Mastopexy (Greek μαστός mastos "breast" + -pēxiā "affix") is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding. The breast-lift correction of a sagging bust is a surgical operation that cuts and removes excess tissues (glandular, adipose, skin), overstretched suspensory ligaments, excess skin from the skin-envelope, and transposes the nipple-areola complex higher upon the breast hemisphere. In surgical practice, mastopexy can be performed as a discrete breast-lift procedure, and as a subordinate surgery within a combined mastopexy–breast augmentation procedure. Moreover, mastopexy surgery techniques also are applied to reduction mammoplasty, which is the correction of oversized breasts. Psychologically, a mastopexy procedure to correct breast ptosis is not indicated by medical cause or physical reason, but by the self-image of the woman; that is, the combination of physical, aesthetic, and mental health requirements of her self.
The patient The usual mastopexy patient is the woman who desires the restoration of her bust (elevation, size, and contour), because of the post-partum volume losses of fat and milk-gland tissues, and the occurrence of breast ptosis. The clinical indications presented by the woman—the degrees of laxness of the suspensory Cooper's ligaments; and of the breast skin-envelope (mild, moderate, severe, and pseudo ptosis)—determine the applicable restorative surgical approach for lifting the breasts. Grade I (mild) breast ptosis can be corrected solely with breast augmentation, surgical and non-surgical. Severe breast ptosis can be corrected with breast-lift techniques, such as the Anchor pattern, the Inverted-T incision, and the Lollipop pattern, which are performed with circumvertical and horizontal surgical incisions; which produce a periareolar scar, at the periphery (edge) of the nipple-areola complex (NAC), and a vertical scar, descending from the lower margin of the NAC to the horizontal scar in the infra-mammary fold (IMF), where the breast meets the chest; such surgical scars are the aesthetic disadvantages of mastopexy.
Breast ptosis
Etiology Gravity is the most common cause of breast ptosis, or sagging.
In a young woman with large breasts the sagging occurs because the volume and weight of the bust is disproportionate to body type, and because of the great elasticity of the thin, young skin envelope of each breast. In middle-aged women, breast ptosis usually is caused by postpartum hormonal changes to the maternal body (e.g., depleted adipose fat tissue and atrophied milk glands) and because of the inelasticity of the skin envelope, which is overstretched by engorgement during lactation. In post-menopausal women, in addition to gravity, breast ptosis atrophy is aggravated by the inelasticity of overstretched, aged skin. Pathophysiology and presentation In the course of a woman's life, her breasts change in size and volume as the skin envelope becomes inelastic, and the Cooper's suspensory ligaments—which suspend the mammary gland high against the chest—become loose, and so cause the falling forward and the sagging of the breast and the nipple-areola complex (NAC). Moreover, additional to tissue prolapse, postpartum diminishment (involution) of the voluminous milk glands in the breast aggravates the looseness of the suspensory ligaments, and of the inelastic, overstretched skin envelope. Mastopexy corrects said degenerative physical changes, by elevating the (internal) parenchymal tissues, cutting and re-sizing the skin envelope, and transposing the nipple-areola complex higher upon the breast hemisphere. The degree of breast ptosis of each breast is determined by the position of the nipple-areola complex (NAC) upon the breast hemisphere; ptosis of the breast is measured with the modified Regnault ptosis grade scale.
The Regnault ptosis grade scale Grade I: Mild ptosis — The nipple is located below the inframammary fold (IMF), but remains located above the lower pole of the breast. Grade II: Moderate ptosis — The nipple is located below the IMF; yet some lower-pole breast tissue hangs lower than the nipple. Grade III: Advanced ptosis — The nipple is located below the IMF, and is at the maximum projection of the breast from the chest. Grade IV: Severe ptosis — The nipple is far below the inframammary fold, and there is no lower-pole breast tissue below the nipple. Laurence Anthony Kirwan published an alternative classification system for ptosis of the primary or non augmented breast that is meant to be better suited than the Regnault scale for planning surgery.
Additional mastopexy considerations Pseudoptosis — The indication is the sagging of the skin of the lower half (inferior pole) of the breast, featuring the nipple located either at or above the inframammary fold (IMF); as such, pseudoptosis is a usual consequence of postpartum milk-gland atrophy. The nipple is located either at or above the IMF, while the lower half of the breast sags below the IMF. Pseudoptosis usually occurs when the woman ceases nursing, because the milk glands have atrophied, and so reduced the volume of the breast, thus the sagging of the breast-envelope skin. Parenchymal maldistribution — The lower breast lacks fullness, the inframammary fold is very high under the breast hemisphere, and the nipple-areola complex is close to the IMF. Such indications of the maldistribution of parenchymal tissues indicate a developmental deformity.
Surgical anatomy of the breast
… excerpt ends here. Continue reading the full article.
