Mastopexy combined with breast augmentation
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Hello! My name is Adrian Richards and today I'm going to be talking about mastopexy procedure which is also know as a breast uplift procedure. Who's suitable for this form of surgery? Well, it's basically anyone who's lost volume in their breast. This might be because of weight loss or most usually because you've had children and the breasts have lost a significant amount of volume following that. Some people following pregnancy maintain their original breast volume, some actually go up, but a lot of people lose fullness, particularly in the upper part of the breast which becomes more scalloped. Because the breasts have been bigger, the skin's been stretched and the nipples lie at a lower position. Breast droop is also known as breast ptosis and is classified into three types. Type 1 is the nipple lies above the fold underneath the breast, this fold is known as inframammary crease. So if facing a mirror, your nipples lie above the fold of the breast, you don't have any significant droop. If the nipples lie at the level of the fold, you're classified as having grade 2 ptosis and if the nipples are facing downwards, that's grade 3. Depending on the degree of descent of your nipples, you would need a different type of approach to mastopexy. All that mastopexy essentially does is remove and tighten the skin of the breast. So mastopexy alone doesn't increase the volume of the breast, it doesn't reduce the volume of the breast like a breast reduction, it just tightens up the skin. If the nipples are descended at one to two centimeters, normally we can just perform an incision either just around the upper part of the nipple, we can remove a crescent of skin from above the nipple to elevate one to two centimeters. If they need slightly more elevation, we need to do what's called a periareolar incision, which is an incision all the way around the nipple, elevate the nipple up. Any more descent of the nipple than that, we need to also add some sort of scar on the breast tissue. Now the scars are always on the lower part of the breast tissue, plastic surgeons avoid any scar on the upper part of the breast tissue, number one because this area doesn't scar very well and number two because it's visible in clothing. So all incisions will be at the lower part of the breast. If a periareolar, a doughnut type skin incision, isn't enough, the next stage is to go to a vertical scar. This is also known as a lollipop incision because the scar goes around the nipple, down to the fold underneath the breast. This generally heals very well and this is probably the most commonly used incision for moderate breast ptosis. If the ptosis is much worse, say if you've lost a massive amount of weight, I see a lot of patients who've lost eight to ten stone. Often, they need a lollipop incision but they also need an additional transverse incision in the fold underneath the breast. It's just really to do with the amount of excess skin you have, the more excess skin you have, the more scars you're going to need to remove it. So normally I would do a short transverse scar if needed, keeping the scar very short to the middle of the breast and that's called an anchor incision, an anchor around the nipple, down vertically to the fold and along the fold. Some patients who really have a very severe breast ptosis, we need to do a traditional, what's called a wise pattern skin reduction which involved a longer transverse scar. All these scars tend to heal well and one solution won't be right for everybody. So essentially, the scars for a mastopexy could either be just above the nipple, a crescent all the way around the nipple, periareolar, a lollipop incision which is around the nipple and vertically down, a short transverse scar which is the lollipop with a short segment underneath in the fold or a full anchor pattern mastopexy with a scar extending more along the fold. So really what you need to do is go and see a surgeon, normally a couple of surgeons, do your researc
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