Breast Lift or Implants

Mastopexy (breast lift) and augmentation (breast implants) are cosmetic surgeries that change the look and size of the breasts. Mastopexy helps reshape breasts that have lost their firmness and sag or droop. Augmentation involves putting breast implants above or below the chest muscle, to make the breasts larger. Together, these procedures change the look and size of the breasts. This sheet tells you more about these surgeries and what to expect. Sometimes these surgeries are done together. But depending on your body and your needs, your doctor may suggest two separate surgeries, so you can heal in between.

Different kinds of implants

Breast implants are made of a silicone shell. The shell may be filled with saline (saltwater) or silicone (gel). Different implant sizes, shapes, and textures are available, as well as different thicknesses of silicone filling. There are benefits and drawbacks to each type of implant. You and your doctor will discuss which type is best for you.

Preparing for surgery

Meet with your surgeon before the day of surgery to ask questions about the doctor's experience with breast augmentation, your specific surgery, and the results you can expect. The Food and Drug Administration (FDA) provides a list of questions that may help you with this conversation. Ask your doctor what makes you a good candidate for breast implants, and what your options are for size, shape, and surface texture. Your doctor will also review the risks and benefits of the surgery. Ask for before and after pictures of other patients so you can understand whether your expectations are realistic.

During this meeting, ask the doctor for a copy of the patient labeling for the breast implant that will be used. As a patient, it is your right to have this information and the doctor will expect to provide it. Talk with your doctor about the risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare type of non-Hodgkin's lymphoma that can develop after breast implants. While the exact number of cases is not known, the most current data suggest that BIA-ALCL is seen more often after breast implants with textured surfaces rather than those with smooth surfaces.

Read and understand the informed consent form. Ask any questions before you sign it.

Prepare for the surgery as you have been told. In addition:

• Tell your doctor if you think you could be pregnant.

• Some surgeons ask that you have a mammogram or breast X-rays before the surgery. This helps show any breast abnormality and gives the doctor a preoperative image of your breast tissue.

• Tell your doctor about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.

• Don't eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)

• Your doctor may delay your operation if you smoke before surgery. Smoking can diminish the blood flow in the skin and increase your risk of wound healing complications. 

The day of surgery

Mastopexy with augmentation takes about 3 to 5 hours. You may go home the same day. Or you may stay overnight.

Before the surgery begins:

• An IV line is put into a vein in your arm or hand. This line delivers fluids and medicines.

• You will be given medicine to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. A tube may be inserted into your throat to help you breathe. Or you may have sedation, which relaxes you and makes you sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. The anesthesiologist will discuss your options with you.

During the surgery:

• For the breast lift, the doctor makes incisions in the skin around your breast. You and your doctor will have discussed incision sites before surgery. The doctor moves the breast tissue higher on the chest. Breast skin is tightened to hold the tissue in position. Any excess skin is removed. The areola (dark skin around the nipple) and nipple are moved higher on the breast. If the size of the areola is being decreased, skin is removed. The areola is stitched into place. The process is then repeated for the other breast.

• For the breast augmentation, the doctor forms a “pocket” to hold the implant. This may be above or below the chest muscle. The doctor then inserts the implant through the incision and into the pocket. If the implant needs to be filled with saline, that’s done next. The implant is then positioned. If both breasts are being treated, the process is then repeated on the other breast.

• When both stages are done, incisions are closed with stitches, surgical glue, or both. A tube (drain) may be placed into an incision before it is closed. This drains excess fluid that may build up as the wound starts to heal.

After the surgery

You will be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medicine to control pain. When you’re ready, you will be able to go home with an adult family member or friend. Or you may be taken to a room to stay overnight.

Recovering at home

Once home, follow any instructions you are given. Your doctor will tell you when you can return to your normal routine. During your recovery:

• Take any prescribed medicines exactly as directed.

• Wear the special bra or bandage you were given before discharge as directed by your doctor.

• Care for your incisions and the dressing (bandage) over them as instructed by your doctor.

• Follow your doctor’s guidelines for showering. Don't swim, take a bath, use a hot tub, or do other activities that cause the incisions to be covered with water until your doctor says it’s OK.

• When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.

• Don’t raise your arms above breast level for 10 days. And don’t lift, push, or pull anything heavier than 10 pounds for at least 7 days.

• Don’t drive until you are no longer taking prescription pain medicine and your doctor says it’s OK. When riding in a car, carefully position the seatbelt so that it doesn’t compress your breasts.

• Be aware that breast swelling may last for 3 to 5 weeks. If advised by your doctor, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. Don't leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your doctor.

Follow-up

You will have follow-up visits so your doctor can see how well you’re healing. If needed, stitches or drains will be removed at one of these visits. If you have any questions about your recovery, let your doctor know. And tell your doctor if you notice any changes in your breasts during or after your recovery. This may include injury to the breast or dimpling of the skin of your breast or nipple. If the implants leak or break, they will need to be removed or replaced. Also, be aware that your breasts may sag again over time. If you have any concerns about your surgery results, talk to your doctor.