Breast lifts are the most challenging aspect of female breast surgery.

If you w
ant a lift, it means something must be dropping, and the medical word for droop
is ptosis. As a point of interest, the â pâ is silent in the word â ptosisâ .
Correction of breast ptosis can be done by a varied number of techniques dependi
ng on the amount of droop, cause of droop, and the surgeon's experience.
A well know system for defining breast ptosis is:
0) Zero degreee ptosis or pseudo ptosis when the nipple is in the right place,
and the breast tissue hangs below the bottom of the breast where it touches
the breast wall know as the inframammary line.
1) First degree ptosis is when the areolar, the pink or brown part around the
nipple, is below the inframmary line but the nipple itself is above. This ca
n be corrected by several techniques including biplanar masopexy, benelli ma
sopexy, or even a very large implant if that is the patient's desire.
2) Second degree ptosis is when the nipple itself is below the inframammary li
ne and most, if not all of the areola. If this is true, an actual breast lift i
s mandatory and no implant alone can correct this problem.
3) Third degree ptois is when the nipple areola complex is below the inframamm
ary line by a couple of centimeters, and in this situation, sometimes the nip
ple points at the ground. Third degree ptosis almost always requires a stand
ard anchor masopexy.
Biplanar masopexy or internal masopexy is when an implant is placed in the sub p
ectoral space, but release is done in the plane between nipple and the pectorali
s muscle, then a large piece of stickey plastic is connected to the skin, pullin
g the nipple and skin upward for several weeks securing a higher position of the
breast tissue and the nipple while the implant stays correctly at the inframamm
ary line.

Large breast implants, by themselves, cause correction in some minimal or Zero d

egree ptosis just because the volume of the implant causes the nipple to move up
along and arc created by the anterior projection of the breast implant away fro
m the body. Then high profile saline or silicone implants that exist today give
the best change of correction of minimal ptosis using only a breast implant.
The benelli mastopexy or circumareolar mastopexy is a technique invented by Dr.
Louis Benelli of Paris, France. I had the privilege of lecturing with Dr. Benel
li for twelve years on the mainland, and I also won a prize for the best videota
pe in plastic surgery for my scientific presentation on the benelli mastopexy (s
treaming video). The benelli mastopexy can be done with or without implants. T
he surgery leaves the incision only at the edge of the areola and is good for a
minimal or moderate ptosis.
Normally, there are four problems associated with breast droop or ptosis. The b
reast tissue hangs on the chest wall, the nipples normally below the inframammar
y fold, the areola is too large, and there is no fullness in the upper quadrant.
Mastopexy alone can correct the first three, but an implant is required to get
the desired fullness in the upper quadrant.
The standard mastopexy with or without implants will correct breast ptosis in an
excellent fashion. There is a vertical scar from the areola down to the fold, a
nd a horizontal scar in the inframammary fold. In breast ptosis surgery, as in
all cosmetic surgeries, it does not matter how much you take away but the appear
ance of what you leave is what counts. I do not believe the surgery ends when th
e patient leaves the operating room. I feel the surgeon is responsible to assis
t the patient in getting the best conceivable scar post operatively. To that en
d, a great number of permanent internal sutures are used on the breast to take t
he tension off the skin closure. The less the tension on the skin, the finer th
e scar. Unfortunately, there are very few people who get a bad scar no matter w
hat the surgeon does, due to their own genetic predisposition. The good news is
that most people do not have this genetic predisposition to scarring. Taping t
he breast scar post operatively decreases the thickness of the scar, the redness
of the scar, and the length of time until the scar is mature and as favorable a
s it will be.

A unique breast lift that I invented falls between a breast reduction and a brea
st augmentation, and I call it the Suction Reduction Augmentation Lift. It is n
ot for every breast, and it is not for every patient, but in the surgery, the su
rgeon does, through a 1/4â hidden incision, a suction breast reduction where all the
fat and much of the grandular tissue is removed by liposuction, very similar to
the technique used for male gynocomastia. It takes about six months for this s
uction reduction to get to the point where the breast can be augmented. During
that time, the areola gets smaller with the weight off the breast tissue, the br
east and nipple move up, often significantly, therefore correcting the first thr
ee problems in the ptotic or droopy breast. Of course, the patient has to put u
p with small breast for about six months, but then a transaxillary sub pectoral
breast augmentation can be done, giving a beautiful lift with smaller areola, th
e breast no longer is hanging on the chest wall, and fullness in the upper quadr
ant along with minimal to no scarring as the suction incision and armpit incisio
n are so small and well hidden that this becomes almost a scarless lift augmenta
tion. As I said, this lift is not for every breast and not for every patient, b
ut it is a great variation for the right breast and right person.