Breast sagging correction (Mastopexy)
1.Pathophysiology of breast sagging
(1) Normal breast anatomy
①Glandular body located in 2-6 ribs
②The nipple areola is located above the inframammary fold, the center of the breast augmentation
(3) The distance from the upper sternal fossa to the nipple is 17-21 cm
④The nipple is 7-8cm from the inframammary fold
(2) Anatomical changes of the sagging breast
①Displacement of the nipple downward
②Mammary tissue is lower than the lower crease
③Increased distance from the upper sternal fossa to the nipple
④Ligament-suspending tissue loss of elasticity
⑤Etiology includes: gravity, hormonal changes, weight loss and glandular atrophy
2. Assessment of the patient: based on a complete medical history and physical examination is required
(1) Assessment of sagging breasts.
①Size, shape and glandular ratio
② Degree of sagging
a. Degree I (mild): nipples are located above the inferior crease
b, II degree (moderate): the nipple is located in the lower crease
c, III degree (severe): the nipple is lower than the lower fold
③The patient’s height and weight should be considered
④The symmetry of the breast should be noted before surgery
(2) Patients with sagging breasts correction should have
① moderate size of the gland: no need for enlargement or reduction
②Pendulous nipples and areolas
③Able to accept scarring
3.Surgery
(1) Surgical treatment generally does not require removal of the gland, but requires the following steps.
①Resetting and shaping the gland
(2) Skin removal and shaping
(3) Nipple areola lift
(2) Lifting method
①Areolar incision
a. Scar is not obvious
b, must do a good job of purse-string suturing otherwise it will stretch the nipple areola
②Wise method (inverted T incision)
a.Can be designed before surgery
b.Significant scar
③Vertical incision
a. More skin is removed than the areolar incision
b, smaller scar than Wise method
④Implant placement
a. The implant supports the loose skin and assists in the lifting effect
b. It is often difficult to lift the breast with augmentation alone, so it is best to lift the gland at the same time.
c. The degree of sagging determines the lifting method
1.I degree (mild)
(1) breast augmentation
(2) circumferential incision lift
(3) Breast augmentation plus circumferential incision lift
2.II degree (moderate)
(1) Vertical scar lift
(2) If the gland is atrophied and the skin is elastic, breast augmentation is possible
3.III degree (severe): Inverted T incision Wise method is the best choice
4. Possible problems and complications
(1) Abnormal nipple sensation
(2) Hematoma
(3) Unacceptable scarring
(4) Asymmetry
(5) Undesirable shape
(6) Infection
(7) Prosthesis-related problems
(8) Recurrence of sagging