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In cases where the breast has become very droopy from childbirth, age, or genetic predisposition, women can opt to have a surgery called mastopexy. It's designed to lift the nipple up higher, by removing excess skin and literally raising up the entire breast. Mastopexy involves several different incision options, some of which may leave quite a bit of scarring. The traditional incision is made in three parts: a circular cut that goes around the areola, a second incision running vertically from the areola to the fold underneath the breast, and a third incision across the fold. The cut looks like a keyhole, and it completely opens up the breast. In some cases, a "crescent mastopexy" can be done, in which the only incision is a small crescent at the top of the areola.

Another option, if appropriate for the patient, is to use only the circular cut around the areola. This separates the areola from the skin, enabling the doctor to cut away excess skin and tighten up the breast by pulling the skin together like a purse string, with a permanent suture. This lifts everything up and moves the nipple and areola to a higher position. Although the scar from this incision is not as obvious as the keyhole incision, it still may show. Use of tattooing may help minimize the appearance of scars.

If the mastopexy patient doesn't have very much breast tissue, implants may be inserted at the same time to make the breast look fuller.

Breast Reduction

Many women seeking breast reduction may have physical or emotional problems because their breasts are too large for their bodies. Physically, the extra weight of the oversized breasts puts a strain on the back and can result in stooped posture, back pain, and more serious spinal problems. Emotionally, many women feel singled out socially because other people notice their breasts rather than their other qualities. I've heard many women say, "I'm having this surgery because I'm tired of people talking to my chest instead of to my face."

These surgeries are complex and require significant experience and training. Even in the best of hands, often the anchor scar described earlier is a prominent deformity after the surgery. Be sure to spend plenty of time in consultation and education before committing to this procedure.

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