A History of Breast Lift Surgery

Mastopexy, or as it's more commonly known, breast lift surgery, is becoming increasingly popular for a variety of reasons, including reconstruction following cancer, dramatic weight loss, and to fight the changes brought on by aging, to name but a few. The goal of breast lift surgery is to elevate the breast tissue, orient the nipple and areola properly, and maximize the aesthetics of the breasts by improving their symmetry. And while this has been the goal since inception, the procedure has changed and evolved quite a lot over the years. Today, the procedure has improved to the point where implants are no longer a necessity and patients can enjoy long-term results.

First descriptions to 1930s

Descriptions of breast reduction can been found as early as Paulus of Aegina who lived 625 to 690 AD. Plastic surgery of the breasts continued through the early parts of recorded history, and was documented as early as 1669, with reports describing post-mastectomy reconstructions. But it wasn't for nearly another 200 years before the first analysis of mastoptosis, or breast sagging, was published by noted French anatomist and surgeon Alfred-Armand-Louis-Marie Velpeau in 1854. However, even with this, emphasis would not be placed on correcting breast ptosis until the early 19th century. Much of the early history of mastopexy procedures closely matches that of breast reduction, and the early attempt to alter the shape of the breasts, and the envelop of skin around them.

Surgeons experimented with improving their techniques throughout the beginning on the 1900s:

• Hippolyte Morrestin, a celebrated French surgeon often hailed as one of the founders of plastic surgery, was the first to describe a mastopexy method that transposed the nipple-areola complex (NAC) in 1907.
• Dr. Max Thorek expanded on this procedure, and is credited with the first free nipple graft. His procedure is still widely used today.
• Dr. Paul Kraske described his "single-stage" technique in 1923. Utilizing many of the principles of mastopexy used today, his techniques removed breast tissue from the lower pole, avoided undermining the skin, and resulted in a traditional inverted-T scar.
• E. von Hollander was the first to use the lateral oblique resection technique in 1924, which results in a L-shaped scar.
• German surgeon E. Schwarzmann developed a procedure in which the nipple and areola were transposed while preserving the blood supply in 1937.

By the late 1930s, nearly all the essential elements of the modern mastopexy had been developed. All that was required was further refinement of the procedure.

1940s to the New Millennium

The late 1940s through the late '70s brought a lot of refinement of techniques developed earlier, better surgical planning, as well as advancement in breast analysis:

• In 1949, Dr. Aufricht was among the first to advocate preoperative planning by using a geometric system, and also stressed that it was the skin envelope that determined the final breast shape.
• Shortly thereafter, in 1956, a Dr. RJ Wise refined Dr. Aufricht's ideas, and developed the preoperative geometric marking system that is still the most common method in use today.
• Mastopexy combined with breast augmentation for women with ptosis with hypoplasia (an underdevelopment of breast tissue) or tissue atrophy was first proposed by Dr. Gonzalez-Ulloa in 1960.
• Finally the mastopexy came into it's own in 1971, when Dr. Goulian Jr. first proposed the dermal mastopexy. During this particular procedure the surgeon only removes extra skin, and reshapes the breast mound using the remaining tissue. The actual mammary gland is not affected at all.
• In 1976 surgeons finally had the tools they needed to best diagnose breast ptosis when Dr. Regnault described his ptosis classification system. A modified version of the Regnault ptosis scale is still the most common standard of breast ptosis classification used today.

The '80s and '90s seemed to sense the coming millennium, and took the mastopexy in a more scientifically advanced direction:

• The early 1980s saw a rise in the use of medical materials to aid in mastopexies. Specifically, in 1981 the use of Marlex mesh (a plastic support structure) became popular to help lift the breast tissue, and avoid skin stretching.
• This procedure advanced quickly, with the development of a mesh that the body is able to eventually absorb in 1993.
• In 1990, Dr. Louis Benelli introduced a mastopexy procedure he called the "periareolar round block." This method removes excess skin in a donut shape around the areola, with lifting occurring as the outer circle is pulled into the areola with a “round block” interweaving stitching. While this technique has its limitations, it is still used today, under the name "Benelli lift."
• By the mid '90s several techniques were being developed to help recreate breast fullness using tissue transplanted from the patient's own body. The use of liposuction to help this process came into prominence in 1994 with Dr. Lejour's "Vertical mammaplasty and liposuction of the breast."

Modern practices

With the dawn of the 21st century, the focus of the development of mastopexy procedures has changed again, this time to minimizing scarring and achieving long-lasting results.

• 2002 saw a big step forward on both these goals when Drs. Graf and Biggs began using a modification of the traditional vertical technique. This modification places a transplanted tissue flap deep against the pectoral muscle. This improved the shape of the breast as well as maximized the longevity of the results.
• 5 years later, in 2007, this modified vertical method was further improved by Dr. Hidalgo. He began using a Y-shaped incision, reducing any eventual scaring.
• That same year a doctor named Umar D. Khan described a new, "vertical scar bipedicle" technique. This method combines minimal scarring with a strong blood supply to the NAC.

Today, anyone considering a mastopexy has the advantage of decades of development and experience. There are many excellent options to achieve that long lasting goal: to elevate the breast tissue, orient the nipple and areola properly, and maximize the aesthetics of the breasts by improving their symmetry.

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