BREAST PTOSIS SURGERY
or
MAMMOPLASTY FOR PTOSIS
Aesthetic surgery:
This document has been conceived under the authority of the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION
The ptosis is defined by a depression of the gland and a distension of the skin envelope. The breast is positioned too low and more frequently "uninhabited" in its upper part.
Ptosis may be present from the start but most often occurs after significant weight loss or subsequent to a pregnancy with breastfeeding. It can be isolated: it is called pure ptosis. It may also be associated with some degree of breast hypertrophy.
Conversely, there can be ptosis with small breast (hypoplasia or hypotrophic).
These aesthetic impairments cannot be supported by your health insurance.
AIMS
The surgery aims to restore the areola and nipple in a good position to refocus and ascend the gland and remove the excess skin to get both breasts harmonious, beautifully curved and ascended.
PRINCIPLES
The operation involves reshaping the breast acting on the skin envelope and the glandular tissue. The gland is concentrated and replaced in good position.
Then the skin envelope is adjusted, which requires removing the excess skin to ensure a good performance and a beautiful shape to the new breast.
These gestures can replace the areola and nipple that were located too low.
The edges of the skin that have been cut are sutured at the end of the procedure: these sutures cause the scars.
If ptosis is very important, the scar has the shape of an inverted T with three components: the periareolar, around the areola between the brown and white skin; vertical between the lower pole of the areola and the crease under the breast; horizontal, hidden in the horizontal crease under the breast. The length of the horizontal scar is proportional to the degree of ptosis.
More often, in the presence of moderate breast ptosis, we could use a method called "vertical" that removes the transverse scar in the crease under the breast and reduce the periareolar and vertical components of the scar.
In some cases of ptosis very moderate, it is possible to use a technique that allows for correction of the sag with only a scar around the areola.
Finally, when ptosis is associated with a lack of volume (breast hypoplasia), it may be desirable to introduce, in the same surgery, a prosthesis to restore a satisfactory volume. In this case, it is usually possible to remove the excess skin around the areola and thus limit the scar only a periareolar circle.
Mammaplasty for ptosis can be done from the end of growth and beyond, throughout the lifespan.
A subsequent pregnancy is of course possible, as well as breastfeeding, but we recommend waiting at least six months after surgery.
The risk of developing cancer is not increased by this intervention.
BEFORE THE OPERATION
A preoperative assessment is normally conducted as required.
The anaesthesiologist will be seen in consultation at least 48 hours before surgery.
In addition to the usual pre-operative examinations, a radiological breast exam is prescribed (mammography, ultrasound).
Stopping smoking is strongly recommended at least one month before and one month after the intervention (smoking can cause a delay of healing).
Stopping oral contraceptives may be required, particularly when associated risk factor are present (obesity, poor venous status, bleeding disorder).
No medication containing aspirin should be taken within 10 days prior to surgery.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia:
This is a general anaesthesia, during which you sleep completely.
Hospital stay:
Hospitalization of one to two days is usually required.
THE PROCEDURE
Each surgeon adopts his/her own technique that adapts to each case to obtain the best results.
By the end of surgery a modelling bandage, with elastic bands shaped like bra, is applied.
Depending on the surgeon and the degree of ptosis, the procedure can last from one thirty minutes to three hours.
POSTOPERATIVE CARE AND FOLLOW-UP
Postoperative pain is generally mild, requiring only simple analgesics.
Swelling (oedema) and bruising of the breasts, and a hindrance on the elevation of the arms are frequently observed.
The first dressing is removed after 24-48 hours and replaced by a lighter dressing, making a sort of elastic corset custom made.
The discharge from hospital takes place 24-48 hours after surgery, then the patient is reviewed in consultation two to three days later.
We then set up a bra ensuring good retention.
Wearing this bra is advised for about a month, day and night, the waning of the response.
The sutures, if they are not absorbable, are removed between the eighth and the twentieth day after surgery.
Should be considered a recovery and a work stoppage of a period of 7 to 10 days.
It is advisable to wait one to two months to resume sporting activity.
THE RESULTS
It cannot be held until one year after surgery: chest will appear then most often smooth and natural contour, symmetric or very close to the symmetry. Beyond the local improvement, this procedure generally has a positive impact on the balance of weight, practice sports, clothing options and psychological state.
They just need to have the patience to wait the time required for the mitigation of scars and to observe during this period a good follow-up at the rate of consultation about every three months to six months for a year.
Breast after surgery is a breast that is natural and sensitive, especially to hormonal changes and weight.
The goal of this surgery is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction
DISAPPOINTING RESULTS
They are essentially scars, which are monitored carefully: they frequently take on a pink and swollen aspect during the second and third months after surgery, and beyond, they fade an usually become progressively, over time, barely visible. They might however remain broad, white or brown instead.
Regarding the scars, you should know that although they fade well, in general, over time, they do not disappear completely. In this regard, we must not forget that if tit is he surgeon who carries out the sutures, the scar, it the fact of the patient.
Sometimes may persist some asymmetry of the breasts, whether the volume, height, size or orientation of the areolas.
In all cases, a secondary surgical correction may be made, but should wait at least a year or two.
POSSIBLE COMPLICATIONS
Mammaplasty for ptosis, although carried out for essentially aesthetic reasons, it remains a real surgery, which involves the risks associated with any medical procedure, however small it may be.
The postoperative course is generally simple after a mammaplasty. However, complications can occur, some general, inherent in any surgery and other loco regional, more specific to mammaplasty.
We must distinguish complications from anaesthesia from those associated with surgery.
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Regarding anaesthesia, during the consultation, the anaesthesiologist will inform of the patient's anaesthetic risk. You must know that anaesthesia induced reactions in the body sometimes unpredictable and more or less easy to control: the facts of using a perfectly competent anaesthetist, in a real surgical environment, make the risks become statistically almost negligible.
Be aware, in fact, that the techniques, anaesthetic drugs and monitoring methods have made tremendous progress over the last twenty years, providing optimal safety, especially when the procedure is performed outside an emergency and in a healthy person.
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Regarding the surgical procedure: choosing a qualified and competent Plastic Surgeon, trained for this type of intervention, you limit the risks at maximum, but not abolish them completely.
Fortunately, the real complications are rare following a mammaplasty for ptosis performed according the rules. In practice, the vast majority of surgeries go without any problems and patients are fully satisfied with their result.
However, despite their low frequency, you must still know the possible complications:
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The occurrence of an infection requires antibiotic treatment and sometimes surgical drainage.
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A haematoma may require evacuation.
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Delayed healing can sometimes be observed leading to longer postoperative course.
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Necrosis of the skin, is rarely seen with modern techniques and may be responsible for delayed healing (the risk is increased by smoking).
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Alterations in sensibility, including the nipple, can be observed, but normal sensitivity usually returns within 6-18 months.
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Especially the development of scars may be unfavourable even with the occurrence of hypertrophic scars or keloids, of onset and unpredictable changes, which can compromise the aesthetic outcome and require specific local treatment, often long.
In most cases however, this operation when correctly planned and executed, does offer very satisfying results in terms of comfort and well-being, even if scars are inevitable and remain its major drawback.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he/she will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.