How Is a Breast Lift Done?

Breasts Are Marked with a Surgical Marker Before Surgery

Breast Lift Markings. Photo © Millicent Odunze, M.D., M.P.H.

Your surgeon will use a surgical marker to demarcate the incisions. These markings serve as a guide or road map for your surgeon, as your breast shape will change once you are lying down on the operating room bed. Surgical markings are an essential part of obtaining good results. For a breast lift, markings determine where your nipple-areola complex will end up. You don’t want them to end up too high on your breasts or you will not be able to wear V-neck, scoop neck or low-cut shirts or blouses.

Anesthesia Is Administered

Andrew Olney / Getty Images

Breast lift surgery can be done with either general anesthesia or local anesthesia, with or without intravenous sedation. Intravenous sedation is also known as "twilight sedation." You and your surgeon will decide which type of anesthesia you receive. The important thing is that you are comfortable throughout your procedure. It is indeed possible to obtain patient comfort without general anesthesia.

Breasts Are Prepped for Surgery

Prepping For Surgery. Photo © Millicent Odunze, M.D., M.P.H.

The breasts and surrounding areas are cleansed with an antibacterial solution prior to surgery. By using an antibacterial cleanser, the likelihood of a breast infection or incision infection is decreased.

Breast Incisions Are Made

Making a Surgical Incision With a Scalpel. Photo © Millicent Odunze, M.D., M.P.H.

The incisions are made along the markings that were outlined pre-operatively. There are several patterns that can be used for a breast lift. Your pattern will depend on how much breast ptosis/sagging you have, and where your nipple-areola complex is positioned on your breast. The patterns for a breast lift are the same as the patterns for a breast reduction. The possible incision patterns are:

  • Donut Incision: Also known as the periareolar incision, this incision is made around the border of the areola.​
  • Keyhole Incision: Also known as the lollipop incision, this incision is made around the border of the areola and extends down vertically from the areola to the breast crease.​
  • Anchor Incision: This incision pattern is the most common. It entails three distinct aspects. Like the other patterns, there is an incision around the border of the areola. Like the keyhole pattern, a second extends down vertically from the areola to the breast crease. The third incision is along the breast crease also known as the inframammary fold. This connected to the vertical incision to make an upside down "T." The length of this incision will depend on how much excess skin will need to be removed to lift the breasts.

Additionally, in this step, if your areolas are large and stretched out from the effects of ptosis, they can be made smaller. This involves using a device called an areolatome. It is more popularly referred to as a "cookie cutter." It is circular in design with a hole cutout in the middle to accommodate the nipple. The cookie cutter is either 38 millimeters or 42 millimeters in diameter. It is centered on the nipple and the outer edge is then outlined with a marker or it is pressed firmly into the breast tissue to leave an imprint. A scalpel is then used to cut along the line.

Excess Breast Skin Is Removed and the Nipple-Areola Complex Is Lifted

Breast Lift Before and After Photo. Photo © Millicent Odunze, M.D., M.P.H.

The excess breast skin is excised with a scalpel and/or cautery. The remaining skin and fat are repositioned and held into their new positions with sutures to make a more youthful breast shape. The nipple-areola complex is moved to a higher position.

Breast Incisions Are Closed

Closure of Incision with Suture. Photo © Millicent Odunze, M.D., M.P.H.

The breast incisions are then closed with sutures. Your skin has multiple layers. The surgeon sutures the deeper layers first, then proceeds to closing the superficial layers. Since the sutures are beneath the skin, they cannot be seen along the length of the incision. However, the ends of the sutures may be visible on either end of the incision where your surgeon has started and ended the closure. Eventually, the sutures will be removed or your surgeon will trim the ends so that they are flush with your skin, allowing the unseen portion of the sutures to remain. Leaving the sutures in is not harmful and may help avoid tension on the incision and result in a thinner scar at the end.

Bandages Are Applied and a Surgical Bra Is Placed on the Breasts

After breast lift surgery. Steri strips have been used to cover the incisions.. Photo © Millicent Odunze, M.D., M.P.H.

After closure of the incisions, the breasts are wiped clean. Steri-strips or their equivalent, a gauze dressing and then a surgical bra are placed over the breasts. A surgical bra places gentle compression on the breasts. It does not have an underwire, as this will irritate the incisions. Use of an underwire bra is usually not permitted until two to four weeks after surgery.

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