achieve a reasonable result with just the circular scar around the areola. In general,  the amount of excess skin after the implant removal surgery determines the scar length. Greater the excess skin removal requirement, longer the scars. 

 

30’s patient with 10 years old silicone 325 cc implants placed submuscularly

Removing excess skin and tightening the soft tissue envelope restored her pre breast augmentation appearance.

30’s patient with 15 years old silicone 330 cc  implants placed submuscularly 

Removing excess skin and tightening the soft tissue envelope restored her pre breast augmentation appearance.

Late 30’s patient with 16 years old silicone 275 cc implants implaced submuscularly and a previous anchor mastopexy

The history of a previous mastopexy implied lesser ability of the skin to contract, which would have caused cosmetic problems after the implant removal surgery. Adding mastopexy eliminated this possibility and gave her a very reasonable appearance.

50’s patient with 9 years old silicone 420 cc implants placed submuscularly and a previous “donut” mastopexy 

The history of a previous mastopexy implied lesser ability of the skin to contract, which would have caused cosmetic problems after the implant removal surgery. Adding mastopexy eliminated this possibility. Unfortunately, she has very little breast tissue which resulted in small breasts.

30’s patient with 17 years old silicone 325 cc implants placed subglandularly

She already had ptosis with a high implant position causing undesirable cosmetic appearance.  Adding mastopexy improved her post-operative cosmetic result.

Late 60’s patient with 16 years old silicone 250 cc implants placed submuscularly

She already had ptosis with a high implant position causing undesirable cosmetic appearance.  Adding mastopexy improved her post-operative cosmetic result.

60’s patient with 32 years old ruptured silicone implants. Previously had a mastopexy due to sagging

Preexisting ptosis and abnormally high implant position created a severe cosmetic deformity. Bilaterally ruptured silicone implants were removed en-bloc. Adding mastopexy improved her cosmetic outcome.

Late 40’s patient with 10 years old silicone 457 cc implants placed submuscularly and a previous “donut” mastopexy

She still had sagging breasts even after the previous mastopexy. Implant removal with mastopexy improved her cosmetic appearance.

 

Mid 40’s patient with 10 years old silicone 450 cc implants placed submuscularly. This was her third set of implants due to recurrent capsular contractures

She already had sagging breasts so adding mastopexy significantly improved her breast shape after en-bloc total capsulectomy and implant removal.

60’s patient with 34 years old ruptured silicone implants placed subglandularly 

She already had significant ptosis and implants that were too high, resulting in poor cosmetic appearance. Both ruptured implants were removed en-bloc. Adding mastopexy significantly improved her cosmetic outcome. 

Late 60’s patient with 12 years old silicone 397 cc implants placed subglandularly

Preexisting ptosis and implants that are positioned too high caused poor preoperative cosmetic appearance. Left ruptured implant was removed en-bloc. Adding mastopexy significantly improved her cosmetic outcome. 

Late 50’s patient with 30 years old silicone implants placed submuscularly.

She already had significant ptosis. Removing implants and mastopexy improved her cosmetic appearance. Notice how much higher the left areola is relative to the tip of the left breast tattoo, as a result of the mastopexy. 

Late 30’s patient with 11 years old silicone 260 cc implants placed subglandularly

Pre-existing ptosis with asymmetry. Adding mastopexy improved her cosmetic outcome. Unlike the previous case where the high implant position is causing mostly upper breast skin stretch, in this case, the lower breast skin is being stretched. This patient would have had  significant cosmetic deformities(caving in, loose skin folds and increased sagging) without the mastopexy.

40’s patient with 22 years old saline 300 cc implants placed subglandulary

Pre-existing ptosis with asymmetry. Adding mastopexy improved her cosmetic outcome. 

60’s patient with 30 years old ruptured silicone implants placed submuscularly

 

This patient had ruptured silicone implants, breast shape deformity from extremely high implant position, and significant ptosis preoperatively. Both ruptured silicone implants were removed. Adding mastopexy noticeably enhanced her cosmetic result.

 Late 40’s patient with 23 years old saline 400 cc implants placed subglandularly

She already had significant ptosis and adding mastopexy improved her cosmetic outcome. This case shows why a mastopexy is not a “lift”.

Mastopexy will remove excess skin and tighten the breast shape but can not change the underlying skin quality, as evidenced by looser breast shape seen here. Tighter post-operative breast shape seen above are usually from younger patients with tighter skin. These types of patients maintain their tighter breast shape. Mastopexy also can not “lift” breast tissue up to the upper part of the breast and give upper breast fullness if there is inadequate pre-existing upper breast tissue.

 

30’s patient with 12 years old silicone 400 cc implants placed submuscularly 

She already had ptosis with very wide and asymmetric areolas. Adding mastopexy which reduced and repositioned the areolas, improved her cosmetic result.  

Mid 60’s patient with 45 years old saline implants placed subglandulary 

This patient presented with older, loose skin combined with ptosis but there is a lot of natural breast tissue. Mastopexy tightened the skin envelope and improved the cosmetic outcome by reducing the preexisting ptosis.

60’s patient with 8 years old silicone implants  

 

 She previously had a left mastectomy for breast cancer and then underwent a TRAM(stomach tissue) flap reconstruction. She also had a subsequent revision where silicone implants were placed. Since she already had a significant amount of right breast tissue and the TRAM flap added tissue to the left breast, removing implants and performing mastopexy/reconstruction enabled her to keep her good cosmetic appearance.

40’s patient with 17 years old saline 395/425 cc implants placed submuscularly 

This patient had a good skin condition which implied good skin contraction after the removal surgery, which in turn,  lessened the excess skin removal requirement. As a result, the periareolar(circular scar around the areola only) mastopexy was performed with a good cosmetic outcome. This procedure only removes limited amount of excess skin so it can only be done successfully on those with very good, elastic skin capable of significant skin contraction. Also smaller implants help.