Otherwise known as a “breast lift,” the procedure is to reposition and possibly reshape the breast into a more desirable position. Although it does not by definition include breast enlargement, that may be performed at the same time.

Anyone who is not satisfied with the position of either breast is a candidate for this operation, but typically it is performed on the woman who was previously satisfied with the position of her breasts, but the Cooper’s suspensory ligaments have lengthened following pregnancy, and/or weight gained then lost, and/or aging, and the nipples are lower than she (or her partner) would wish. The contents of the breast may not be interfered with by the surgery, and lactation in a subsequent pregnancy will remain possible.

The degree of droop (ptosis) is graded:

• Grades 1& 2: The nipple is below the inframammary fold but not below the lower breast margin.
• Grades 3 & 4: The nipple is located below the inframammary fold, and may be beneath the breast pointing downwards.

Although the surgeon may combine the operation with either enlargement or reduction of the breast volume, the operation consists essentially of moving the nipple-areolar complex (NAC) up the breast and tightening the skin distal (beneath) that by excising a wedge of it. The technique adopted depends on the degree of ptosis.

If the ptosis is slight, a periareolar lift may be adequate: a disc of skin is excised above the areolar, a circular incision is made around the areola, the NAC is moved to the position of the excised disc, the skin from around the areola’s previous position is then sutured. The NAC is thin and stretchable, and if too much tension occurs because the breast is heavy, the NAC may end up oval.

In more severe degrees of ptosis a larger incision is required, in effect a modified lollipop to anchor incision. The surgeon by direct measurement decides where (s)he would like to place the nipple, and draws a circle on the breast at that point; the skin is excised through the epidermis layer only at this circle, down to and around the nipple and then with a wedge of skin excised distal to the nipple and along the inframammary fold. Drawing the margins of the skin together beneath the NAC forces the breast tissue up; it may be stabilized by deep sutures between the breast tissue and the underlying fascia, making it more than a “skin job.”