Introduction With the passing of time and also due to gravity and other factors that can affect the appearance of the breasts, the breasts can become saggy with a low position on the chest wall, an excess of skin envelope, and the nipple and areola complex facing down or positioned below the level of the inframammary fold. The only efficient method to correct mammary ptosis is with the help of plastic surgery, namely the breast lift. The breast lift is also known under the medical term of mastopexy and is performed with the aim to elevate saggy breasts and restore their beauty by making them firmer, rounder and eliminating the excess skin. Mastopexy is performed to contour and elevate the breasts of patients who are suffering due to breast ptosis. In this article, we will discuss the procedure and some of its details. Pre-operative consultation for mastopexy Just like any other plastic surgery procedure, the first step you need to take if you want perky breasts again is to schedule a meeting with the plastic surgeon. During this initial consultation, you will be asked to talk about your medical history, potential current medication and allergies, and also your goals and expectations from the surgery. The plastic surgeon will perform a medical examination and extensive measurements of your body and will ask details about the desired size, shape and position of the breasts. Don’t expect the plastic surgeon to know what you want because plastic surgery to lift the breasts is a very customized experience and there are rarely any patients with the same exact aesthetic goal in mind. Aside from the results that can be achieved, the plastic surgeon will also tell you whether he sees it necessary to combine the procedure with other plastic surgery techniques. It is quite common practice nowadays for patients with small breasts to also get implants while undergoing mastopexy. This is recommended because when the skin tissue is excised and if the sagginess is severe, the patient might be dissatisfied with the slight reduction in the size of the breasts, especially if the breasts are on the small side to begin with. Make sure to cover all the details about the procedure with the plastic surgeon during the initial consultation and if you have concerns related to the potential risks and complications. Finding out all the details of the procedure before scheduling it makes you prepared to undergo plastic surgery. Mastopexy: An overview There are many details that should be discussed about mastopexy, but mostly you should know how to prepare for it, what happens when it is performed, and what to expect after the surgery during the recovery period. The preparation period for the breast lift is associated with a cessation of smoking for at least three weeks before the procedure takes place. Birth control pills and also anti-inflammatory medication need to be avoided for two weeks or more before the procedure. The patient should make sure to have a balanced and healthy eating regimen in the weeks before the breast lift as this creates good premises for a fast and smooth recovery. When the surgery is performed, the patient is often under general anesthetic. This form of anesthesia is usually preferred by both the plastic surgeon and patients because it is more comfortable for the patient. A consultation with the anesthetist where the anesthesia type will be discussed will be scheduled a few days before the procedure. Once again, it is important to mention to the anesthetist during the consultation what certain medication you take currently or allergies that you know of. The surgical approach for the breast lift is different from surgeon to surgeon, patient to patient, and according to the severity of the breast ptosis. This means that different surgeons will prefer different techniques. Generally speaking, a responsible and experienced plastic surgeon will adapt the breast lift method he prefers according to the anatomical characteristics and aesthetic desires of the patient. When the breast sagginess in minor, the plastic surgeon might choose to perform the periareolar incision to correct the ptosis. This means that only one incision will be performed on each breast, around the edges of the areolas, following the contours of the areolas. The periareolar incision is a good solution only for minor sagginess as it doesn’t allow to excise a considerable amount of skin. The skin that is removed is dissected in a circular motion around the areola. If the patient has chosen to have implants inserted, this can also be done using the periareolar incision if the implants are made out of silicone and have a small or moderate volume or are saline solution implants. But most patients are confronted with more severe cases of breast ptosis that need two or three incisions to be performed on each breast. The second incision is from the edge of the areola vertically towards the inframammary fold, and another incision can be positioned in the fold under the breasts. The more severe the breast ptosis, the more incisions will be required. This is why my recommendation is not to wait until your breast ptosis becomes severe but schedule the procedure at the early signs to have a less invasive procedure compared to a more complex one later on when the breast sagginess is more serious. After the procedure, the incisions will be sutured and the patient will be moved to a recovery room where she will remain for a few hours after waking up from the anesthesia. If no complications occur, the hospitalization period is no longer than a few hours, so the patient can start the recovery period in the comfort of her home. It is important to know that a certain level of pain and discomfort is to be expected after the breast lift procedure. The plastic surgeon will provide pain medication for the management of pain and also antibiotics to prevent infections that could occur after any type of surgical procedure. There are several recommendations that are mandatory to be followed after the breast lift with the purpose of reducing the risks and potential complications. An important thing to remember and do after the breast lift is to avoid sleeping on the tummy and lifting heavy objects from the floor. These recommendations are valid for any type of breast enhancement procedures. The unnecessary pressure put on the breasts when lying on them can cause the rupture of the sutures and wound opening if it occurs in the first few weeks post-op. Wearing a special post-op bra or a good quality sports bra is also important for a few weeks or even months after the breast lift. It is important to understand that the breasts need support and compression after the procedure to allow for a fast recovery and to reduce swelling. Moreover, the breasts always need support when the woman engages in physical activities. This means that even if your breasts will be perky and firm after the procedure and you might be tempted to go braless, the recommendation is to wear a bra still, especially when physical activities are performed. This will help you sustain the results of the procedure and the beautiful appearance of your breasts for longer. The results of mastopexy are visible immediately after the procedure, but should only be evaluated after at least six to nine months. An intrinsic part of the success of the surgery and the appearance of the final results are the scars left behind by the procedure, and it can take up to one year for the cicatrization process to be completed. Conclusion Mastopexy is the plastic surgery procedure performed with the purpose to contour and elevate the breasts. Patients confronted with breast sagginess have a good solution to correct the appearance of their breasts. Moreover, the results of the breast lift will last in time, and the patient will have a youthful appearance for longer compared to women who didn’t have plastic surgery. However, it is important to understand that the appearance of the breasts can be altered and the results of the breast lift can be compromised if the patient will have an ulterior pregnancy or undergo weight fluctuations after the breast lift. The general recommendation is to have the procedure when no pregnancies are planned for the future, and the weight of the patient is normal and has been stable for at least six to eight months, preferably longer.