Mastopexy

Mammoplasty procedure to raise sagging breasts

Mastopexy (Greek μαστός mastos "breast" + pēxiā "affix") is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast lift surgery to re establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast feeding. The breast lift correction of a sagging bust is a surgical operation that cuts and removes excess tissues (glandular, adipose, skin), overstretched suspensory ligaments, excess skin from the skin envelope, and transposes the nipple areola complex higher upon the breast hemisphere. In surgical practice, mastopexy can be performed as a discrete breast lift procedure, and as a subordinate surgery within a combined mastopexy–breast augmentation procedure. Moreover, mastopexy surgery techniques also are applied to reduction mammoplasty, which is the correction of oversized breasts. Psychologically, a mastopexy procedure to correct breast ptosis is not indicated by medical cause or physical reason, but by the self image of the woman; that is, the combination of physical, aesthetic, and mental health requirements of her self. Pathophysiology and presentation
In the course of a woman's life, her breasts change in size and volume as the skin envelope becomes inelastic, and the Cooper's suspensory ligaments—which suspend the mammary gland high against the chest—become loose, and so cause the falling forward and the sagging of the breast and the nipple areola complex (NAC). Moreover, additional to tissue prolapse, postpartum diminishment (involution) of the voluminous milk glands in the breast aggravates the looseness of the suspensory ligaments, and of the inelastic, overstretched skin envelope. Mastopexy corrects said degenerative physical changes, by elevating the (internal) parenchymal tissues, cutting and re sizing the skin envelope, and transposing the nipple areola complex higher upon the breast hemisphere. The degree of breast ptosis of each breast is determined by the position of the nipple areola complex (NAC) upon the breast hemisphere; ptosis of the breast is measured with the modified Regnault ptosis grade scale. The Regnault ptosis grade scale
Grade I: Mild ptosis — The nipple is located below the inframammary fold (IMF), but remains located above the lower pole of the breast. Grade II: Moderate ptosis — The nipple is located below the IMF; yet some lower pole breast tissue hangs lower than the nipple. Grade III: Advanced ptosis — The nipple is located below the IMF, and is at the maximum projection of the breast from the chest. Grade IV: Severe ptosis — The nipple is far below the inframammary fold, and there is no lower pole breast tissue below the nipple. Laurence Anthony Kirwan published an alternative classification system for ptosis of the primary or non augmented breast that is meant to be better suited than the Regnault scale for planning surgery. Additional mastopexy considerations

Pseudoptosis — The indication is the sagging of the skin of the lower half (inferior pole) of the breast, featuring the nipple located either at or above the inframammary fold (IMF); as such, pseudoptosis is a usual consequence of postpartum milk gland atrophy. The nipple is located either at or above the IMF, while the lower half of the breast sags below the IMF. Pseudoptosis usually occurs when the woman ceases nursing, because the milk glands have atrophied, and so reduced the volume of the breast, thus the sagging of the breast envelope skin. Parenchymal maldistribution — The lower breast lacks fullness, the inframammary fold is very high under the breast hemisphere, and the nipple areola complex is close to the IMF. Such indications of the maldistribution of parenchymal tissues indicate a developmental deformity.

Surgically, the breast is a milk producing apocrine gland overlaying the chest; and is attached at the nipple, and suspended with ligaments from the chest; and which is integral to the skin, the body integument of the woman. The dimensions and the weight of the breasts vary with the woman's age and her habitus (body build and physical constitution). Hence, small to medium sized breasts weigh approximately 500 gm or less, and large breasts weigh approximately 750–1,000 gm. Anatomically, the breast topography and the locale of the nipple areola complex (NAC) on the breast hemisphere are particular to each woman; thus, the statistically desirable (mean average) measurements are a 21–23 cm sternal distance (nipple to sternum bone notch), and a 5–7 cm inferior limb distance, from the nipple to the inframammary fold, where the breast joins the chest.