I get asked certain questions often. Sometimes in person, sometimes via socials (and yes, I do respond to DMs...eventually 😁). You can see an example of what I mean above.
One of those questions is: "I want to have a mastopexy, but I might decide to have (another) child in the next few years. Should I wait?"
It's a good question. There is no clear right/wrong answer. And whilst there are certain ideological positions that some surgeons will take, I think we should break those positions down a little to look at what is actually going on.
Whilst for many surgeons the answer is a hard "NO", the alternative response is typically a "YES, BUT..."
Aesthetic breast surgery is always considered in the context of what might happen after surgery to influence/compromise outcomes. What I find really interesting is that whilst there are plenty of surgeons who will happily throw a couple of silicone implants at a lady in her early 20s whilst knowing very well that the outcome of breast implant surgery will be fundamentally compromised by changes in the breast during pregnancy, those same surgeons will express hesitancy about a young woman asking about a mastopexy with exactly the same considerations.
So why the double-standard?
Why will some surgeons happily perform a breast augmentation for a woman who definitely intends to have children at some point in the future, but those same surgeons will refuse a woman a mastopexy because she intends to have children in the future?
We can be cynical and point to the commercial expediency with which breast augmentation is performed. We can consider the financial motivations of doing a breast augmentation and taking a blasé attitude to future changes - "don't worry, we'll just revise things down the track". Both of these statements point to the "short-termism" underlying much of the cosmetic surgery market (ie. make a buck and make it quickly with no thought for the future prospects of a patient). But I think there is also something else to consider.
In general, I reckon there are 2 basic philosophies that underlie how surgeons approach cosmetic plastic surgery procedures. We can consider those two philosophies as: a) surgeon-centric, and b) patient-centric.
On the one hand, there are surgeons who will take a position that they will only offer surgery to the "ideal" patient. That ideal often relates to weight, or BMI, or age, or some other personal feature. These surgeons will profess that by taking this approach, they are ensuring that their patients get the "best possible outcomes". Which might be true in their eyes. But in reality, this has more to do with surgeon ego than it does with the patient's outcome. These surgeons are essentially saying: I will only offer my magical surgical skills to the ideal patient because I don't want my reputation sullied by a less than ideal patient getting a less than perfect outcome, which might ruin my instagram. This is the "surgeon-centric" approach.
There are of course other surgeons who will consider each patient's desires, weigh that against other factors, and then have a discussion about the pros and cons of doing something now vs. waiting. They will allow the patient to make an informed decision. This can be a difficult thing for a surgeon to do because they have to accept some loss of control over the outcome.
In reality, there is likely to be a little of both at play, so that whilst I like to think we take more of a patient-centric approach, I will concede that I still want each patient to get the best possible outcome and there will always be times where I counsel a patient away from surgery for one reason or another. It is a matter of balance.
So let's come back to the question I posed at the start of this article.
Many ladies have had children, and experience changes in the breast after pregnancy and breast feeding. Many ladies then consider whether a breast lift is something they would like to do. Some of those ladies also think they might have another child.
I guess the question then is what will a mastopexy achieve, and how much of that result will change in the event of a further pregnancy. This is basically the same question we have to pose for those young ladies having breast reductions or mastopexy procedures early in life before ever having children (but with some subtle differences).
Well, the first part is easy. A mastopexy will elevate the breast, tighten the tissue to create a firmer bust, remove excess skin, narrow the breast (for those ladies who feel that their breast falls into their armpit), and of course, in correcting ptosis, a mastopexy will deal with the issue of the breast skin resting on the skin of the lower ribs, which means no more sweating or chafing in warmer weather. These are all the things that a typical mastopexy does.
If a woman then falls pregnant again, then there may be (a variable degree of) breast enlargement. For some ladies, their breast enlargement is greatest with their first pregnancy; for others, the degree of enlargement increases with subsequent pregnancies. I think the point to make is this: even if the breast enlarges with a pregnancy after mastopexy, it will be chaging from a totally different starting point. Which means that the pregnancy-induced change is going to have a very different impact to if that change was occurring to a breast that had never been lifted. This means that for many women, that change is far more tolerable than it would otherwise have been.
The other point to make is that when I am asked this question, it is often being asked by ladies who don't have any firm plans for more children; rather, I think they are just wanting to know that it is still an option. Therefore, those ladies don't have a time-frame in mind, and the question I put back to them is "what is the value to you of having a mastopexy now and enjoying the outcome of that surgery for as long as you can?". Implicit in that question is accepting that whilst a future pregnancy might alter the outcome of a mastopexy, there is often an enormous positive change to be enjoyed for these ladies after surgery. A mastopexy restructures the breast in such a way that even if there is a subsequent pregnancy, the breast won't just end up back where it started.
"...whilst a future pregnancy might alter the outcome of a mastopexy, there is often an enormous (and ongoing!) positive change to be enjoyed for these ladies. A mastopexy totally restructures the breast in such a way that even if there is a subsequent pregnancy, the breast won't just end up back where it started."
As with all cosmetic procedures, these are personal decisions underpinned by personal preferences and desires. You can let a surgeon dictate the terms of a mastopexy to you, or you can have an honest discussion about your options and accept a different outcome. Neither option is wrong, but perhaps one will suit you better than the other.
Ok, bye.