Breast Lift Mastopexy Incisions
Skin incision scar patterns for a breast lift depend on the amount of excess skin, elasticity, and degree of elevation needed. Variations can include a circle around the areola, a vertical line extending down from the lowest aspect of the areola to the crease under the breast, and along the crease under the breast.
Not every woman will need all three incisions. Short scar options are a compromise on the skin reduction depending on the ability of the skin to contract to the new form of the deeper breast sculpture. The selection of incisions depends on the amount of loose skin and the elastic quality of the remaining skin. Explore short scar options.
The basic problem with breast ptosis is that the suspension ligaments and breast tissue are sagging and the skin envelope is too large. The areola and nipple have drifted down towards the lower pole of the breast in this Third Degree Breast Ptosis example. To correct the breast to a more natural appearance, the nipple and areola need to be moved higher.
Older breast lift mastopexy techniques depended on reduction skin suspension alone. Depending on skin support alone has been shown to result in earlier drooping and failure. Dr. Bermant prefers to reestablish the main support with the breast tissue and internal supporting ligaments. Internal pillar support tends to hold the breasts up longer and results in a more "perky" youthful breast. The skin then is redraped over the suspended breast tissues.
The problem is with the extra skin. In this example there is just too much to use an incision around the areola only. The incision needs to be closed. The length of the outer wound is much longer than the length around the areola. Dr. Bermant can "cheat" the extra material of the outer wound only so much before buckling takes place. You can see what we are talking about by trying to sew a small circle of cloth into a much larger hole.
The extended pattern anchor skin scar down to the chest and under the breasts permits a more even skin removal and surface tailoring. Sewing this pattern redistributes the skin into a more natural breast. Dr. Bermant does not need this longer anchor scar and prefers short scar alternatives when possible.
We do use methods to minimize scars. In this example Dr. Bermant tries to minimize the length of the chest wall extensions under the breasts. These scars are placed in the breast / chest crease. Dr. Bermant also try to keep away from the central chest region, an area that tends to have worse scars. Special tissue handling and suture techniques further minimize scars.
No plastic surgeon likes to make scars. We just do not have the ability to take skin and put it into the clothes washer to shrink it. We wish we had such a tool, but none exists outside the realm of science fiction today.