A breast lift, formally known as mastopexy, is a cosmetic surgical procedure designed to raise and reshape the breasts. This operation addresses the effects of gravity, aging, and weight fluctuations, which can cause the breasts to sag or appear elongated. The primary goal is to restore a more youthful, elevated contour by tightening the breast’s skin envelope and repositioning the internal tissue. While fundamentally a reshaping operation, not a volume reduction procedure, the resulting change in shape often makes the breasts look smaller, firmer, and more compact.
Mastopexy Versus Reduction Mammoplasty
The distinction between a breast lift (mastopexy) and a breast reduction is based entirely on surgical intent and the amount of tissue removed. Mastopexy focuses on correcting breast ptosis, or sagging, by removing excess, stretched skin and tightening the remaining tissue structure. Success is measured by the vertical movement of the nipple-areola complex and the overall improvement in breast shape.
A reduction mammoplasty, by contrast, aims to decrease the overall volume and weight of the breast. This procedure involves the intentional removal of significant amounts of glandular tissue, fat, and skin. The success of a reduction is often measured by the weight of the tissue excised, which can alleviate symptoms like chronic neck and back pain.
A mastopexy aims to maintain existing volume while improving position and shape, typically for women satisfied with their current size. A reduction is chosen by women seeking smaller breasts for both aesthetic reasons and physical relief.
Both procedures may use similar incision patterns, such as the inverted-T, to access internal tissue. However, in a mastopexy, the deep tissue is primarily rearranged and tightened, sometimes using internal sutures for support. A reduction involves removing a measurable quantity of tissue, often hundreds of grams per breast, to achieve the desired size decrease.
How Repositioning Changes Appearance
The perception that a breast lift reduces size results from surgical recontouring and tissue repositioning. Before surgery, a ptotic breast often has a wide base and a downward-sloping shape, with volume spread across a larger surface area. This “spread” appearance of loose tissue can make the breast look heavier and larger than its actual volume suggests.
During a mastopexy, the surgeon gathers the loose tissue and repositions the entire breast mound, centering the volume higher on the chest. By tightening the skin envelope and elevating the nipple-areola complex, the breast gains improved projection. This moves the tissue forward rather than downward, creating a narrower, firmer profile.
This recontouring eliminates the visual effect of tissue pooling at the bottom of the chest. Although the actual volume remains largely the same, the improved shape gives the illusion of a smaller, more compact breast. Patients often find their silhouette appears more streamlined because the breast is no longer sagging below the inframammary fold. The improved firmness and height emphasize the uplifted shape, which is interpreted visually as a reduction in size.
Surgical Factors That Influence Volume
Despite the primary goal of mastopexy being volume preservation, a slight reduction in actual breast volume can occur as a secondary effect. This volume change results from removing the excess skin necessary to lift and tighten the breast envelope. When a woman has significant ptosis, a substantial amount of stretched skin must be excised to create the new, firmer shape.
The removal of this excess skin results in a measurable, though usually minor, decrease in volume. For more dramatic lifts, some patients may experience a reduction of about half a cup size up to a full cup size. This subtle reduction is due to the consolidation of tissue and the trimming of the skin, not the intentional removal of deep glandular tissue.
In some larger mastopexies, a surgeon may also remove a small, controlled amount of glandular tissue and fat to refine the new breast contour or improve symmetry. This minor excision is performed to achieve a more aesthetically pleasing shape and is secondary to the main lifting objective. The resulting volume reduction is a byproduct of the reshaping process, contrasting sharply with a reduction mammoplasty where tissue removal is the main focus. The goal of a breast lift remains the restoration of shape and position, and any volume reduction is incidental to tightening the breast’s supporting structure.