Breast Ptosis

Breast ptosis is defined by sagging of the breast and distension of its skin envelope. The breast is positioned too low and frequently "emptied" in its upper portion.

Ptosis may be present from the outset but most often occurs after significant weight loss or following pregnancy with breastfeeding. It may be isolated: this is referred to as pure ptosis. It may also be associated with a degree of breast hypertrophy.

Conversely, breast ptosis may be observed in the context of an overly small breast (breast hypoplasia or hypotrophy).

These defects alone do not warrant health insurance coverage.

The surgical procedure aims to reposition the areola and nipple in the correct position, to reconcentrate and elevate the gland, and to remove excess skin to obtain two harmonious, beautifully contoured and elevated breasts.

The operation consists of reshaping the breast by acting on the skin envelope and the glandular tissue. The gland is concentrated and placed in the correct position.

The skin envelope must then be adapted, which requires removing excess skin to ensure good hold and a beautiful shape for the new breast. These steps allow repositioning of the areola and nipple, which were too low.

The edges of the skin that have been cut are sutured at the end of the procedure: these sutures produce the scars.

In cases of very significant ptosis, the scar takes the shape of an inverted T with three components: peri-areolar around the areola between the brown and white skin, vertical between the lower pole of the areola and the inframammary fold, horizontal concealed in the inframammary fold. The length of the horizontal scar is proportional to the extent of ptosis.

More often, in cases of moderate breast ptosis, a so-called "vertical" method can be used, eliminating the transverse scar in the inframammary fold and reducing the scar burden to its peri-areolar and vertical components.

In certain cases of very moderate breast ptosis, it is possible to use a technique that allows correction of the sagging with only a scar around the areola.

Finally, when ptosis is associated with insufficient volume (breast hypoplasia), it may be advisable to place, during the same procedure, a prosthesis to restore satisfactory breast volume, or a fat complement to improve the cleavage.

Sometimes, breast asymmetry may persist, whether in volume, height, size or orientation of the areolas.

In all cases, a secondary surgical correction can be performed, but it is advisable to wait at least one to two years.

Mastopexy, although performed for essentially aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

Postoperative recovery is generally straightforward following a mastopexy. However, complications may arise, some general and inherent to any surgical act, others loco-regional and more specific to mastopexy.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

• Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. Having recourse to a fully competent Anaesthetist practising in a truly surgical setting means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety.

• Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, you minimise these risks as much as possible.

Fortunately, true complications are rare following a mastopexy performed according to standard practice. Nevertheless, you should be informed of possible complications:

• Infection requiring antibiotic treatment and sometimes surgical drainage.
• A haematoma may require evacuation. • Delayed healing may sometimes be observed, prolonging recovery.
• Skin necrosis, rarely observed with modern techniques, may cause delayed healing (risk greatly increased by smoking).
• Sensitivity changes, particularly nipple sensitivity, may be observed but normal sensation usually returns within 6 to 18 months.
• Especially, scar evolution may be unfavourable with hypertrophic or even keloid scars, of unpredictable appearance and evolution, which may compromise the aesthetic result and require specific local treatments, often prolonged.

Thus, in the vast majority of cases, this procedure, well planned and correctly performed, produces a highly appreciable result, even if the inevitable scar burden remains the main drawback.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty. Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.