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Hospital Clinica Biblica

Dr. Victor Eduardo Alvarez Murillo

DR.WILLIAM PEREZ

DR. MARIO SPERANZA

Dr. Ronald Alberto Salazar

Dr. Guillermo Cortes

Dr. Marcial Fallas

Dr. Javier Brenes

Dr. Gustavo Chavarría León

Dr. Alberto Jose Arguello Choiseul

Dr. Arnoldo Fournier

Dr. Oscar Oeding

Dr. Marios Saenz

Dr. Jacobo Zafrani

Dr. Roberto Velázquez

Dra. Tamara Velázquez

Dra. Olga Montoya

 

Mastopexy
The stretching of the skin is produced by weight changes, breast feeding, or aging. Today, most women feel uncomfortable with their breasts’ contour and shape after breast feeding or loosing a considerable amount of weight. If you presently have a C cup or more, you are a candidate for a Mastopexy. Otherwise you might be a candidate for Crescent Mastopexy with Breast Implants.

Mastopexy allows the contour of the breast to be improved by removing the excess of the skin to make it firmer around the nipple moving it upward and below the nipple to support the new position. The new position could be maintained by stitches fixed under a band lifted from the Pectoralis Major muscle. The lower part passed under the muscle is also fixed to the same muscle giving more volume to the upper half of the gland.

Furthermore, the superficial removal of the skin around the areola and nipple allows preservation of circulation and nerves around the areola to maintain normal feelings, erection, and changes with temperature. Scars are left around the areola and below the areola, a radial oblique position towards the crease of the breast, shaped as a lollipop. This can be explained if you imagine pinching the skin under the nipple and pushing the breast upward resulting the lifting of the breast.

For minimal sag or ptosis, Crescent Mastopexy procedure is done. The minimal sag or ptosis may be corrected by repositioning the nipple upwardly, and tightening of the breast apex skin by excising, or cutting, a crescent-shaped piece of the excess skin from above the nipple. This procedure can be done altogether with Liposuction for Breast Reduction, or Breast implants for Breast Augmentation.

BEFORE THE SURGERY EVERY PATIENT MUST:

  • Surgery Costa Rica will schedule an appointment with your doctor for you. During this visit you can ask him any questions you might have about the surgery.
  • Have a complete medical check up, an electrocardiogram and laboratory blood and urine tests; including a complete whole blood count, partial tromboplastin time, prothrombin time, platelets, and HIV.
  • Take antibiotics such as Augmentin 500mg, (one capsule three times a day with each meal) Cipro or Ceclor 500mg (one capsule twice a day with a full breakfast and dinner); two days before surgery, the day of the surgery, and seven more days after the surgery.
  • Mammography is REQUIRED for those women over 40 years of age.
  • Inform your doctor of your daily vitamin and medication intake.
  • Notify your doctor if you have developed a cold or the flu a week prior your surgery date.
  • Please avoid: aspirin, more than 500mg of Vitamin E, caffeine, ginkobiloba, ginseng, or any blood thinners two weeks prior your surgery. Also avoid alcohol intake, and passive or active smoking for one month before and one month after the surgery. Remember that nicotine and alcohol delays and might even complicate your healing processes.

    THE DAY OF SURGERY:

  • You may rinse and brush your teeth, but do not eat or drink coffee or tea.
  • Please do not wear make-up, remove your contact lenses or dentures before the surgery. Do not apply any moisturizer in your body or face.
  • Please remove your nail polish.
  • The evening and the morning prior your surgery, clean the operative area with soap and water.
  • Please do not bring any jewelry or valuables to the Hospital.
  • Please wear a robe, housecoat or warm up suit that buttons or zips in the front and flat shoes after the surgery. No tight-fitting clothes.
  • Someone must drive you home, to your Hotel, or to the Recovery Home you choose to stay at. *Postoperative instructions regarding activity, medications and office visits will be given following your surgery.

    THE SURGERY:

    The surgery is done under local anesthesia and sedation. Some patients might stay two nights after surgery, or could be outpatients. Mastopexy usually takes one and a half to three hours. Techniques vary, but the two most common procedure involves “lollipop” shaped incision following the natural contour of the breast, named Dufourmentel Technique; and the Crescent Mastopexy when the women as minimal sagging or ptosis in her breasts.

    In the Dufourmentel Technique, the incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, and in a vertical line extending downwards from the nipple area.

    Some patients desire to have volume in the upper part of their breasts. In these cases, implants are recommended because the Mastopexy procedures usually results in breast reduction. I strongly recommend women who want volume in the upper part of their breast or women who are a cup B or smaller to have implants placed under their muscles.

    Furthermore, those patients with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the “half moon” mastopexy or Crescent Mastopexy in which circular incisions are made around the areola, and a half-moon area of skin is removed. With the Crescent Mastopexy, known as scar less breast lift, an incision is made above the areola in a half moon shape. Then, the upper part of the areola is lifted or repositioned. Crescent Mastopexy allows the top of the areola to be repositioned upward by about 2-3cm, and will allow the nipple to move up about 1-1.5cm. As mentioned before, this procedure can be done with Breast Reduction and Breast Augmentation.

    There is a wide variety of implants’ shape, size and form. Some have a round shape, tear drop shape, oval shape, or low or high profile. Others are smooth or with texturized surface, and the most expensive have an anatomical and biodimensional silicone texture that will never loose its contour. The saline implants may deflate after one day, one year or after years due to the tiredness of the material or a problem within their valves. The implants are placed in contact with the chest cage, over the ribs, behind and protected by the Pectoralis Major muscles. Therefore, the implants are in contact with the ribs and muscle to avoid contact with the breast tissue. Sub muscular implants are placed under the pectorals muscles allowing the normal texture of the breast tissue to be felt over the implants.

    On the other, if the implants are placed above the Pectoralis Major Muscles, 20% of the patients will suffer of a scar or hard tissue which develops around the implants called capsule formation. This percentage diminishes to a 3% when the implants are placed under the muscle and over the ribs. The patients should also have in mind that immediately, two weeks after surgery and continuously for six months after surgery, breast exercises and massages are recommended to reduce such risk. The pressure and soreness in the chest is reduced by resting for one week with local ice plastic packs and a towel. Take Acetaminophen or Cataflam one tablet every six hours. Some of the stitches are removed in the first week and the remaining in the second week after the surgery.

    AFTER YOUR SURGERY:

    After surgery, you'll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a week, but the pain in most women shouldn't be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon.

    Within two weeks after the procedure, the bandages or surgical bra will be replaced by a soft support bra. You'll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two.

    If your breast skin is very dry following surgery, you can apply a moisturizer with Vitamin E several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas.

    You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more. Please consider that in some cases people have reported that the sensitivity in their areola or nipple areas increases a year after their surgery.

    If you had implants, four weeks after the procedure, please remember to massage your breasts in a circular motion, and push them towards your cleavage with moderate strength. Massage your breasts prior going to bed for 200 times. You should continue your massages for at least six months. This will help the implants to sink in the right position.

    GETTING BACK TO NORMAL:

    Healing is a gradual process. Although you may be up and about in a day or two, you can return to work for a week or more, depending on how you feel. Avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don't hesitate to contact me anytime.

    I will give you detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month or two. After that, you can resume these activities slowly.

    If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

    YOUR NEW LOOK:

    Your doctor will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that mastopexy scars are extensive and permanent. They often remain lumpy and red for six months to one year, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

    You should also keep in mind that a breast lift won't keep you firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have implants along with their breast lift may find the results last longer.

    Your satisfaction with a breast lift is likely to be greater if you understand the procedure thoroughly and if your expectations are realistic.

    Remember that during the first two weeks, rest as much as you can, eat plenty of fruits and vegetables and keep a positive attitude.

    Please AVOID:

    · Stress and anxiety after surgery · Bending over, nor put pressure on your arms or chest · Lifting your arms higher than your shoulders areas · Lifting any weight · Driving for three weeks · Avoid alcohol, smoking or being around smokers, aspirins, exercising, motrim, alka seltzer, and Vitamin E for one month after the surgery.

    · Avoid visiting the sauna, and showering or bathing with hot water for one month after the surgery.

    Thank you!



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