INSTRUCTIONS
This is an informed consent document to help you learn about breast lift (mastopexy) surgery. You will also learn about its risks and other treatment(s).
It is important that you read the whole document carefully. Please initial each page. Doing so means you have read the page. Signing the consent agreement means that you agree to the surgery that you have talked about with your plastic surgeon.
GENERAL INFORMATION
Breast lift or mastopexy is done to lift and reshape sagging breasts. Pregnancy, nursing, weight change, aging, and gravity cause changes in the appearance of a woman’s breasts. As the skin loses elasticity, the breasts often lose shape and sag. This surgery can also reduce the size of the areola, the dark skin around the nipple. If your breasts are small or have lost volume after pregnancy, breast implants may be put in during a breast lift. Implants can make breasts firmer and bigger. There are many surgical methods for reshaping and lifting breasts.
Breast lift surgery works well for women who are healthy, emotionally stable, and have realistic goals for their surgery. Breasts of any size can be lifted, but the results may not last as long in women with big breasts. Breast lift surgery leaves permanent, visible scars on the breasts. Your breasts will be smaller than your current size unless you get implants.
Note: You will need separate consent forms for the use of breast implants in addition to breast lift or when a breast lift is performed during breast implant removal.
OTHER TREATMENTS
This surgery is a personal choice. You can also opt to not have surgery. You can wear supportive bras to lift sagging breasts. If your breasts are large and sagging, a reduction mammaplasty can be done. There are risks and potential complications with all surgeries.
RISKS OF BREAST LIFT SURGERY
All surgeries have some risk. It is important that you know these risks. You must also understand other issues that might come up during or after surgery. Every procedure has its limits. Choosing to have a surgery means comparing the risks and benefits Most people do not face problems, but you should talk about them with your plastic surgeon. Make sure you know all possible risks of breast lift surgery.
SPECIFIC RISKS OF BREAST LIFT SURGERY
Asymmetry:
Most women have breasts of unequal size or shape. Surgery may also change the shape and size of the breast and nipple. More surgery may be needed to fix these differences. Even surgery may not give you exact symmetry.
Change in Nipple and Skin Sensation:
You may have less, more, or a total loss of sensitivity of the nipples and the skin of your breast. Partial or total loss of nipple and skin sensation can occur after a breast lift in one or both nipples. These changes in sensation may affect your sex life or the ability to breastfeed a baby.
Breast Augmentation with Breast Lift:
Risks of breast implants are listed in a separate informed consent document. Risks vary with the type of implant. Patients who go in for breast implants at the time of a breast lift may be at higher risk of necrosis of the nipples and breast tissue. Necrosis, or dead skin cells, is caused by decreased blood supply to the tissues.
Page 1 of 4 ©2020 American Society of Plastic Surgeons®
This form is for reference purposes only. It is a general guideline and not a statement of standard of care. Rather, this form should be edited and amended to reflect policy requirements of your practice site(s), CMS and Joint Commission requirements, if applicable, and legal requirements of your individual states. The ASPS does not certify that this form, or any modified version of this form, meets the requirements to obtain informed consent for this procedure in the jurisdiction of your practice.