13 Minute Read | Posted August 14, 2026 in Breast Lift
Few procedures change how a patient feels in her clothes — and in her own skin — as reliably as a breast lift. Yet mastopexy is also one of the most misunderstood operations in aesthetic surgery. Patients often arrive at a consultation confused about what a breast lift actually does and does not do. Some patients of mine also are unsure of whether they will need an implant placed at the same time or not to meet the desired effect they want.
I will certainly try to provide some clarity on these and other questions.
What Is a Mastopexy?
A mastopexy is the official term for a “breast lift”. It helps to lift the nipple and breast tissue into a more youthful contour with the nipple areola complex (NAC) at its appropriate placement. This is done primarily by removing excess skin on the breast. As the breast descends over time and fluctuates in volume with pregnancy, age, and breast feeding – the skin envelope of the breast can become redundant. Removing the excess breast skin, reducing the diameter of the areola, shaping the underlying breast tissue and lifting it, and possibly placing a temporary mesh to support the breast tissue while the tissues heal.
What a lift does not do is add volume. It is a frequent occurrence where patients will comment to me when asking about a breast lift how “I want my breasts to look like they have implants”, or will point to the upper part of their breast stating they want more volume in that area. What I do is from the underside of their breast with my hand I will lift their breast until the nipple at its aesthetically ideal position which is at the breast fold, and I will ask them to look at the upper part of their breast and appreciate how even though yes we are lifting the breast and lifting the nipple, volume restoration is not the main goal of a breast lift. I will explain solutions for this issue later on.
Why Breasts Lose Position
Breast ptosis (the clinical term for sagging) is a skin and support-structure problem more than a tissue problem. The common contributors include:
- Pregnancy and breastfeeding. The breast enlarges, then involutes, leaving a skin envelope larger than its contents.
- Weight fluctuation. Significant gain and loss stretches skin past its capacity to recoil — a frequent finding after bariatric surgery or major weight loss.
- Aging. Collagen and elastin decline, and the ligaments that suspend the breast lengthen over time.
- Genetics. Baseline skin quality, breast size, and chest wall anatomy are inherited and matter more than most patients expect.
- Gravity and time. Unavoidable, and cumulative.
Surgeons often describe ptosis using the Regnault classification, which compares the position of the nipple to the inframammary fold (the crease beneath the breast). In mild ptosis the nipple sits at or just below the fold; in severe ptosis it sits well below and points downward. There is also pseudoptosis, where the nipple remains above the fold but the breast tissue has descended below it — a pattern that sometimes calls for a different approach.
Are You a Candidate?
Mastopexy tends to suit patients who:
- Are bothered by breast position, elongated shape, or downward-pointing nipples
- Have areolas that have stretched or enlarged
- Have finished childbearing, or at least are not planning a pregnancy in the near term
- Are at a stable weight
- Are in good general health and do not use nicotine products (nicotine meaningfully increases the risk of wound-healing complications and nipple loss)
- Hold realistic expectations about scarring
Pregnancy and substantial weight change after surgery can undo results, which is why timing matters. Patients who plan future pregnancies aren’t disqualified — many proceed anyway — but they should understand the tradeoff and that having another child can certainly work to undo a lot of the improvement seen from their prior breast lift.
Anyone with a personal or family history of breast cancer should have appropriate imaging and screening in place before elective breast surgery. It is very standard for me to order a pre-operative mammogram in patients as young as 30 years old; and if you fall into regular mammogram monitoring age that your prior one is no older than 1 year from the day of your surgery.
Lift, Augmentation, or Both?
This is the central decision in most consultations and is the crossroad in the conversation where I begin talking to patients about volume restoration if they desire that as well..
Mastopexy alone improves position and shape and reduces the skin envelope. Best for patients happy with their volume when supported by a bra.
Augmentation alone adds volume and can create modest upper-pole fullness, but an implant placed into a stretched, ptotic breast often makes the sagging more obvious rather than less. You can see this effect in a patient who has had breast implants placed when they were young before ptosis started to become apparent and as the patient ages the breast tissue and NAC descend off the mound created by the implant. Some surgeons call this a “Snoopy deformity” or “Waterfall deformity”. I take a fair amount of time during my consultations for breast lifting and breast augmentation to assess this possibility.
Augmentation-mastopexy combines both. It is a powerful operation and also a technically demanding one, because I am simultaneously enlarging the breast and reducing its skin envelope — two opposing goals. Revision rates are higher than for either procedure alone, and some surgeons prefer to stage the two operations in patients with severe ptosis. It is routine for me to perform them together because in my aesthetic surgery fellowship I performed numerous amounts of augmentation-mastopexy and understand the nuanced techniques to lift the breast and add volume and anticipate the changes after surgery as the breast settles. I do stage the surgery in patients with extremely ptotic breasts. Where I place the implant would be an entire blog post in and of itself but I typically place my breast implants infront of the muscle but under the tissue covering the muscle in what is called a “sub-fascial plane”. This does not harm the pectoralis muscle, this also prevents any animation deformity in its entirety, and is also less painful and gives my patients a much more comfortable experience in their post-operative state. It is also possible to add volume to the beast using fat grafting after doing liposuction to acquire some of the patients fat. This is a good technique for overall volume increase and means no implant is used, but this technique still does not restore upper pole volume as powerfully as an implant can, but can be a nice compromise between implant or no implant.
Breast reduction overlaps significantly with mastopexy in technique but removes glandular tissue as well, and is typically pursued for symptom relief — neck and back pain, shoulder grooving, intertrigo. Essentially what I tell patients is “we do not reduce a breast without performing a lift, so yes a breast reduction reduces the amount of tissue in the breast and also lifts it. Therefore a breast reduction and a breast lift are sister surgeries, they are very similar, except in a reduction we reduce and lift but in a mastopexy we do not remove large amounts of breast tissue.”
Incision Patterns
The right technique depends on how much skin needs to come out and how far the nipple must travel.
Crescent lift. A thin crescent of skin removed above the areola. Suitable only for very minor asymmetry or elevation of a centimeter or so. This technique is for very special cases only.
Periareolar (donut or Benelli) lift. This technique essentially removes skin around the areola in a circular pattern. Many surgeons use this technique widely for many patients, but I find this inappropriate. They are offering patients a surgery with minimal scarring in the hopes that the limited scar will make the surgery more appealing to the patient, but the limitations of a periareolar breast lift are real and unforgiving. I have seen many revision patients where the scar around the areola has widened due to tension. I have seen many revision patients where the areola widens and flattens over time due to the normal physiology of scar formation. I have also seen many patients for revisions from other surgeons who also are unhappy with the amount of lift provided. This technique also does not address the deeper breast gland issue itself.
Vertical (lollipop) lift. Incisions around the areola and vertically down to the fold. This is the workhorse technique for moderate ptosis — it allows genuine reshaping of the underlying tissue and produces a projected, conical result. Well suited to most patients.
Inverted-T (anchor or Wise pattern) lift. Adds a horizontal incision along the inframammary fold. Reserved for significant ptosis or large breasts where a great deal of skin must be removed. More scar, more control.
More scar generally buys more shape. The goal is the least incision that will achieve the result — not the least incision, full stop.
Many of my patients fall into either the vertical pattern lift or the anchor pattern, the only difference being the incision in the breast fold. The incision around the areola is well hidden because every patient’s areola is a different skin tone than the surrounding skin. The incision in the breast fold is well hidden because the breast drapes over the fold to hide it. The third component of the anchor incision – the vertical line connecting the breast fold and areola incision – is the only component with no natural disguise to utilize. However this incision routinely heals extremely well and there are many examples of my patients in whom you would need to have your eyes inches from this well healed pencil thin scar to even notice it.
The Procedure
Mastopexy is typically performed under general anesthesia as an outpatient procedure, taking roughly two to three hours depending on technique and whether an implant is involved. Markings are made preoperatively with the patient standing, since gravity is doing the work being corrected.
Most patients go home the same day with a surgical bra and, sometimes, drains.
Recovery: A Realistic Timeline
Days 1–7. Soreness, tightness, and swelling are expected; most patients describe it as pressure rather than sharp pain, and it is generally well controlled with oral medication. Sleeping elevated helps. A supportive surgical bra is worn continuously.
Weeks 1–2. Many patients return to desk work within a week to ten days. Driving resumes once off narcotic pain medication and once you are able to move comfortably.
Weeks 2–6. Light activity increases gradually. Strenuous exercise, chest work, and heavy lifting are typically restricted for four to six weeks to protect the healing tissue. At week three I typically transition my patients from the surgical bra to a light cotton sports bra as compression and support are not paramount once that far out from surgery. And at week six my patients can get fitted for a new underwire bra which I encourage them to wear as much as possible because the breast tissues will settle and take on some of the shape of the bra, like a mold.
Months 2–6. Swelling resolves, the breasts settle, and the shape softens into its final form. Early postoperative results often look higher and tighter than the eventual outcome — this is normal.
Months 6–18. Scars mature. They begin firm and pink or red, then gradually flatten and fade. Silicone sheeting or gel, sun protection, and scar massage all help. Final scar appearance shouldn’t be judged before a year.
It is very important to bear in mind that gravity never takes a day off. We plastic surgeons understand this and anticipate descent of the breast until healing is finished. In all of the textbooks written about breast lift surgery many surgeons describe the immediate result as “an upside-down breast”. Where the volume is more prominent near the top of the breast and a flatter than expected bottom half. This is done on purpose. As you heal and the tissue settles and softens, the breast tissue slowly but surely falls back to a more natural position over the ensuing weeks and results in a nice full bottom half of the breast with a nice pleasing contour leading towards the top of the breast.
Risks and Considerations
Mastopexy is a well-established procedure with a good safety record, but no surgery is without risk. Patients should be counseled about:
- Scarring. Permanent and unavoidable. Quality varies by individual healing, and hypertrophic or keloid scarring is possible.
- Changes in nipple sensation. Some patients do report temporary numbness in their nipple after surgery. Some actually report increased sensitivity. These changes are temporary and resolve with time. Permanent alteration of the sensation in the nipple is an extremely rare but certainly real risk.
- Breastfeeding. Many patients can still nurse afterward, but the ability may be reduced. Techniques that preserve the nipple’s blood supply and ductal connections are generally more favorable.
- Asymmetry. Some degree exists in nearly everyone before surgery and may persist after. I take great care to point out asymmetry in regards to posture, shoulder height, where the breast folds sit and if those are different, and differences in volume and shape.
- Wound healing problems, infection, hematoma, seroma.
- Nipple-areola compromise. Rare, but the reason smoking cessation is non-negotiable.
- Recurrent ptosis. Skin and gravity continue to act. Results are long-lasting, not permanent.
- Need for revision surgery.
How Long Do Results Last?
Most patients enjoy their result for many years. Longevity depends on skin quality, breast size and weight, weight stability, and whether pregnancy follows. Consistent, well-fitted support and stable weight are the two variables most within a patient’s control.
Frequently Asked Questions
Will I be bigger after a lift? No. You may look fuller because the tissue is repositioned, and you’ll likely fit a bra differently, but volume is unchanged. Adding size requires an implant or fat grafting.
Can I have a lift and implants at once? Often, yes. Whether to combine or stage depends on your anatomy and goals, and is one of the more important judgment calls made in consultation.
Will insurance cover it? Mastopexy for cosmetic reasons is not covered. Breast reduction for documented symptoms sometimes is but very subject to insurer criteria.
How visible will my scars be? They are placed in concealed locations and fade substantially, but they are permanent. A patient unwilling to accept a scar is not a candidate for a lift.
When can I go back to the gym? Lower body and light cardio often around two to three weeks; full upper-body and high-impact work usually at six weeks.
Next Steps
The best way to know whether a mastopexy is right for you is an in-person evaluation, where measurements, skin quality, tissue volume, and your specific goals can all be assessed together.
To learn more about Breast Lift surgery in New Orleans, LA, schedule a consultation with Dr. Bartow at Bartow Plastic Surgery. Call (504) 895-7200 or complete our online contact form to request your appointment.