Surgical procedures of mastopexy

Indications
The surgeon–physician evaluates the woman requesting a breast-lift operation to confirm that she understands the health risks and benefits of the mastopexy procedure. The surgeon confirms that her ideal body image (aesthetic goal) corresponds to what can realistically be achieved with the plastic surgery options available. The following conditions are indications for mastopexy.
Sagging breasts, which prolapsed (fell forward) consequent to postpartum milk gland diminishment, menopause, gross weight-loss, et cetera.
Post-explantation ptosis, the sagging of the inelastic skin envelopes, once emptied of the breast implants.
Congenital ptosis and pseudoptosis, as observed in conditions such as tuberous breast deformity (constricted breast).
Acquired or relative ptosis, as seen in the post-mastectomy breast reconstruction of a bust that is of natural and proportionate size, look, and feel.

Mastopexy of the sagging breast
The following descriptions of the full breast-lift and of the modified breast-lift techniques are limited to the surgical incisions used to address the skin envelope of the breast, not the internal parenchyma, the substance of the breast.
Full breast lift
The sagging bust is lifted using the circumvertical- and horizontal-incision plan of the Anchor mastopexy (also Lexer pattern, inverted-T incision, Wise pattern, inferior pedicle), which features three incisons:
The Anchor ring: a circular incision at the upper-edge of the periphery of the nipple-areola complex.
The Anchor shank: a vertical incision from the lower edge of the nipple-areola complex to the inframammary-fold incision.
The Anchor stock: a horizontal incision along the inframammary fold, where the breast joins the chest.
In cutting the folds of excess skin from the sagging, inelastic skin-envelope of the breast (and occasionally reducing the nipple-areola complex diameter), the three-incision technique of the Anchor mastopexy allows maximal corrections to the breasts, thereby producing an elevated bust with breasts of natural size, look, and feel. Moreover, each of the three scars to the breast hemisphere produced by the Anchor-pattern mastopexy has a characteristic healing pattern:
at the periareolar area — the edge of the nipple-areola complex — the surgical scar is concealed by the light-to-dark skin color at the pigment transition, where the light-color breast skin becomes the dark-color areola skin (the ring of the Anchor pattern)
the medial vertical scar (the shank of the Anchor pattern) extends from the lower edge of the nipple-areola complex to the inframammary fold; the shadow of the breast hemisphere hides it
the horizontal scar (the stock of the Anchor pattern), which follows, and is hidden in, the inframammary fold.
Post-surgically, of the three breast-lift surgery scars, the scar to the inframammary fold exhibits the greatest tendency to hypertrophy, to thickness and large size. Although the coloration of mastopexy scars fades with the full maturation of the tissues, they do remain visible.
Modified breast lift
The incision plans of the techniques for modified breast lift feature fewer cuts and fewer scars, but limit the plastic surgeon by allowing fewer changes to the skin envelope of the breast. In surgical praxis, the modified breast lift often is a sub-ordinate surgery within a mastopexy–breast augmentation procedure, the simultaneous lifting and enlarging the bust. Moreover, these incisions are applied to correct the ptosis discussed above; some technical variants of the modified breast lift are:
the periareolar lift (crescent lift), featuring a crescent-shaped incision, above and at a variable portion of the nipple-areola complex perimeter, allows the cutting and removal of a crescent of flesh, thereby facilitates the elevation (transposition) of the nipple-areola complex to its higher (new) locale upon the breast hemisphere.
the circumareolar lift (Benelli breast lift, donut lift), featuring the cutting out of a concentric ring of flesh from around the nipple-areola complex, limits the size and diameter of the circular scar.
the circumvertical lift (lollipop lift, vertical scar), featuring a circumareolar incision, around the circumference of the nipple-areola complex, and a vertical incision from the lower edge of the nipple-areola complex periphery to the inframammary fold.

Mastopexy of the augmented breast
Women who have undergone breast augmentation also are susceptible to breast ptosis; which incidence might be induced by the physical and mechanical stresses exerted by the breast implants upon the internal tissues and the skin envelope; such overstretching thins the skin and atrophies its elastic qualities.[12] Statistically, breast augmentation and mastopexy are plastic surgery operations with low incidence rates of medical complications; yet, when performed as a combined breast-repair procedure (mastopexy–augmentation), the physiologic stresses upon the health of the woman increase the risks of incision-wound infection, breast-implant exposure, damage to the breast and nipple nerves leading to sensation changes, malposition of the nipple-areola complex, and malposition of the breast implant in the implant pocket. Therefore, a mastopexy–augmentation procedure features increased surgical complication rates, when compared to the lesser complication rates of breast augmentation and mastopexy as discrete surgical operations; likewise, the individual incidence rates of surgical revision and complications, when compared to the revision and complication rates for the combined mastopexy–augmentation procedure.[13] Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications. The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the final result, before making any surgical incisions to the breast.
Contraindications
The contraindications for mastopexy are few: aspirin use, tobacco smoking, diabetes, and obesity are medical and health conditions associated with increased incidences of nipple necrosis. In resolving the perceived ptosis of a woman with encapsulated breast implants, the surgeon determines her suitability for a breast lift procedure after explantation, which facilitates assessment of the true degree of ptosis present in the explanted breasts; likewise the assessment of the effects of a combined breast-lift and revision-augmentation procedure, featuring the removal and the replacement of breast implants. For the woman who is at high risk for developing breast cancer (primary or recurrent), the mastopexy might alter the histologic architecture of the breasts, which tissue change might interfere with the accurate MRI detection and subsequent treatment of cancer; the risks and benefits will be discussed in that setting.

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