Sydney

Breast Lift (Mastopexy)

A lift changes position, an augmentation changes volume. Mastopexy takes away excess skin and raises the breast and nipple, but it adds nothing. Implants are what create fullness. Where breasts have lost volume and also sit low, neither operation on its own will cover both concerns.

Which one you need comes down to what actually bothers you. A breast that still has decent volume but sits lower than you would like, or a nipple that points downwards, is what a lift is for. Lost fullness, especially across the top of the breast, is not something a lift can put back. Plenty of patients arrive convinced they need one when what they describe is the other, so it helps to come to a consultation without a fixed answer. A lift makes the breast look firmer, not larger, and because skin is taken away, some patients feel theirs looks slightly smaller afterwards.

Yes. The two can be done in the one operation where the goal is breasts that are both fuller and higher. Combining them carries consequences. The operation runs longer, and the Medicare items covering correction of breast ptosis drop out, because those items cannot be claimed where a prosthesis is inserted.

Items 45556 and 45558 both exclude use with the insertion of any prosthesis, so adding implants removes the item even where your circumstances would otherwise have met it. Depending on the anatomy involved, some surgeons also prefer to stage the two operations instead of combining them. Breast implants are medical devices with their own risks and follow-up requirements, and the breast augmentation and breast implant checks pages of this site cover those. Bring the combined option up at consultation, so you have the trade-offs, cost included, before you decide.

Usually not. Where a breast lift is done to improve appearance it is cosmetic surgery, and no Medicare rebate applies. A small number of items exist for defined clinical circumstances, and the criteria are tight. Those items also require photographic or imaging evidence to be documented in your patient notes.

Item 45558 covers correction of bilateral breast ptosis by mastopexy where at least two-thirds of the breast tissue, including the nipple, lies below the inframammary fold and the nipple sits at the lowest part of the breast contour. Item 45556 is for unilateral ptosis correction in the setting of breast cancer or developmental abnormality, to match the other side, and is payable once per patient. Item 45060 covers single stage correction of a developmental breast abnormality, and bilateral mastopexy for symmetrical tubular breasts can fall under it. None of the three can be used with insertion of a prosthesis. Assume nothing here, and ask at consultation whether any item applies to you.

Usually yes. A breast lift done to improve appearance is cosmetic surgery, so the Medical Board of Australia’s cosmetic surgery guidelines apply. That includes a cooling-off period of at least seven days after informed consent is given, before the surgery can be booked or a deposit paid.

Alongside that sit a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who will operate, and assessment for psychological conditions using a validated screening tool. Patients under 18 must also be evaluated by a psychologist, psychiatrist or general practitioner working independently of the operating surgeon, and their cooling-off period is at least three months. Reconstructive surgery sits outside these guidelines, so a mastopexy done as part of reconstruction after breast cancer, or to correct a developmental abnormality, follows a different path. Your first appointment is the place to confirm which one applies to you.

Yes. No referral, no appointment: A/Prof Bish Soliman cannot see you about surgery of any kind without one from your GP. And where the procedure is cosmetic, that referral has to come from an independent medical practitioner, under the Medical Board’s guidelines. It is a regulatory requirement, not a billing formality.

Your GP is asked to consider your general health and your reasons for seeking surgery, so that a doctor who knows you is part of the decision from the start. A GP referral form is available on A/Prof Soliman’s website, and consultations are booked by paying the consultation fee in advance at the time you make the appointment. Note that having a referral does not automatically make the specialist consultation rebatable, since that depends on whether the service is clinically relevant.

You will have permanent scars. There is no version of this operation without them. The incisions usually sit around the areola, with a vertical line down from it, and where the anatomy suits it a short scar technique avoids the extra horizontal scar along the breast crease that longer incision patterns leave.

Scars tend to look their worst in the first few weeks. They flatten and pale over the months that follow, and most keep changing for something like 12 to 18 months. Clean incisions, sun protection for new scars and a topical scar treatment, if you are told to use one, all make a difference. Your skin and the way you heal shape the end result too, and nobody can predict that part with confidence. Before surgery, ask to see the incision pattern drawn out so you know where the scars will sit and roughly how long they will be.

Both can be affected. Changed nipple sensation is a recognised risk and may be temporary or permanent. A breast lift can also reduce the ability to breastfeed, since the procedure involves repositioning the nipple and areola. Neither outcome can be predicted with certainty before surgery.

Most people find sensation picks up again over the first several months, as the nerves recover. Some are left with a lasting difference. One side can end up more affected than the other. Tell the surgeon at your first consultation if breastfeeding matters to you, and ask what the planned technique does to the tissue under the nipple. Go slowly through this part of the consent conversation. Of all the trade-offs, it is the one patients most often say they had not really taken in.

Most patients take about two weeks off work and are back to light activity by then. Heavy lifting and strenuous exercise wait six weeks, and a medical bra is worn across that same period. Gentle movement in the meantime is encouraged, not discouraged.

Your incisions will be taped after surgery, and drains are sometimes used for the first 48 hours. Sleeping on your back with your upper body raised helps keep swelling down. Alcohol and smoking both slow healing, so leave them alone while you recover. Swelling and bruising are normal, and they need to settle before the result shows. Most patients start to see theirs somewhere between six and 12 weeks, with the final settling taking longer again. If something concerns you during recovery, call your surgeon or GP instead of waiting for the next appointment.

The list is long, and it is worth reading properly. Pain, bleeding and bruising, infection or irritation, swelling, scarring, fluid build-up, skin discolouration. Asymmetry, or a result you are not satisfied with. Changes in nipple sensation, temporary or permanent, and reduced ability to breastfeed. Damage to deeper structures, complications of general anaesthesia, and the possibility that revision surgery is needed.

Pain, bruising and swelling are expected parts of recovery, not rare events. The more serious complications turn up less often, though they remain possible. Smoking materially raises the risk of wound healing problems, which is why you are asked to stop well ahead of surgery. Tell your surgeon about any medication that affects bleeding or healing, and about any previous trouble with anaesthetic. Increasing pain, spreading redness, fever or unusual swelling after your operation are all reasons to contact the practice or seek medical help promptly. A/Prof Bish Soliman’s website has a dedicated risks and complications page covering surgical risk in more detail.

The change is long-lasting, though calling it permanent would overstate it. Skin that has been removed does not come back. Breasts still respond to ageing, gravity, weight change, hormonal shifts and pregnancy, so some settling over the years is normal and expected.

How well a result holds depends on skin quality, breast size and weight, and genetics. None of those sit entirely within anyone’s control. Big swings in weight and pregnancy are the two things most likely to change the result noticeably. What you can do is wear supportive bras during exercise and keep your weight steady. Some patients look at revision surgery years later, which is a normal part of the picture and not a sign the first operation failed.

It is worth thinking through. Pregnancy and breastfeeding can stretch the skin and shift breast volume and position again, which may alter the result of a lift. No rule says you have to wait, and plenty of women have a lift before having children.

None of this is a medical absolute. It is practical. If a pregnancy is close, waiting may spare you a revision. If children are years off, or you are not sure they are coming at all, the sums look different, and how you feel about your breasts in the meantime is worth counting. Breastfeeding after a lift may be affected too, so bring that into the same conversation. Tell the surgeon what you are planning, undecided included, so timing gets settled before surgery and not after.