Cosmetic breast lift surgery, or mastopexy, is a procedure that raises and reshapes a sagging or pendulous breast to a more youthful contour.

Breast lift can be performed alone or in conjunction with augmentation implant surgery if the breast has lost substance and firmness. It can reposition nipples that point downward or have become asymmetric in position or size from either developmental imbalance, after pregnancy or breast feeding, or as the result of common aging changes such as loss of skin elasticity or weight loss.

The best candidates for breast lift are women with small sagging breasts. While large or heavy breasts can be lifted, the results may be fleeting unless accompanied by breast reduction. While most women wait until after childbearing age to have such surgery, the nipples, milk ducts, and nerve supply are preserved and so early surgery does not generally interfere with breast feeding.

The operation is designed to remove excess skin located below the areola and position the areola and nipple upward. Either one, two, or three incisions are required.

Most commonly, two incisions are made, one around and above the areola and another that courses vertically from the bottom of the areola to the crease (inframammary fold) where the breast meets the chest wall.

If the amount of lift needed is significant, a third incision is made along the crease of the breast where it meets the chest wall. Together, the three incisions resemble the shape of an anchor or inverse T and so this approach has become known as the "anchor incision."

After the incisions have been made, flaps are raised in the areas where extra skin will be excised, the nipple and areola are repositioned upward, and the skin is then closed with sutures. Enlarged areolas can be reduced by excising tissue around their edges prior to suturing.

Breast lift surgery is a complex operation that takes about two to three hours depending on the starting point and degree of lifting required. Most commonly, it is performed under general anesthesia.

Scarring can be problematic, especially in Asian skin where scarring often tends to be more noticeable. Even though breast shape is improved, permanent scarring may be visible in lingerie or swim wear. Recent efforts have been directed at developing methods that require fewer and/or smaller incisions, especially for use in women without large or heavy tissue.

In milder cases, a single incision made around the areola may be all that is needed. In moderate cases, the second vertical incision is still required but may be shorter. Or, for women with small breasts and minimal drooping, a series of much smaller concentric incisions can be used in place of both the vertical and horizontal incisions.