Did you know – we can offer a skin-only mastopexy (breast lift) in the office as an awake procedure for women who like the volume of their breasts and don’t have implants, OR who do have implants that are in good shape but want their nipples to be higher up and their areolas reduced in size?

Scroll down to see a step-by-step account of one woman’s in-office breast lift that created “lollipop scars” and left her breast implants alone.  This procedure is appropriate for women who do not need a major rearrangement of their breast tissue, just a minor lift of their nipple position and reduction of their areola size.

Here are her preoperative photographs:  She had breast implants in place, which were intact and soft.  She did not want or need a redo of her implants.  Her goals were to have her nipples higher up to a more youthful position and her areola diameter reduced.

Thankfully, we can offer patients in-office procedures under local anesthesia when patients want to avoid general anesthesia, they are fully educated about the procedure and are comfortable with having their skin numbed.

We compare this procedure to having a mole removed under local anesthetic or visiting the dentist – although it is much more rewarding than mole removal and much more pleasant than the dentist (and no drooling or numb lips/tongue afterwards)!!

Here are the surgical markings for a skin-only mastopexy: 

The midline of each breast, called the “meridian” of the breast, has been marked with a vertical line of dots.  The top of the oval above the nipple is the location of where we want to move the top of the areola up to.  The circle around the nipple is the new size of the areola.  The wide oval will be closed as a circle to create the lollipop part of incision.

The vertical lines on either side of the nipple are where the skin will be tucked inwards, creating a vertical line which will become the stick of the lollipop.  We make the analogy of tucking the skin inward around the breast as like making a dart in a dress to contour it to the body.

This procedure took around one hour to perform.  Since it is under local anesthesia, no fasting is required and the patient participates in the process of surgical markings and planning for incision location, areola diameter and other details.

Once the numbing is injected under the skin, it takes around 30 seconds to start working and lasts for several hours afterward.  We use a combination of short-acting local anesthesia for immediate effect mixed with long-acting local anesthesia so the effects persist for up to 1o hours in some people.  The local anesthetic also contains epinephrine (adrenaline), which constricts the blood vessels in the skin and prevents bleeding during surgery.  It is actually a very neat procedure!

The area that is being addressed is prepped with surgical prep solution and draped in the usual sterile fashion, just as for the main Plastic Surgery operating room.  All the same steps are taken as in the O.R. for in-office surgery.  During the procedure, only tugging or pulling is felt while excess skin is removed and the stitching is occurring.  Don’t worry about seeing any details – we don’t allow peeking but show our patients the immediate results with a hand-held mirror before dressings are applied and a compressive ACE wrap is applied to the chest.

WARNING:  “Frankenboobs” are expected early on after surgery:  Here is a self-picture this patient sent on postoperative day 4 when she was immediately out of the shower.  The dressings can be removed on day 2-4 after surgery (when patients feel ready) and they can shower daily.  Just no bathtubs, pools or hot tubs for at least 3 weeks after surgery to avoid infection.

It takes at least 2 weeks for bruising to fade, 6 weeks for the puckers around the areola to flatten, and several months for the scars to start to fade.  Exercise can resume in 3 weeks or when the bruising is all gone and patients feel comfortable increasing their activity.  Pain medication is usually required only for the first night when the numbing wears off, and scar therapy begins around 6 weeks after surgery.  What is scar therapy?  Learn all about scar therapy here!

Here are follow up images at 5 months after surgery:

Her breasts look more youthful, her nipples are higher up, her areolas are smaller, and she is so happy with her early results!  It will take a full year for the scars to fade further.  She is grateful she was able to have surgery awake and that she did not require general anesthetic.

Her entire before and after series of images is available to view here.

To learn more about breast revision surgery and in-office procedures, contact our office at 415-923-3067 or contact us online.

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~ Dr. Karen Horton