The most aesthetically pleasing location for the nipple is at the most projecting part of the breast "around the level of the crease underneath the breast". When the nipple sits lower than this, the breast will have a droopy appearance. It is common for women (either from breast feeding, weight change or aging) to notice that their breasts appear less perky with time. Some women also note that the upper part of their breast becomes more flattened. A breast lift, or mastopexy, can restore the ideal shape and position of the breast tissue.
Several different approaches are available to lift the breast tissue. For a small amount of required nipple movement, a circumareolar (incision around the nipple and areola) can be utilized.
For a moderate to significant amount of nipple movement, a vertical pattern (lollipop shaped scar) mastopexy or a Wise pattern (anchor shaped scar) mastopexy would be recommended.
For most breast lifts, an incision is placed all the way around the nipple and areolar complex; there is also often an incision that runs along the breast crease and an incision from the bottom of the areola to the breast crease. The ultimate incisional pattern you would need would be discussed with you at the time of your consultation.
During a breast lift, the nipple is not removed. The nipple and areolar complex are left attached to the underlying tissue for both a blood supply and a nerve supply. You should still have sensation in the nipples after a breast lift, but they would likely be a little less sensitive than your preoperative levels. Also, areolas are usually reduced at the time of your breast lift to the aesthetically ideal size.
Patients interested in breast feeding should still be able to do so after a breast lift; there is a theoretical increased risk of needing to supplement with formula following this procedure because of reduction in milk production.
Some patients are hesitant to accept the scars associated with a breast lift. A breast lift is an excellent way to reposition the breast tissue into a more youthful and perky appearance; the trade-off for this reshaping is the associated scars. For most patients, the scars are well worth the improvement in shape and position.
Breast lifts are also commonly performed with implant-based augmentations. While an implant alone can provide some degree of breast lift, it is unfortunately not enough lift in many cases.
Small breast lifts (of the circumareolar variety) can be performed at the same time as a fat transfer to the breasts. However, significant breast repositioning will likely have to be staged from fat transfer to the breasts.