MASTOPEXY surgery (breast lift) All PROMOTION PRICES and DISCOUNTS in Moscow

Aesthetic breast surgery is one of the most common plastic surgeries. About 700,000-800,000 operations are performed annually in the world. These include augmentation, reduction, lifting, as well as combined operations.

Women's breasts begin to undergo changes from puberty, and this process continues throughout life.

These changes are cyclical, and they are also observed with changes in body weight, during pregnancy, during and after breastfeeding, and also occur with age. Changes can lead to hypertrophy, postpartum involution, ptosis (with or without stretch marks).

Changes/deterioration in breast shape greatly affect a woman’s self-esteem. For this reason, many women decide to undergo breast surgery in order to regain their former shape or improve theirs.

Is it possible to have a breast lift without using implants?

Breast lift is performed with or without implants. There are two options, from which the patient chooses the appropriate one.

Mastopexy with implants - features of the operation

Main features of mastopexy:

❣ The operation is suitable for solving the problem of ptosis at all stages of its manifestation;

❣ The risks and level of complexity are assessed by the doctor during the patient’s personal visit and examination;

❣ It is imperative to refuse intervention if there are contraindications;

❣ The result of the procedure is stable, and repeated interventions are not required;

❣ Subsequent breast ptosis depends on its size, tissue elasticity, possible weight loss;

❣ The early postoperative period lasts three days;

❣ The time spent in hospital rarely exceeds 2 days;

❣ Antibacterial therapy is mandatory (to everyone, without exception, as preventive measures to prevent complications);

❣ Stitches are removed after about six to ten days;

❣ The dressing is done two or three times every week;

❣ You must wear compression underwear for a month;

❣ You cannot carry heavy things for a month (maximum weight for lifting is 5 kg);

❣ The localization and length of the scars depend on the chosen technique - all this is agreed with the doctor.

Before the operation, it is necessary to undergo a package of tests and undergo a consultation with a mammologist to exclude contraindications. In some cases, a visit to a phlebologist is required.

Preface

For many active readers of the site, the concept of “circular or vertical mastopexy” has become familiar, and inverted T-shaped mastopexy or reduction (reduction) is usually called “anchor lift”. From a professional point of view, the concept of “vertical mammoplasty” is a specific concept, a fundamental approach to the technique of performing an operation under the general name “breast lifting or reduction of the mammary glands.”

The plastic surgeon is required not only to “gather” the sagging, splayed breasts, but also to “put” the newly created wealth into a small vertical seam. In this case, it is necessary to carefully avoid performing a horizontal inframammary suture. In any case, make it as short as possible. It is a known fact that the inframammary suture most often looks unattractive due to its hypertrophy (coarse scarring).

Almost always, when performing mastopexy, a circular incision is made around the areola, since it is necessary to move (often reduce in size) the areola higher, to an aesthetically attractive position. In most cases, mastopexy requires a vertical suture. Attempts by some surgeons (sometimes to please patients) to use only a circular suture when there are indications for a full lift most often lead to rough scarring of the sutures around the areola (due to strong tension) and flattening (loss of cone shape) of the mammary glands. Foreign authors call the shape of such breasts “tomato breast”. That is, a chest that looks like a tomato. And there is logical, physically and geometrically proven confirmation of this. I can refer particularly inquisitive readers to A.M. Borovikov’s monograph “Ptosis of the mammary glands.”

So. _
What is important for the surgeon when performing mastopexy:
1. Assessing the condition of the mammary glands (the very structure of the parenchyma and skin).

2. Correct markings.

3. Virtual vision of the “assembled” mammary gland, when it is still in a “disassembled” state. Call it what you want: experience, intuition, mathematical or vice versa - artistic approach, etc.

4. Having some experience in using a different, unplanned method of correction if something does not go as planned. In other words, it is not enough for a surgeon to be able to “harvest” the gland in only one way or technique.

5. The ability (all plastic surgeons should have this, of course) to “sew” correctly.

The rest, as they say, will follow.

What
is important for the patient ?
The ability to find the right surgeon (just kidding). Of course, trust the doctor you choose (logically, calculatedly, or intuitively – it doesn’t matter) and be positive about an excellent result. Of course, that's not all. The rest – everyone has their own views on this point (surgeon’s experience, results, reviews, financial side, etc.). We will try to explain the above in more detail as we comment on the stages of mastopexy. So to speak, put it into pieces.

1. Assessment of the initial condition of the mammary glands

Our patient has ptosis of the mammary glands of the 2nd degree (the nipples are below the level of the inframammary groove), slight asymmetry (the right breast is slightly larger than the left), and the nipple-areolar complex (NAC) is located laterally (outward). The tissues of the gland are elastic and dense. The skin has good elasticity, elasticity, no stretch marks.

With this condition of the gland tissue itself - the parenchyma (let's call it "filler" according to Borovikov A.M.) and the skin (let's call it, probably, a little offensive for patients with the word "cover") - the prognosis for this patient regarding the stability and longevity of the result of the operation will be good. It is possible to plan a gland lift without an inframammary horizontal suture, since there is a harmonious correspondence between the volume of the “filler” and the size of the “cover”, and there is no significant excess skin. For example, in patients with pronounced sagging, stretched gland tissue (the so-called “empty breast”, albeit large in volume), as well as pronounced excesses of sagging skin with stretch marks, the prognosis for the long-term effect of the operation will be much lower, and the result will be less stable . In addition, with this type of operation, it will most likely be necessary to perform an “anchor” mastopexy due to the discrepancy between the physical properties of the “filler” and the “case”.

2. Preoperative markings before mastopexy

There are many schemes and even marking templates (even patterns) proposed by various surgeon authors. Their number is probably comparable to the many different methods of vertical mastopexy (at least several dozen). In his practice, a plastic surgeon, having gone through a certain path and tested many of the proposed methods, usually “calms down” on several of them (usually 3-4). The choice, as a rule, remains with those methods of operation (and, accordingly, marking), as a result of which this particular surgeon obtains the best results. Of course, it is pointless to try all the methods of operation proposed by various authors. Life simply isn't enough for this.

Next, the practicing surgeon only perfects and polishes the technique of a particular method. And sometimes he supplements the method of operation used with his own nuances, not forgetting to add his last name to an already well-known author in some publications. And in some cases, you can even forget to mention the original source... But this is already lyrics.

In our particular case, I planned to perform a vertical mastopexy using an inferior Ribeiro flap. True, in some modification, having spotted this moment at one of the regular events (master classes). Accordingly, the marking, let’s call it a work plan, was carried out based on the chosen method of operation. I will only note the main most important points of marking, on which the result of the operation largely depends.

First, the midline is marked from the jugular notch to the xiphoid process. Next, a perpendicular line at the level of the inframammary groove is projected onto it (the midline) (some people are more accustomed to hearing the “inframammary fold”). It is very important to mark the meridian as accurately as possible (to be honest, “by eye” - mathematics will not help here) - a line running from the collarbone through the middle of each mammary gland. This line does not necessarily go through the nipple. As, for example, in this case: the SAH is not in the center of the chest - it is shifted outward. Therefore, the meridian runs a little more medially (inward) from the nipples. The meridian line runs through the entire chest and continues to the chest wall (you can see this in the photo with raised arms).

After the meridian is marked, we determine the upper limit of the edge of the future displaced areola. To do this, measure 4 or 5 cm (depending on what level we want to see the “new” NAO) on the midline and project a perpendicular onto the meridian line. This is a very important point! After all, if the surgeon does not take into account the physical properties of the “filler” and “case” and cannot correctly predict the result of the operation (that is, postoperative natural gravitational ptosis of the breast), then this author may find himself in an awkward position. And the formed SAC will look like a button sewn high to the chest. Correcting this situation (lowering the SAC lower) will be very, very difficult. As you correctly understood, it’s better to under... than over...

Next we need to mark the lateral boundaries of the vertical leg . This is where we need the meridian line below the chest. Using his palm, the surgeon slightly shifts the breast alternately to the right and left, projecting (marking with a marker) the vertical line of the meridian onto the mammary gland. There is very little left. Connect all these points (upper border of the areola, points of the vertical leg) into one drawing. Around the SAC, the pattern resembles a “mosque roof” - these are the boundaries of the skin to be removed. The drawing below resembles half a leaf, well, for example, a birch tree. It may seem quite difficult to you for now, but the further course of the operation, I hope, will put everything in its place.

All other mathematical calculations and proposals in practice can be erroneous and sometimes even harmful. It is impossible to use standard criteria and numbers when labeling in a stereotyped manner; for all patients in a row. For example, “the distance from the jugular notch to the nipple should be 19 -21 cm,” some authors write. Others argue that if the distance from the nipple to the inframammary groove is more than 7-8 cm, an anchor lift should be done, etc. I repeat once again - there are a lot of physical factors of breast tissue that cannot be measured by any mathematical measurements. Plus the individual initial breast structure of each individual person, plus wishes for the future shape and much, much more.

3. Technical aspects of mastopexy

The operation is performed under general anesthesia and takes on average 2-3 hours. Although in simple cases it is possible to perform mastopexy in a shorter time. It is very important for the surgeon to be able to sit the patient down during the operation. This is necessary to assess the shape of the future breast in the otostatic position. Fortunately, modern operating tables allow you to perform a similar maneuver with one press of a remote control button.

Usually, in order to permanently preserve the “war paint” until the end of the operation, instead of fancy imported markers (which are washed off or smeared during the treatment of the surgical field), I prefer to use a “strong” solution of potassium permanganate of our domestic production. As they say, two in one: useful (antiseptic) and visual.

Next, a tourniquet is applied to the base of the mammary gland in order to obtain maximum straightening of the areola skin under the pressure of the bulging breast tissue. The concept of “tourniquet” (French tourniquet) in medicine is a hemostatic tourniquet in the form of a fabric or leather loop, twisted using a lever (stick). In particular, during mammoplasty, twisted gauze is used as a tourniquet, pulled under the base of the mammary gland. To form a new areola of the appropriate diameter, special markers are used. These are metal circles (in the photo in the lower right corner) of a certain diameter. As a rule, we use markers with a diameter of 4.0 to 4.6 cm in diameter, depending on the wishes of the patient and the aesthetic correspondence between the size of the breast and the diameter of the future areola.

In this case, we used an areolar marker with a diameter of 4.2 cm. The main points on the areola at 12, 3, 6 and 9 o’clock must be marked. In the future, we will need this for the most accurate, uniform comparison of the edges of the wound.

The next step is subcutaneous infiltration with a solution of adrenaline along the boundaries of the future incision. This helps not only to make the correct skin incision, but also to spasm the blood vessels, which means less bleeding.

A skin incision around the areola. The scalpel blade should be directed strictly perpendicular to the skin, which is facilitated precisely by preliminary infiltration.

The skin incision along the boundaries of the marking is completed.

The stage of de-epidermization of the skin (removal of its surface layer to the dermis itself) around the areola. A sign of correctly performed de-epidermization is the appearance of blood “dew” - droplets of blood on the dermis of a whitish color. If de-epidermization is performed incorrectly (removing the dermis itself down to the subcutaneous fat), then the capillary network of vessels responsible for the blood circulation of the SAH can be damaged.

The SAH has a well-developed network of feeding vessels running from the periphery to the center of the chest and forming a dense subdermal plexus. In general, the SAH receives a double blood supply - directly from the adjacent parenchyma of the gland and through the subdermal plexus. Therefore, the surgeon has the opportunity to cut out the SAH on both the dermal and parenchymal pedicles. The types and methods of cutting out dermoglandular “legs” will be discussed in more detail in the subsequent photo report dedicated to reduction mammoplasty. Unlike reduction matoplasty, with mastopexy the risk of SAH ischemia (circulatory impairment) is minimal, since we preserve both the subdermal and parenchymal blood supply.

Next, a flap (“tongue”) on a feeding pedicle is cut out from the tissue of the lower slope of the mammary gland. We will need this “tongue” to move it higher and “put it” under the gland.

Detachment of breast tissue (m.g.) from the pectoralis major muscle (PMM), covered with fascia, is performed. The level of detachment is the upper border of the m.zh. A central tunnel about 6–8 cm wide is formed under the mammary gland. In this case, the detachment should not be carried out too widely to the sides so as not to damage the branches of the arteries (superior external and internal perforating) and not to disrupt blood circulation in the area of the SAH.

After the detachment is completed, we carry out plication (gathering) of the tissues of the upper slope of the m. by moving and fixing it to the fascia of the femoral bone. To do this, we apply several separate interrupted sutures with absorbable threads (the so-called “suspension threads”). This allows the upper slope of the chest to be filled to some extent.

Deep-epidermization of the skin is performed on the lower flap - the “tongue”. We deliberately do not do this immediately after isolating the tongue. The skin “island” allows us to correctly orient ourselves and not twist the thin feeding “leg” of the flap.

Next, we fix the flap of the lower slope to the posterior layer of the capsule (proper fascia) of the mammary gland. This maneuver is called “autoaugmentation” - increasing the volume with one’s own tissue. Of course, in essence, there is no increase in the total volume of the gland, since changing the places of the terms does not change the sum. And yet, with this maneuver, we to some extent reduce the ptosis factor, which is the sagging tissue of the lower slope of the mammary glands.

Most authors who use the lower flap for autoaugmentation (L.Ribeiro and others) propose fixing this flap to the fascia of the femoral bone (a) or even pass it under the muscle “strap” (R.Graf) (b), arguing that this The technique allows you to steadily fill the upper slope of the chest. Unfortunately, long-term follow-up of patients does not confirm the stability of the effect of this maneuver. In addition, fixation of the flap to the femoral bone in some patients leads to tissue retraction in the lower part of the vertical incision when raising the arms.

After completing all the “deep internal work,” temporary sutures are placed on the edges of the areola and on the upper edge of the vertical incision.

The assistant lifts the mammary gland with a hook, simulating an orthostatic position. We stitch the lateral “columns” of the mammary gland with separate interrupted sutures using absorbable thread (a), the stitching stage is completed (b).

Temporary sutures are placed on the skin. The most exciting moment for the operating team is coming.

The patient was transferred to an orthostatic position for a preliminary assessment of the shape of the right breast - the difference between the right (“collected”) and left breast was clearly determined. (A). It is very important to evaluate the shape of the breast in the position of orthostasis (the effect of gravity), even if the “collected” breast looks great in the lying position. Additional “adjustment” of the shape of the breast: small excess skin around the areola was marked (with potassium permanganate) and it was determined that it was necessary to remove some skin in the area of the inframammary fold to obtain optimal roundness of the lower slope of the breast (b).

Excess skin around the areola is excised. As you can see, our “notes” on the areola were preserved during the operation. They will help us correctly form the roundness of the future areola.

Symmetrically with the marks on the areola, marks are projected onto the edges of the skin incision - at 12, 3, 6, 9 o'clock and in the middle between them. This will allow us to distribute the seams as evenly as possible and bring the shape of the areola closer to a perfect circle.

Applying a circumareolar suture according to Hammond using Gortex thread on a straight needle. We deliberately use Gortex - it is a non-absorbable thread (the areola will not spread in the future), smooth and inert (does not cause inflammatory reactions in the tissues). Additionally, a marked area of skin at the bottom of the vertical seam will be removed.

Final assessment of the result of the operation in the orthostasis position before suturing the skin. You can see the difference between the “collected” right and untouched left mammary glands. Mastopexy on the left will be performed in a similar way.

The final appearance of the mammary glands after skin suturing. Rubber outlets (drains) are left in the wound. To prevent circulatory problems in the areola, papaverine injections were made.

Postoperative period

Drains are usually removed the next day during dressing. Next, the patient is recommended to wear supportive underwear (top), treat the seams with alcohol, and dry them with potassium permanganate. To reduce swelling and resolve bruises and hematomas, ointments (traumeel, bepanthen, lyoton, etc.) are used. Showers are allowed for 3-4 days. Heavy physical activity, sports, visiting baths, saunas are not recommended for 3 weeks. The sutures cannot be removed, as the threads are made of absorbable material. Only the “tails” of the threads sticking out on the skin are trimmed on the 8-10th day. Next, the patient glues special Steri-strip strips to the edges of the wound for 3-4 weeks to reduce the load on the sutures and better scar formation. After 1.5-2 months, we recommend wearing special silicone patches (Mepiform, etc.).

Result of the operation

The preliminary result of the operation can be assessed after 3-4 weeks. The final formation of the breast occurs by 3 months. Up to 6-8 months, the scar goes through the stage of maturation (it is red, dense, sometimes slightly convex, etc.). After which it gradually brightens, thins out and becomes unnoticeable. Of course, the quality and type of scar largely depend not only on the sewing technique and the threads used, but also on the individual characteristics of the body.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

View of the patient 6 days after surgery. Bruises are still visible, with the yellowness characteristic of the last stage of their maturation. The seams are “tinted” with a strong solution of our favorite potassium permanganate. Of course, the upper slope looks well filled after the “internal work” we carried out. But, to our great regret, a natural prolapse of the gland tissue gradually occurs under the influence of gravity. As a result, the breasts will have a beautiful, teardrop-shaped shape, and the vast majority of patients are quite happy with this type of breast. In any case, patients rarely return to us for breast augmentation with implants after mastopexy.

This is not a public offer! There are contraindications. Before use, consultation with a specialist is required.

View of the patient one month after surgery in comparison with preoperative photographs. The shape of the breast has undergone virtually no changes compared to its appearance in the early postoperative period.

In conclusion, I would like to note that mammoplasty is one of the most interesting, spectacular and at the same time quite complex operations. Many steps cannot be “calculated” and there are no templates that can be used in each case. The physical properties of skin and gland tissue (firmness, elasticity, rigidity) cannot be measured or calculated mathematically.

But let's be fair. All of these factors can be attributed to most operations performed by surgeons. Maybe that’s why there is no more interesting specialty (as they say, IMHO) than surgery. And what if it’s plastic surgery!…

To communicate with patients who have undergone breast augmentation, lifting or reduction, come to our forum in the Mammoplasty

How is breast lift surgery performed?

Typically a breast lift is performed under general anesthesia. The exception is light operations with minimal intervention. The surgeon makes marks on the skin, indicating the boundaries. The doctor also marks the incision lines where the tissue will be excised, the place where the nipple and areola will be moved.

After the procedure, the patient is taken to the ward, where she regains consciousness. The duration of the operation is from 30 minutes for mild cases and 2-3 hours for complex cases, when several procedures are combined (for example, endoprosthetics).

Preparing for mastopexy surgery: important points

As part of the preparation, the patient visits the doctor. It is necessary to agree on the type of operation to be performed and the desired result. The surgeon gives an appointment for tests and visits to other specialists. If no contraindications are found, a time is set when the patient needs to come for the procedure with the expectation that she will stay in the clinic for a day after the operation.

Before and after surgery, medications that reduce blood clotting should be avoided. You should not smoke, drink alcohol, or drink aspirin for two weeks before the procedure. On the day of surgery, no liquids or food are taken.

Indications

As mentioned above, the main indication for mastopexy is prolapse of the mammary glands. In most cases, women turn to plastic surgeons after lactation, sudden weight loss, or women with age-related changes.

Mastopexy is contraindicated under the following circumstances:

if the breastfeeding period ended less than a year ago
if a woman plans to become pregnant and/or breastfeeding
if a woman suffers from diseases of internal organs (cardiovascular pathologies, blood diseases, diabetes mellitus, cancer and others)
if a woman does not have a constant weight, and her body weight changes
if there are fibrous changes in the area of the mammary glands and the sutures do not heal well
other contraindications (determined by a doctor)

To avoid complications, the patient must undergo a preparatory stage before undergoing mastopexy. First of all, this is a complete examination to identify contraindications.

How to choose the right plastic surgeon for a breast lift?

Pay attention to the doctor's experience in the field of plastic surgery. A breast lift in Moscow is performed by a specialist who can provide photographs of previous work. Pay attention to the reviews about the specialist, talk about the conditions, the specifics of the methods being implemented, discuss the possibility of obtaining the desired result.

Experience and high qualifications are the main selection criteria. In general, mastopexy, prices for procedures and other issues are usually discussed in a personal meeting.

Vertical mastopexy: before and after

Patients come to the appointment with various complaints:

Development of mastoptosis;
Breast asymmetry;
Deformation of the areola and nipples;
The appearance of stretch marks;
Loss of shape and firmness of the mammary glands.

A breast lift using a vertical incision helps to get rid of many appearance defects.

After plastic surgery the following is observed:

Disappearance of sagging skin and sagging breasts;
The raised shape visually increases volume;
Disappearance of psychological discomfort;
Almost invisible scars.

The final result depends on the qualifications of the surgeon, his experience and knowledge, as well as on the existing disorders of the mammary glands.