Understanding Breast Ptosis

Breast ptosis is a common condition that affects many women, especially as they age, experience weight changes, or go through pregnancy. It is characterized by an inferior descent of the nipple relative to the breast fold and lower pole skin redundancy. The natural history of breast ptosis begins with the stretching of the skin envelope, ductal structures, and supporting ligaments. As the breast parenchymal volume changes, either increasing or decreasing, the supporting structures become ineffective, leading to skin redundancy and the development of ptosis ⁶.

The regnault classification is commonly used to categorize the degree of ptosis. Grade 1 or mild ptosis occurs when the nipple is at the level of the fold. Grade 2 or moderate ptosis is when the nipple is below the level of the fold, but not at the most dependent part of the breast. Grade 3 or severe ptosis is when the nipple is below the fold and is the most dependent part of the breast. Pseudoptosis is when the nipple is above or at the level of the fold, most of the breast is well below the fold, and the nipple to inframammary fold (IMF) distance is usually more than 6 cm ⁶.

Indications for Treatment

The correction of breast ptosis is typically achieved through surgical approaches. The choice of surgery depends on the degree of ptosis and whether the patient wishes to correct breast shape, volume, or both. The overall goals of treatment are to achieve a pleasing breast contour, a well - positioned nipple, breast symmetry, upper pole fullness, and a non - redundant skin envelope ⁶.

However, all surgical approaches have advantages and disadvantages, as well as different degrees of scar burden. It is crucial for surgeons to adequately manage the patient's expectations, establish open communication, and obtain well - documented consent to minimize the probability of litigation ⁶.

Popular Surgical Procedures for Breast Ptosis Suspension

Mastopexy

Mastopexy is indicated for patients with ptosis who only want to change the breast shape without altering the volume and desire to gain upper pole fullness and a youthful, lifted appearance. It is contraindicated in active smokers or patients who also want a change in volume ⁶.

Periareolar Mastopexy

This procedure is suitable for patients with mild or moderate ptosis, or nipple asymmetry, and little lower pole skin redundancy, as long as they have reasonable skin and parenchyma quality. The main purpose of periareolar mastopexy is to reposition the nipple, usually by a maximum of 2 cm ⁶.

The traditional mastopexy technique involves re - draping the circumareolar skin to support the parenchyma. An eccentric oval is drawn around the areola, with more skin included superiorly to elevate the nipple. The skin between the nipple edge and the outline is de - epithelialized, and the incision is then closed around the nipple. However, this technique has a high rate of patient dissatisfaction and revision due to issues such as loss of breast projection, nipple widening, and flattening. Some surgeons advocate for a superior crescent - shaped marking and the use of barbed or permanent suture purse - string closure to reduce these problems, with varying degrees of success ⁶.

The Benelli periareolar mastopexy has become more popular as it also redistributes the parenchyma to buttress the breast. In this technique, a slightly larger ellipse is drawn, the parenchyma is incised inferiorly, and the resulting medial and lateral edges are crossed or invaginated in the midline. This gives the breast shape more projection and a narrower width. However, after parenchymal incision, the normal blood supply to the nipple is disrupted, and it becomes dependent on the superomedial vessels. Therefore, in patients undergoing augmentation / mastopexy, an implant placed in the submuscular plane is considered safer ⁶.

Vertical Mastopexy

Vertical mastopexy can be used for any degree of ptosis. Generally, all vertical mastopexies involve small amounts of parenchymal excision and skin envelope redraping, which may modestly reduce the breast size. The traditional vertical mastopexy techniques have evolved into current methods such as the Spair mammaplasty by Hammond and the Hall - Findlay mastopexy ⁶.

The Short - Scar Periareolar Inferior Pedicle Reduction Mammaplasty (Spair) is performed via a circumareolar elliptical incision. The nipple is left on an inferior pedicle, and the parenchyma is trimmed and redistributed superiorly. The pedicle is then tacked to the superior chest wall by suspension sutures to maintain the nipple's new position. Subsequently, the lower pole redundancy is tailor - tacked and excised vertically, sometimes in a slight lateral J - pattern to avoid dog ears. However, this technique can cause changes in nipple sensation, periareolar pleating, and periareolar widening. Additionally, the use of an inferior pedicle increases the risk of bottoming - out, and it may not be suitable for combined augmentation and mastopexy as the implant weight can attenuate the blood supply to the nipple ⁶.

The Hall - Findlay vertical mastopexy uses a medial or superomedial based pedicle. It is also performed through a circumareolar elliptical incision, but the parenchyma is trimmed and redistributed inferolaterally. The lower pole skin redundancy is tailor - tacked and excised vertically. One caveat is that the native inframammary fold tends to rise with this technique, so the most inferior portion of the incision must end above the native fold to avoid extending the scar onto the abdomen as the breast settles. This technique provides structural support by excising parts of the lower pole parenchyma, adjoining the medial and lateral edges inferiorly, and narrowing the breast, which counteracts the downward forces and decreases ptosis recurrence. The superomedial pedicle is based on the main arterial supply to the nipple, allowing for subglandular or submuscular augmentation / mastopexy as the implant does not exert pressure on the pedicle ⁶.

Inverted - T Mastopexy

Inverted - T mastopexy is indicated for patients with severe ptosis due to an excessive skin envelope to parenchyma ratio. It is also suitable for patients of any grade of ptosis with fatty parenchyma or poor skin quality. Similar to vertical mastopexy, it has periareolar and vertical incisions, but it also includes a horizontal incision within the inframammary fold ⁶.

The traditional Wise - pattern is the most commonly used skin incision approach for inverted - T mastopexy, as it is also widely used in reduction mammaplasty. Regardless of the incision pattern, the parenchyma is trimmed and redistributed. The inferior crossing of the lateral and medial parenchymal edges often provides longevity to the mastopexy. To improve upper pole fullness, the lower pole parenchyma can be suspended from the pectoralis fascia. Different pedicle types and parenchymal manipulations can be used, but inferior pedicles are associated with bottoming - out. Although inverted - T mastopexy has a significant scar burden, it is widely used because of its predictable results and surgeons' familiarity with the procedure ⁶.

Augmentation / Mastopexy

Breast augmentation can be achieved using autologous breast tissue, fat, or more commonly, implants. It increases the breast size, stretches the skin envelope, and exerts pressure on the lower pole's parenchyma. Mastopexy, on the other hand, aims to reposition the nipple and reshape the breast by excising redundant skin and redistributing the parenchyma to reinforce the lower pole. Therefore, the two procedures have opposing forces ⁶.

Augmentation alone is sufficient for patients with hypomastia without ptosis or with minimal ptosis (nipple - IMF distance less than 10 cm, or skin stretch less than 4 cm). In these cases, augmentation can project the nipple and correct relative skin redundancy. Mastopexy alone is adequate for patients with ptosis and minimal hypomastia by reducing the surface area to correct relative volume deficiency. Augmentation / mastopexy (combined augmentation and mastopexy) is only indicated when both the volume deficit and ptosis are severe enough that neither procedure alone can achieve the desired results ⁶.

The type of mastopexy combined with augmentation depends on the degree of ptosis. Periareolar mastopexy is used for patients with nipples less than 2 cm below the fold and not pointing inferiorly. Vertical or inverted - T mastopexies are used for more severe ptosis ⁶.

The single - stage versus two - stage approach is a controversial aspect of augmentation / mastopexy. The single - stage approach has traditionally been considered more unpredictable and associated with a higher revision rate. However, a recent meta - analysis of 4856 cases of single - stage augmentation / mastopexy reported a pooled complication rate of 13.1% and a reoperation rate of 10.7%, which is comparable to the mastopexy - only reoperation rate. Proponents of the single - stage approach argue that it has a lower reoperation rate compared to the two - stage approach. Nevertheless, further clinical trials are needed to reach a consensus. The ideal candidate for a single - stage procedure would have mild or moderate ptosis, a flaccid and soft breast with good skin elasticity, not require large parenchymal or skin resection, and only desire a moderate augmentation (<360 cc). Patients with severe ptosis, a vertical excess greater than 6 cm, attenuated nipple vascularity, or a desire for a marked augmentation would benefit from a two - stage approach ⁶.

Top Hospitals in New York City for Breast Ptosis Suspension

New York - Presbyterian Hospital - Columbia and Cornell

New York - Presbyterian Hospital - Columbia and Cornell is one of the top - ranked hospitals in the United States. It has a long - standing reputation for excellence in medical care across multiple specialties, including plastic surgery. The hospital's plastic surgery department consists of highly skilled and experienced surgeons who are well - versed in the latest techniques for breast ptosis suspension. They offer a comprehensive range of surgical options, tailored to the individual needs of each patient. The hospital also provides state - of - the - art facilities and a multidisciplinary approach to patient care, ensuring the best possible outcomes for patients undergoing breast ptosis correction ².

NYU Langone Hospitals

NYU Langone Hospitals are known for their expertise in women's health and plastic surgery. The plastic surgeons at NYU Langone are at the forefront of innovation in breast surgery. They use advanced surgical techniques and technologies to perform breast ptosis suspension procedures with precision and care. The hospital offers patient - centered care, with a focus on personalized treatment plans. Additionally, NYU Langone has a strong research program, which allows their surgeons to stay updated on the latest developments in the field and provide the most effective treatments to their patients ².

Mount Sinai Hospital

Mount Sinai Hospital has a well - regarded plastic surgery department that offers high - quality breast ptosis suspension services. The surgeons at Mount Sinai are experienced in handling complex cases of breast ptosis. They take a holistic approach to patient care, considering not only the surgical aspects but also the psychological and emotional well - being of the patients. The hospital is committed to price transparency, providing patients with clear information about the costs associated with breast ptosis suspension procedures. Patients can expect a high level of care and support throughout their treatment journey at Mount Sinai ².

Determining the Reference Price

Determining the reference price for breast ptosis suspension in New York City hospitals is a complex process. Hospital pricing in the United States is notoriously convoluted, and there is a great deal of variability in the charges for medical procedures ⁸.

Each hospital has a "chargemaster," which is a list of gross charges for the services it provides. However, these chargemaster prices are often arbitrary and may not reflect the actual amount that patients will pay. Factors such as insurance coverage, discounts negotiated with insurance companies, and the patient's out - of - pocket expenses (including deductibles, copayments, and coinsurance) all play a role in determining the final cost ^3,8.

For example, at Mount Sinai South Nassau, in compliance with Centers for Medicare and Medicaid Services regulations, the hospital provides machine - readable files that include all standard charges, such as gross charges, discounted cash prices, and payer - specific negotiated charges. However, the standard charges do not easily translate into the price of expected care, as costs can vary based on the exact combination of services received, the patient's annual health care spending, and other factors. To get the best estimate of out - of - pocket costs, patients are advised to contact their insurance company ³.

Another challenge in determining the reference price is the lack of transparency in hospital pricing. Historically, hospital chargemaster prices have been secret, and patients often have difficulty comparing prices between different hospitals. However, there has been a push for greater price transparency in recent years, with some hospitals and organizations making efforts to provide more accessible pricing information. For instance, there are search engines created by individuals who have dug through medical price lists from multiple hospitals in NYC, allowing patients to see potential charges for medical procedures ⁷.

Factors Affecting the Price

Several factors can affect the price of breast ptosis suspension in New York City hospitals:

1. Type of Procedure: As discussed earlier, different surgical procedures for breast ptosis suspension, such as periareolar mastopexy, vertical mastopexy, inverted - T mastopexy, and augmentation / mastopexy, have different levels of complexity. More complex procedures typically cost more due to the increased time, skill, and resources required ⁶.
2. Surgeon's Experience and Reputation: Highly experienced and well - known surgeons may charge higher fees for their services. Their expertise and track record of successful outcomes can justify the additional cost, as patients often place a high value on the quality of care provided by these surgeons ⁶.
3. Hospital Facilities and Location: Hospitals in prime locations in New York City may have higher operating costs, which can be reflected in the prices of their services. Additionally, hospitals with state - of - the - art facilities and advanced technology may charge more to cover the costs of maintaining and updating these resources ^3,8.
4. Patient's Medical Condition: Patients with additional medical conditions or complications may require more extensive pre - operative evaluations, post - operative care, and longer hospital stays. These factors can increase the overall cost of the breast ptosis suspension procedure ⁶.
5. Insurance Coverage: Insurance coverage varies widely, and patients with different insurance plans may pay different amounts for the same procedure. Some insurance plans may cover a significant portion of the cost, while others may require patients to pay a larger share out - of - pocket ^3,8.

How to Obtain a Price Estimate

If you are considering breast ptosis suspension in New York City, here are the steps you can take to obtain a price estimate:

1. Research Hospitals: Start by researching the top hospitals in New York City that offer breast ptosis suspension services, such as New York - Presbyterian Hospital - Columbia and Cornell, NYU Langone Hospitals, and Mount Sinai Hospital. Look for information about their surgical expertise, patient reviews, and pricing policies ².
2. Schedule a Consultation: Contact the hospitals and schedule a consultation with a plastic surgeon. During the consultation, the surgeon will evaluate your condition, discuss the available surgical options, and provide you with a detailed explanation of the procedure. They can also give you an initial estimate of the cost based on your specific case ⁶.
3. Contact Your Insurance Company: Reach out to your insurance company to understand your coverage for breast ptosis suspension. Ask about deductibles, copayments, coinsurance, and any pre - authorization requirements. Your insurance company can also provide you with information about in - network and out - of - network providers, which can affect the cost ^3,8.
4. Compare Costs: Obtain price estimates from multiple hospitals and surgeons. Compare not only the costs but also the quality of care, the surgeon's experience, and the hospital's facilities. Keep in mind that the lowest price may not always mean the best value, as the quality of the procedure and the post - operative care are also crucial factors ^6,8.
5. Ask About Financial Assistance: If you are uninsured or underinsured, inquire about the hospital's financial assistance programs. Some hospitals offer programs to help patients with limited financial resources cover the cost of medical procedures ³.

Conclusion

Breast ptosis suspension is a surgical procedure that can help women achieve a more youthful and lifted breast appearance. In New York City, there are several top - notch hospitals that