The underlying principle of the operation is to reduce the amount of breast skin while preserving the breast tissue. At the same time the nipple is raised to a higher position on the breast profile.
Sometimes the breast mass is increased by using an implant. Some patients may require a reduction in volume of the breast. This may be done using liposuctio or by direct excision rather like a breast reduction.
The main methods to remove excess skin are classified by the type of incision used.
The most extensive method uses an inverted "T" or anchor incision. This incision removes excess skin from below the nipple. It leaves a scar around and below the nipple shaped like an upside down "T" . It is sometimes referred to as a "Wise pattern" operation or "anchor"operation.
A second method uses an incision around the nipple and extending vertically downwards to the crease under the breast. This is called a lollipop incision. This avoids a long horizontal scar on the undersurface of the breast. In this technique the surgeon may undermine skin above and below the nipple to help tighten the breast.
A third method uses only an incision around the nipple called a circumferential, or circumareolar, incision. This avoids a long scar on the undersurface of the breast. In this technique the surgeon may undermine skin above and below the nipple and tighten the breast tissue directly with stitches. This may damage the blood supply to the nipple but can improve the shape.
A fourth method often used in younger patients, or those with a smaller amount of laxity, is called a crescent mastopexy. A semicircular areas of tissue is removed from above the nipple leaving a scar only on the upper half of the nipple. The advantage is the smaller scar and more normal shape. The disadvantage is that it will not produce the same amount of tightening as with longer scar mastopexies.
If a patient has extensive ptosis a longer scar is used but this is often not acceptable to many patients.