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Medications are administered for your comfort during the surgical procedure. An anesthesiologist will administer general anesthesia, which is nearly always required for this procedure.

For more information about our breast enlargement and lift procedures, please contact us online or call us at We look forward to helping you look your best.


The procedure typically takes about three hours depending on the individual and certain surgical variables.

There are nine basic steps to performing a Breast Augmentation-Mastopexy.

Step 1 – Marking

While you are sitting up, Dr. Alexander makes careful measurements and markings on the breast. This is arguably the most important part of the procedure, and requires skill, patience, experience, and a good eye for symmetry and detail.

Step 2 – The incision

An areolar incision is made around the areola, often reducing the diameter. The incision is carried through the skin, down to the pectoralis muscle, which covers the anterior chest wall.

Step 3 – Creating the pocket

A space is made for the implant, usually under the pectoralis muscle.

Step 4 – Determining the right size of implant

A temporary saline-filled sizer is used to determine which size implant should be used. Saline can be added or removed to determine which range of volume will give the desired appearance.

Step 5 - Placing the implant

The pocket is washed with saline and antibiotic solution is placed. The permanent implant is placed and positioned correctly in the pocket. We then sit the patient up to check for symmetry. We make minor adjustments as necessary to make the breasts as symmetrical as possible.

Step 6 - Re-marking the breast

With the implants in place, the breast marks are rechecked to make sure that the skin to be removed is accurately indicated.

Step 7 - The skin incisions

There are three common incision patterns, depending on how low the breast sits and how much skin needs to be removed:

  1. Around the areola. This is called a ‘periareolar’ or ‘donut’ mastopexy.
  2. Around the areola and vertically down from the areola to the breast crease, often referred to as a ‘vertical’ mastopexy, because it requires a vertical line. Patients often worry about this incision, but it actually heals extremely well.
  3. Around the areola, vertically down from the breast crease and horizontally along the breast crease. This is often called an ‘anchor incision’ or ‘inverted T.’

Step 8 - Reshaping the breasts

If necessary, enlarged areolas are reduced by excising skin at the perimeter. The underlying breast tissue is lifted and reshaped to improve breast contour and firmness. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. The nipple and areola are repositioned to a natural, more youthful height, and excess breast skin is removed to compensate for a loss of elasticity.

Step 9 - Closing the incisions

After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed with sutures. No drains are needed. Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.


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