The breast lift has become the third most popular portion of a total Mommy Makeover after the tummy tuck and the breast augmentation. Historically, the breast lift was a natural consequence of the breast reduction invented in Germany during the 19th century. The original technique, commonly referred to as the ANCHOR technique, reduced the overall volume of the breast, elevated the nipple areolar complex, decreased the nipple areolar complex in size, and eliminated the breast tissue that was hanging on the chest wall. Newer variations on this lift/reduction technique have allowed minimal tissue removal and lessening of the original scarring.
The reason or necessity for a breast lift is basically the breast hanging on the chest wall. This is usually a post pregnancy phenomenon, although at times, it is seen as a genetic variant, i.e. some women just get droopy breasts as a consequence of their genetic makeup. The medical term for breast droopiness is breast PTOSIS. Breast ptosis usually has four components: 1) the areola is too big; 2) the areola is too low on the breast mound; 3) the breast is hanging on the chest wall; 4) there is no fullness in the upper quadrant of the breast.
The ANCHOR technique has been given a bad rap due to excess scarring. However, this technique normally gives an excellent breast shape, and when a subpectoral breast augmentation is added to it, corrects all four of the major problems seen in a droopy or ptotic breast. There are many techniques in the anchor breast lift surgery to decrease scarring. The majority of these techniques include taking tension off the suture line by putting strong heavy sutures deep in the breast tissue to bring the tissue together, and therefore decrease tension on the actual suture line. I personally place a dart of breast tissue along the horizontal limb of the breast reduction surgery to also decrease tension.
Surgery does not end at surgery. It ends when the patient has the least possible scarring based on their genetics. To that end, I always tape along the suture line post surgery for weeks to months to increase the likelihood of minimal scarring and redness.
The VERTICAL breast lift has gained a great deal of popularity in the past decade, but I personally feel this surgery is overused by many plastic surgeons leading to the appearance of too high a nipple areolar complex, and very often breast tissue fallout. I believe the vertical lift should be used in cases of minimal to moderate droop, and I feel that correction of “star gazing” nipples seen in many vertical lifts can be accomplished by adding a horizontal limb which then makes it obvious that the standard or anchor breast lift should have been done in the first place.
For lesser degrees of droop, the BENELLI MASTOPEXY leaving minimal scar just at the edge of the areola, is an excellent alternative to more scarring, and therefore less aesthetic techniques.
For the minimal droop of ptosis or for low placed nipples, I recommend the INTERNAL MASTOPEXY, also known as the DUAL PLANE MASTOPEXY which allows nipples to rise higher and offers minimal to no scarring when done through a surgical approach through the armpit. This is a unique technique, and it is not for every patient, nor should it be done by every plastic surgeon. This technique allows the nipple to move up on the breast mound without any visible scarring, while at the same time keeping the breast implant below the pectoralis muscle in its upper portion.