Getting ready for vertical mammoplasty
First the surgeon will take measurements in order to find out specific distances (see below) so the breasts will have as close to the same shape and size after the surgery. Complete symmetry can never be achieved.
We usually measure the following distances:
1. nipple - jugulum (the pit on the upper edge of the breast bone)
2. further distance nipple - middle line
3. nipple - inframammary fold
4. the incision is then set according to the drawings
Next, the surgeon sets the position level of the areolas so the breasts are of an adequate height based on the patient’s figure, shape of her chest and also according to the planned size of the breasts after surgery (in a breast reduction). The areolas must be well positioned on the breasts. The shift of the areolas is not done through cutting and then suturing on the elevated breasts. The areolas are only shifted up together with the gland.
The breast surgery process
For the actual surgery, first we make the incisions according to the drawings, make incisions around the areolas, remove the extra skin and eventually any extra breast tissue (for reduction). Breast reduction is performed by removing the wedge on the lower half of the breasts. The wedge can be moved differently depending on where the most tissue is. We also reduce the so-called breast basis, which is the part of the breast connected to the muscle. It shortens the breast’s projection, i.e. how the breast protrudes forward. We sew the breasts and form them with absorbable material.
The fixation of the gland to the muscle in specific heights is to prevent its early and excessive droop after the surgery and therefore sagging breasts as well. Absorbable as well as non-absorbable material is used. Then the skin is sutured and so-called sucking drains are inserted. The wounds are covered with gauze and the breasts are bandaged with elastic bandages.
After thebreast lift or breast reduction
The drains are kept in for 2 to 3 days on average, depending on the bleeding. The patient uses a bandage bra for approximately 2 weeks. After the largest swellings fade, normally in 2 to 3 weeks, patients can use a normal bra, a so-called push-up is not recommended. It is necessary to wear a bra for a longer time during the day until the scars around the gland are so firm that the breasts do no sag at all or minimally. Such a period usually lasts around nine months. In general, the larger the breast, the longer the time needed to wear a bra after surgery. It can be even one year.
Usually pressure massages are recommended for minimizing scars, although it is not necessary. The pressure of the breast against the bra is an optimal permanent pressure massage. It can eventually be completed with a local application of ointment with silicone (Prosil, Dermatos and others). It is necessary to emphasize that the most significant factor in softening the scars are pressure massages.
Sometimes a slight deformation of an areola might occur, which changes its round shape to ellipse in some time. It is caused by the tension of the scars and the drooping of the breasts. Scars on the edge of the areola do not look good. In these cases we recommend considering a correction of the slightly deformed areolas and eventually perhaps camouflaging them through tattooing.
Every surgeon will proceed with specific differences; he/she has had different experiences. The important thing is that the client is satisfied with the result of the surgery and as we say all the ways lead to Rome.
The author of this article is Josef Hrbaty, M.D., a plastic surgeon at LAUREA Clinic in Brno.