- - - Hilton Becker, MD, F.A.C.S, F.R.C.S -

Mastopexy (Breast Lift)

Traditional Mastopexy

One of the major concerns of a patient undergoing breast lift surgery is the resultant scars. Traditionally, breast lift surgery was performed using an anchor incision, which included a scar around the areola, a vertical scar and a horizontal scar at the bottom of the breast.

Vertical Mastopexy

Recently, the vertical mastopexy has come into vogue. With this procedure, the horizontal scar under the breast is eliminated, leaving only a vertical scar.

The Doughnut Mastopexy

The doughnut mastopexy eliminates both the vertical and horizontal scars; leaving the circular scar around the areola. Unfortunately with this technique, the scar around the areola can become stretched and visible. Puckering of the skin around the scar can also be problematic.

Sub-areola Mastopexy

Dr. Becker has developed a new technique called the sub-areola mastopexy. This technique enables a breast lift to be performed with virtually no scarring. The sub-areola mastopexy also results in less tension at the suture site. The scars are often barely noticeable.

Pioneer in the field

Dr. Becker is the pioneer of the sub-areola mastopexy technique. He serves as an instructor and teaches these techniques to other doctors around the United States and the world. Dr. Becker has also written numerous articles and plastic surgery textbook chapters on this topic, including:

1.      The dermal overlap sub areola mastopexy: A preliminary report. Aesthetic Surgery, September/October 2001.
2.      The correction of breast ptosis with the expander mammary prosthesis. Annals of Plastic Surgery, Vol. 24, No. 6,           June 1990.
3.      Sub areola Mastopexy: Update. Aesthetic Surgery Journal, September/October 2003.

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Mastopexy Augmentation (Breast Lift with Augmentation using silicone gel or adjustable saline implants)

The most common breast problem seen after a woman has had one or more children is sagging of the breasts, combined with a loss of volume. This condition is best treated by combining a breast lift procedure with a breast implant. However, by combing the two procedures, the risk of complications are increased since the breast lift procedure results in tightening of the breast skin, while the implant enlarges the breast, resulting in increased tension on the scar. It is for this reason that the sub-areola technique and the adjustable implant is beneficial when combining mastopexy with augmentation.

Dr. Hilton Becker uses the adjustable implant, known as the Mentor-Becker implant, which he developed and pioneered in 1984. Use of this implant, either saline or a combination of gel-saline, reduces the risk of scarring and complications associated with the mastopexy augmentation procedure.

If the adjustable saline implant is used it is placed under the muscle, the silicone gel implant is placed above the muscle.

A minimal amount of saline is placed in the implant at the time of the surgery. Saline is added slowly over a period of 5-10 days to allow for healing of the incision. When swelling has subsided and the implants are filled to the desired volume, the fill tubes and domes are then removed. The implant seals itself with a self-sealing valve.

If a vertical scar is warranted, due to excessive ptosis (sagging), use of the adjustable implants greatly improves the shape and symmetry of the breast, while reducing the amount of scarring.

The new Silicone Cohesive Gel (MemoryGel –Gummy Bear) implants have been used with excellent results in combination with a sub areola mastopexy procedure.

Pioneer in the field

Dr. Becker has lectured and performed live surgery at several national and international plastic surgery meetings on these techniques. He has written two chapters in plastic surgery text books and has published three articles on this topic, including:

1) The Adjustable Breast Implant – Plastic Surgery Journal 1992
2) Augmentation Mastopexy using Adjustable Implants with External Injection Domes Aesthetic Surgery Journal – November 2006

BREAST AUGMENTATION AND LIFT –USING THE ADJUSTABLE IMPLANT

One of the most common problems seen in women after breast feeding is atrophy (shrinkage) and sagging of the breast. The best procedure to correct this problem is combining a breast augmentation with a breast lift. However combining the two procedures can sometimes be problematic. A mastopexy (breast lift) involves skin incisions around the areola and often a vertical incision as well. Placing a breast implant at the same time can place excessive tension on the wounds, resulting in poor scars. The two procedures are at odds with each other. The mastopexy procedure tightens the skin while the augmentation procedure expands the skin. Tension can also in terfere with circulation to the skin and occasionally lead to skin and even nipple loss. In some cases therefore when performing an augmentation mastopexy I use adjustable implants in order to decrease the tension on the skin during the healing phase.

Adjustable implants are available in a saline version (Spectrum) and a gel version (The Becker 50/50). The implant has a thin tube attached to it which can be brought out through the skin. An injection dome is attached to the filling tube allowing the implant to be adjusted and filled after the procedure.

The adjustable implant is positioned in the usual fashion. The saline implant normally placed sub muscularly (under the muscle). The adjustable gel implant can be placed above the muscle.

The implant is filled to the desired volume after completing the mastopexy. At the end of the procedure 25 – 50% of the saline is removed, reducing the tension on the incision and also reducing the pain postoperatively.

Five to seven days after surgery the implants are filled to the desired volume. Over filling results in more projection and symmetry (breasts even) can be obtained.

The fill tubes are then removed with a gentle pull, thus allowing the three-way valve to close. Once fill tube is removed, adjustments cannot be made.

The more complex cases such as marked asymmetry (Polands Syndrome) or constricted breasts (Tubular Breasts) improved results can be obtained by burring the fill tube and adjusting the volume over several months. This has been extremely successful and has normalized many major breast deformities some of my patients that have been unfortunate to have.

A minor procedure under local anesthetic is then required to remove the fill tube