- Pre-op instructions
- Risks and Complications
- Frequently Asked Questions
- Tailor Tacking Technique
- 2-Stage Breast Procedure
- Post-op Instructions
- Before & After Photos
Mastopexy refers to lifting and reshaping of the breast. It can be combined with an increase in breast size (augmentation-mastopexy). The operation involves rearranging the breast tissue, shifting the nipple position and increasing the breast firmness by tightening the skin. Modern innovations in breast lift techniques include limited incision techniques, nipple sensation sparing techniques. Many of our post-bariatric patients are in need of breast lifting and breast augmentation to give them fuller, perkier breasts. You have a choice of breast implants and we will discuss the differences of saline vs. silicone gel implants with you at your consultation.
Before & After Breast Lift with Implants
Breast Implant Settling
One of the most frequent questions from patients is regarding breast implant settling. Patients are interested in understanding implant settling expectations immediately post-op, and then over time. Click on the button below to view two cases over time what these patient’s implants looked like immediately post-op, and then how they settled over time.
PICO Dressing Placed Intra Operatively After Breast Augmentation / Mastopexy Surgery
La Jolla / San Diego Cosmetic Surgeon Dr. Tom Pousti Talks About Breast Lift (Mastopexy) with Implants
Patient Vision Boards Help Achieve the Perfect Look & Results!
The Surgical Procedure
This patient desired to lift her breasts to achieve a larger and more perky look. She desired and thought about this surgery for years. She was unhappy with the way her breasts presented.
She came in for a consultation where Dr. Pousti determined she would be an excellent candidate for a breast augmentation and stage 3 breast lift. He recommended the use of silicone gel breast implants due to her goals of a more natural look and feel.
The markings and measurements are performed the morning of surgery and once everything is finalized, the patient is taken into the operating room. These markings are used to ensure symmetry and help the surgeon know where incisions should be located.
The use of the Tailor Tacking technique prevents errors in nipple-areolar placement and is a very important part of the mastopexy procedure. It ensures that the right amount of skin is removed during the surgery. If too much skin is removed during a breast lift with implants it can limit the size of the implant that is going to be used and can cause tension on the incision lines during closure and healing. This could then result in further surgery due to wound healing problems and possible implant exposure. If not enough skin is removed during the lift the patient can be left with loose skin and be unhappy with their results.
She is shown immediately post surgery and has bilateral 495cc high profile Sientra silicone gel breast implants.
The patient is shown below at 10 weeks post surgery.
Note the long term superior volume that is present.
The Surgical Procedure
The operation takes between three to four hours.
Markings are done prior to surgery
Dr. Pousti reviews the patient’s goal photos with her several times prior to surgery
Before Breast Lift with Implants
Dr. Pousti used a sizer implant to view potential results
Immediately After Breast Lift With Implants
Tailor Tacking Technique During Mastopexy Surgery
Potential Risks and Complications
Breast augmentation / mastopexy (breast lifting) surgery is one of the most commonly requested breast contouring surgeries performed. Patients who seek to have this operation done generally wish to improve the contour of the breast by lifting the nipple-areola complex by tightening up the “skin envelope” and achieve increased fullness of the breasts especially superiorly and along the cleavage area. The combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time. Revision mastopexy may also be necessary if the patient gains or loses weight or becomes pregnant. Loss of breast skin elasticity may contribute to the earlier need for revisionary surgery (repeat lifting) as well.
When breast augmentation / mastopexy surgery is performed, an implant is used below or on top of the pectoralis muscle. The breast tissue and skin is then elevated lifted) to cover the breast implant. This “lifting” often involves skin excision, the areola, vertically and sometimes horizontally. This skin excision serves to tighten the “skin envelope”. By doing so, a lifted appearance of the breast is achieved and the loose-saggy appearance and feel of breast tissue is eliminated. Herein lies the competition and the potential risks and complications: the mastopexy procedure by definition involves reducing the skin envelope allowing for repositioning of the nipple-areola (and reshaping the breast). Breast augmentation by definition enlarges the breast and expands the skin envelope. Also, placement of an implant necessitates dissection of a “pocket” that reduces blood flow. The blood flow is further compromised by incisions used to reduce the skin envelope.
Because of these factors, while breast augmentation OR mastopexy surgery is relatively simple and complication free, breast augmentation / mastopexy surgery done together carries increased chances of complications and need for further surgery. For example, there is an increased risk of infection, implant exposure, breast asymmetry, loss of nipple-areola sensation, inability to breast feed, mal-positioning of the nipple-areola complex, mal-position of the implants, wound healing problems, tissue necrosis, loss of blood supply to the nipple-areola complexes. Any of these complications may require further surgery, therefore, increasing the likelihood of revisionary surgery. It is important that the patient understands the principles behind any planned procedure of any breast augmentation / mastopexy surgery. An understanding of the procedure will facilitate an understanding of the potential risks and complications when they occur. A well-informed patient may decide to stage the procedures (for example, perform the breast lifting operation initially followed by breast augmentation at a later date). A well informed patient who decides to proceed with single stage breast augmentation / mastopexy procedure should understand the nature of the procedure, the increased potential risks and complication so the combined procedures (compared to the procedures performed individually), and the higher likelihood of revisionary surgery to correct imperfections that arise from the combined procedures. This revisionary surgery may impose additional discomfort, recovery time, time off of work and cost to the patient.
To summarize, single staged breast augmentation / mastopexy surgery carries increased risk compared to either of the procedures done separately. In order for the patient to make a well informed decision, it is necessary for her to understand the potential increased risks and complications as well as the potential need for further surgery when the single staged procedure is performed. This will allow the patient an opportunity to proceed with two staged procedures (procedures done separately) or proceed with the single staged procedure with the increased risk of potential risk and complications and need for further surgery.
What To Expect After Surgery
Pain is rarely strong, more commonly being a degree of discomfort. Swelling occurs but usually begins to subside by the third or fourth day. Some degree of swelling may persist for longer periods. A well-fitted bra is worn day and night for three weeks. While there is probably seldom interference with future breast feeding, women are cautioned that it may not be possible to breast feed in the future.
Post Operative Care Instructions (Massaging post surgery)
Use of Silicone Sheeting to Improve Scarring from Breast Augmentation Surgery
Driving may be resumed in 2 weeks.
Non-contact sports in 3 weeks.
Contact sports in 6 weeks.
Sexual activity in 2 weeks.
I never really thought that I was the type of person who would get plastic surgery done. My body was far from being perfect, but I was comfortable with the way that I looked and never saw the need for surgical intervention. Having four kids completely changed that. My once flat stomach had turned into a wrinkly mess. My abdominal muscles had completely stretched so it looked like I had a big belly, even though I had lost all of my pregnancy weight. I breastfed all four of my children so my breasts looked deflated. Prior to having children, I never had to worry about clothes – but now I had to think about how best to hide my stomach or pick tops that didn’t accentuate my saggy breasts. I was exercising every day, eating only healthy foods and soon was back down to my pre-pregnancy weight. I was thrilled but
still so disappointed because there was nothing I could do about the extra skin on my stomach or my saggy breasts. Even my doctor said that I could do a million sit ups a day but nothing but surgery could get rid of the wrinkles and extra skin on my stomach. So, after discussing it with my husband, I decided to have plastic surgery.
I had heard about Dr. Pousti through a friend of mine. After meeting him I knew that he was the right doctor for me. He was extremely professional and understanding. His staff was all so friendly. One of the things that helped me in choosing Dr. Pousti as my surgeon was the fact that he introduced me to previous patients who had had similar surgeries done. I was able to see actual patients and not just pictures. It was so helpful to see his work and talk to patients about their experiences. After leaving Dr. Pousti’s office after that first visit, I knew that he was the doctor for me.
I ended up getting a tummy tuck, breast lift and breast augmentation. The surgery itself was uneventful. Everything went smoothly and I had no complications. The hardest part was not being able to pick up my children for almost 4 weeks after the surgery. Dr. Pousti and his staff were absolutely amazing. They walked me through the whole process and followed up with phone calls almost twice a week. They were sincere and genuine in their concern for my well-being. The girls in his office are so warm and caring – I actually looked forward to my follow-up visits – his staff made the appointments so enjoyable.
It’s been 4 months since my surgery and I can honestly say that it’s been life-changing. I was prepared for the physical changes that occurred but was not at all prepared for the emotional changes. I have so much more self-confidence than I had after having my children. Even my husband noticed and said that I exuded a confidence that he hadn’t seen in a while. I know that a person’s self-worth shouldn’t be found in one’s physical appearance. However, I think that if you’re unhappy about something about yourself (whether it be a physical or character trait) you should work to change it. I had done all that I could to change my problem areas – I just needed a little assistance to complete it. I’m absolutely and completely thrilled about my new body. I feel just like I did before having kids. I owe everything to Dr. Pousti and his wonderful staff. I feel completely indebted to him for giving me a part of my identity back.
Thank you Dr. Pousti. Your kindness, hard work, and professionalism will forever be appreciated.
OK, so we have all been there or we wouldn’t be here. We’ve sat on the beach next to our man and caught him catching a glimpse of a girl in the bikini and wished we were her or at least built like her. Nice shape and all. We are the ones at the swimming pool covered up with the over-sized towel to hide what time has either taken away or maybe didn’t give us to start with. I WAS ONE OF THOSE WOMEN. After having several children, my body was definitely lacking what once was. But at my age, I thought I was crazy for even thinking about having plastic surgery. I thought long and hard about it and met with several specialists. It was not until I met Dr. Pousti that I was sure this was the right thing to do. Right from the start, Dr. Pousti made it clear to me that he would not do the surgery for my husband’s sake. He would do it if it was for me. I did not know how much it would change my life. Dr. Pousti made me feel so comfortable from the very first visit to his office. His staff was very professional and made me feel very comfortable the way they helped me with the scheduling, the paperwork and the appointments. It was after my first visit with Dr. Pousti that I made the decision to go ahead with surgery. I FEEL LIKE A NEW WOMAN. My confidence is way beyond my expectations! I am proud of my body! Thanks to help from Dr. Pousti, I love the way I see myself when I look in the mirror. I have the confidence in myself that I haven’t had in many years. I thank God for Dr. Pousti, for giving me my woman-hood back. To all of you reading this letter, all I can say is, you are in the right place with the right doctor. GO FOR IT! and enjoy life the way that I am finally enjoying it!!!