Women's breasts lose their tension and slacken as they get older. On the one hand the elasticity of the skin is decreasing and on the other hand childbirth or abortion can cause significant changes. During pregnancy, the breast glands swell up, due to hormonal activity, in preparation for milk production. After childbirth milk production usually begins. Following this period, or after the spontaneous or surgical interruption of the pregnancy the breast glands will not return to their original condition, but will be smaller (atrophied). Thanks to the elasticity of the expanded skin this can be remedied (such as in the belly). However, if the elasticity is not enough or the extent of atrophy is bigger, the breast will slacken. The extent of slackening depends on the factors above and on the original size of the breast. Slackening is common after frequent losses or gains in weight.
4 main stages may be identified:
- the areola (mamilla) is over the crease below the breast (where the lower curve of the breast meets the chest)
- the areola is on the level of the crease below the breast
- the areola is under the crease
- the areola already hangs downwards
In the first stage, during transition, the distance increases between the areola and the crease below the breast and the areola goes lower and lower. During surgery the areola should be put higher in order to reduce the distance. In the second stage we can get good results by implanting only, without the need for excision of the skin (one of the mastoplexy techniques) which would inevitably leave some scarring.
There are 3 types of mastoplexy:
- Excising the skin around the areola. This procedure causes the least scars, but it can only be used occasionally (just in the case of tubular breasts, when their base is small and their shape is elongated). If wrongly chosen, this type of surgery can results in a badly shaped and flat breast.
- Excising the skin around the areola and from the lower areas, when the form is like a mushroom. After this the scar will be round the areola and vertically below it. This way the vertical scar could be thicker than usual.
- The conventional (form of a reversed "T") incision means vertical and horizontal scars (this is in the crease below the breast) and a scar around the areola. With the right decision all of these 3 techniques can produce excellent results. Surgery is carried out under general anaesthesia. It is preceded by an examination by an anaesthesiologist. If no complications occur, the patient can go home the following day. Stitches are taken out at the end of the second week. In the first four weeks the patient must constantly wear a bra, and for two more weeks during the daytime. Scars will go pale, and in time they will become almost invisible. The patient should take it easy in the first month, avoiding sports and physical exercise. Afterwards she can slowly return to her previous lifestyle. The most frequent complications can be bleeding, inflammation, damage to nerves, skin necrosis and problems with the wound healing.