Breast Lift, Augmentation, and Reconstruction: Insight and Considerations

While there can be no ignoring that plastic surgery remains an ethical concern for many individuals (with cosmetic breast surgery an especially sensitive area for many feminists), the growing worldwide acceptance of body modification in general, and of female breast enhancement in particular, reflects an evolution of cultural priorities regarding how we have come to define acceptable self-improvement. Accordingly, plastic surgery today strives to provide an ever-expanding array of technological advances that broaden the horizon for those considering breast surgery procedures.

The Breast Lift

Often described as a “face lift for the breasts,” mastopexy is a popular procedure chosen by a growing number of women wishing to correct sagging or drooping breasts due to weight loss, having congenitally large breasts, or simply to counteract the passage of time.

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Most often referred to as a breast lift, the procedure involves removing excess skin and fat from the breast and then repositioning the nipple at a higher position, most often by some variation of the “keyhole” technique.

The so-called “keyhole” technique involves first deciding how much tissue is to be removed, then drawing a keyhole-like pattern directly onto the breast, encircling the areola. The tissue is then removed from below and from the sides of the breasts, with the nipple preserved on a small section of skin, retaining as much of the blood-supply as possible. The nipple is then raised into its new position, the skin is drawn together and sutured, creating both uplift and reduction of the breast size. The resulting scar encircles the nipple and extends downward to the underfold of the breast.

Sometimes incorporating breast reduction or augmentation, a breast lift is most often performed in a surgeon’s office under general anesthetic on an outpatient basis, and typically takes about two to two and half hours to complete.  While the stitches can be removed after about two weeks, it is generally recommended that driving or participation in sports be postponed for about three weeks.

Although patients typically suffer significant pain for the first day or two, the breast lift procedure is said to have no inherent medical side-effects. Nonetheless, as with most breast surgery procedures, women often report a reduction of sensation to the breasts and nipples, which many consider a deterrent to undergoing the procedure. Additionally, women planning to breastfeed at some future time should be aware that about half the women undergoing a breast lift lose the ability to nurse.

While many women report having no regrets about having opted for a mastopexy, others fail to appreciate that a breast lift will not restore breasts to what they were at 20 years-of-age, and will not enable their breasts to defy the passage of time.  A mastopexy is only a temporary fix that needs to be repeated to be maintained.

Breast Augmentation

Medical experts suggest that before committing to this potentially complicated procedure, women should undergo a mammogram to check for signs of cancer, as well as an aspiration biopsy cytology (ABC) procedure to check for cysts to make certain they are viable candidates for breast augmentation. (The ABC procedure involves the insertion of a fine needle into the breast to extract tissue for microscopic examination.)

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Once designated a healthy candidate, the size and type of implants to be used must be decided. This is generally a matter of a woman’s (or man’s) particular size, build, and amount of breast tissue available. Then it’s a matter of saline or silicone (which come in a variety of styles and textures), and where the implants should be placed. Placement relates directly to where the incisions will be made: through the armpit, under the breast, or around the areola (or variations of these techniques) are most common. Implants can be placed under the breast tissue between the breast and the chest muscle, or under the muscle itself, depending on the overall look a woman wishes to achieve.

While most surgeons have their preferred method of implantation, the general consensus is that placing the implant under the muscle has two advantages, and two disadvantages. While this position seems to carry less risk of “contracture” (an abnormal pulling that can be unsightly and uncomfortable) and is less likely to hide cancer should it develop in the future, the breasts often appear flatter, with the breasts often moving with use of the muscle.

Most often performed on an outpatient basis requiring about two hours or more--depending on where the implants are positioned--breast augmentation patients can generally go home immediately after the procedure. Though the stitches can be removed after about 10 days, driving and strenuous activities should be avoided for at least three weeks. After that, jogging and even tennis can be resumed.

While complications from breast augmentation are less frequent in recent years, infection does occur in about 1% of patients, and permanent desensitization of the nipples (and overall reduced sensation of the breast) in about 2% of patients. There is also, of course, the likelihood of visible scarring and difficulty breastfeeding. And looking long term, implant ruptures due occur do to impact or strenuous physical force.

Reconstructive Breast Plastic Surgery

In past decades, women who had undergone a mastectomy, had to choose between “stuffing” her bra--which seldom looked or felt natural--or proceeding through day-to-day life obviously missing a breast.  In more recent times, however, the ability to create an artificial yet natural-appearing breast through reconstructive surgery has made an enormous difference in countless women’s lives around the world--both physically and emotionally. It is, however, essential for any woman considering this type of surgery to be fully aware of the limitations of this highly complicated procedure, and be prepared to set realistic expectations from the start.

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The most important thing to understand is that an artificially “constructed” breast is not a real breast. Although it may look and perhaps even feel real to anyone touching it, it will never have the full range of sensation a natural breast has. And while in some cases sensitivity may improve with time, a woman should never expect a constructed breast to substitute for your own natural breast. Even so, many women report that since it makes them feel normal, and is perceived by outsiders as real, they often learn to emotionally connect with their constructed breast(s) much as if it were nature-given.

For many breast cancer survivors, breast reconstruction provides something nothing else can: a means by which to put their cancer ordeal in the past. Breast cancer survivors speak of having to relive the cancer ordeal each time they look at the concave scar where their beautiful breast had once been. Even casually brushing their arm across their flat chest becomes a constant reminder of what they lost. Reconstruction surgery gives many women the ability to perceive themselves as whole and healthy and ready to resume their normal lives.

Performed by a number of methods, reconstructive surgery of the breast applies two basic approaches: those using artificial substances (saline or silicone implants), and those utilizing the patient’s own body (a flap of skin, muscle, and fat taken from another part of the body and then incorporated into the chest). While implants provide a viable option for most women, the general lack of breast tissue greatly limits the size implants that can be utilized. Thus, the myocutaneous flap-harvesting approach allows for the construction of larger breasts with more natural droop, while avoiding the potential mismatch when only one breast is to be constructed.

It should be noted, however, that because of the extreme complexity and newness of the flap-harvesting approach (and breast reconstructive surgery in general), health professionals warn that relatively few surgeons have sufficient experience in this area, and may be difficult to find. Additionally, the recovery period following reconstructive surgery can involve many weeks or even months during which time activities need to be greatly restricted.

References:

http://www.plasticsurgery.org/cosmetic-procedures/breast-lift.html

http://www.implantinfo.com/

http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastReconstructionAfterMastectomy/index

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