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Women in western societies generally do not suffer as badly from
the early sagging of the breasts as those in less-developed
cultures (where brassiere wear is not common). However, ladies who
are well endowed or who grow very large during pregnancy or
nursing will eventually suffer from exposure to gravity and lose
youthful contour. This problem usually takes three forms. 1)
Hypertrophy (overdevelopment) of the breast may be so severe that
neck, back and shoulder pains are a problem. In these cases, a
reduction of the breast tissue may be required, as well as a
lifting of the breast. 2) Simple sagging of the breast may be the
problem if adequate volume of breast tissue is present, but the
contour has suffered from relaxation of the Cooper's ligaments,
which are the body's natural attachments of the gland to the
muscle of the chest. 3) Sagging with inadequate volume is most
commonly the result of atrophy of the breast tissue following
pregnancy, nursing, or menopause. In this case it is usually
necessary to place a breast implant, as well as do a breast lift
procedure.
Hypertrophy of the breast, when severe enough to produce neck,
back or shoulder pains, and when the amount of excess tissue is
more than a pound, may be covered by insurance. To determine this,
a consultation is necessary, and a predetermination from your
insurance will be obtained. Sometimes there is only a small amount
of excess breast tissue, and in this circumstance the procedure is
considered cosmetic (not covered by insurance).
Simple sagging of the breast, when the patient is satisfied with
the volume of tissue, requires a straightforward lift of the
breast, resecting only skin and basically constructing a skin
brassiere. Since all breasts are different (even your own two) the
exact planning of the operation, placement of the scars, etc.,
must be determined in a personal consultation. Some general
guidelines can be applied, however.
When the amount of sagging is minimal (the nipple rides low on the
breast, but not below the crease beneath the breast, the skin
incisions may be kept to a circle around the areola (the brown or
reddish-brown area around the nipple) and be fairly inconspicuous.
As the nipple rides lower, below the crease, or even to the point
where the nipple is the lowest point on the breast, more extensive
scars are required. In the worst-case situation, the scar will
circle the areola, go vertically down the breast from the 6
o'clock point on the areola to the crease under the breast, and
then go both directions to the inside and outside edges of the
breast. This scar has been described as looking like the anchor
tattoo on Popeye's arm. The exact length of the scar is determined
by the severity of the sagging problem and is beyond the control
of the surgeon.
Inadequate volume of tissue, with sagging, is both a positive and
negative factor. The use of a breast implant (see that page also)
will enable a lesser lift procedure with shorter scars than when lift
alone is performed, because the implant takes up some of the
excess skin. Whenever a mastopexy patient is willing to accept an
increase in volume, this technique usually simplifies the lift and
decreases the length of scar required.
All of the above procedures can be done on an outpatient basis,
but usually require general anesthesia, the exception being some
minimal lift operations, where the amount of movement of the
nipple required is less than two or three inches. Time off from
work varies with the extent of the procedure. Breast reduction may
require a month off work, while a minor lift may allow return to
some work the next day.
The potential complications of these operations are similar. As
with any plastic surgery, risks include hematoma (a collection of
blood), infection, and wound healing problems such as excessive
scarring, possibility of needing additional surgery, etc. Loss of
sensation in the nipple is an uncommon problem in all but the
breast reduction procedure, where it does occur, especially with
the more extensive operations.
To schedule an appointment to discuss this procedure with Dr.
Johnson, click here.
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