What is breast uplift surgery, and what scarring is normal?

A breast lift, or mastopexy, raises breasts that have begun to droop through age, weight change, pregnancy or breastfeeding. The procedure is carried out under general anaesthetic, generally takes two to three hours to perform and may be performed in conjunction with the likes of breast implant surgery.

The surgeon removes excess skin, tightens the remaining breast skin, and repositions the nipple on a pedicle of tissue that keeps its blood supply intact. Underlying breast tissue and glandular tissue are reshaped to restore a higher, fuller contour to sagging breasts.

The pattern of scarring depends on how much skin is removed. There are three main incision patterns used in this procedure:

• Peri-areolar (or "donut") for mild sagging, leaving a scar around the areola.
• Vertical (or "lollipop") for moderate cases, adding a scar running down from the areola.
• Wise-pattern (the "anchor" or "inverted-T") where more skin must be taken away, adding a scar along the breast crease.

These scars are permanent, though they fade a great deal over the first year or two. It is normal for a scar to feel firm, tight and painfully sensitive for a time, and for scar tissue to look raised or pink before it settles. Some patients develop hypertrophic scarring, which is thick and raised, while others develop keloid scars that spread beyond the original wound. How your skin heals depends on genetics, skin type, smoking and general health, which is why the same surgical procedure can leave very different results on two patients.

The British Association of Aesthetic Plastic Surgeons says the extent of scarring is variable and cannot be predicted. A visible or firm scar is usually a sign that your body is healing as it should, not evidence that anything was done wrong.

A breast reduction, or reduction mammoplasty, uses these same anchor and lollipop patterns, so scars after breast reduction surgery look much like those from this procedure. A breast reduction and a breast lift heal in much the same way. Your surgeon should explain this healing process to you before surgery.

Your surgeon's duty of care: consent, technique and aftercare

Every surgeon owes you a duty of care before, during and after your procedure. They must provide treatment that meets the standard expected of a responsible body of competent plastic surgery specialists.

Your surgeon should:

• be registered with the General Medical Council and have suitable training and experience in plastic surgery
• have specific expertise in breast surgery, ideally with a specialist practice in this area
• explain the procedure, alternatives, expected outcome and material risks clearly
• use an appropriate and competent surgical technique
• provide suitable monitoring, advice and aftercare following surgery

Membership of recognised professional organisations, such as the British Association of Aesthetic Plastic Surgeons or the British Association of Plastic, Reconstructive and Aesthetic Surgeons, may also indicate a commitment to specialist professional standards.

Medical negligence may arise where the care provided falls below the required standard and that breach causes avoidable harm. A successful cosmetic surgery negligence claim must show that the surgeon breached their duty of care and that this breach caused or materially contributed to your injury.

Proper consent before surgery

Before a breast lift, your surgeon must take reasonable care to ensure you understand the material risks of the procedure and any reasonable alternatives. This is the standard set by the Supreme Court in Montgomery v Lanarkshire Health Board [2015]. For a breast lift, patients should be told about the scar pattern, its location and permanence, possible asymmetry, and changes to nipple sensation. Your surgeon should also assess your general health and any medical condition that could affect healing. Where a surgeon fails to warn you about the scars you will realistically be left with, your consent may not have been properly informed.

Competent surgical technique

During an operation, a surgeon’s technique must meet the standard expected of a reasonably competent professional. This is assessed using the Bolam test, which considers whether the technique was supported by a responsible body of competent surgeons and whether that professional opinion withstands logical scrutiny.

Examples of potentially substandard surgical technique may include:

• selecting an inappropriate incision pattern
• carrying out an inadequate lift
• inappropriately placing the nipples
• failing to recommend or use appropriate suturing around the areola, resulting in areolar stretch

Where poor surgical technique causes avoidable harm, this may amount to surgical negligence.

Aftercare and follow up

Your surgeon’s responsibility does not end in the operating theatre. Good post-operative care should include clear wound-care instructions, regular monitoring of your healing and timely follow-up appointments so that any concerns can be identified and treated quickly.

Appropriate aftercare should include:

• checking for infection, swelling or unusual discharge
• monitoring for wound separation
• assessing changes affecting the nipple tissue
• investigating persistent physical discomfort
• checking for possible nerve damage
• reviewing swelling or tenderness around the lymph glands

Neglecting infection signs can lead to increased scarring. Poor post-operative care may also allow a manageable complication to develop into a lasting injury, particularly where wound separation, reduced blood supply to the nipple tissue or nerve damage is not identified promptly.

When can breast uplift scars point to negligence?

Because scars are unavoidable, they are judged not by whether they exist or are prominent, but against what you were told to expect and the standard of care you received during the procedure. Some risks are unavoidable; others are not. There are three realistic situations in which scars and related complications may support negligence claims.

Scars in areas you were never told about

If you are left with scars in a location your surgeon never discussed or warranted, that may be a failure of consent under Montgomery. One of our clients, Sandra, was left with significant, unsightly scars after facial and breast surgery that were most unusual for the operation and that she had not been told about beforehand. We settled her claim for £35,000. In such cases the problem is not the scar itself, but the fact that you were never given the chance to weigh that risk.

Scars far more extensive than you were warned about

Some patients are left with excessive scarring that goes well beyond what they were told. Where that gap is substantial, and a competent surgeon would have explained the true likelihood, it can support a claim. Excessive scarring alone is not enough, because the real question is always what you were reasonably led to expect.

Scars caused by avoidable errors

Scars can also be worsened by avoidable mistakes in technique or aftercare. Poor incision planning, or wound problems that are left unmanaged, are the sort of errors that careful practice would avoid. If your initial surgery caused harm that a responsible surgeon would have prevented, the resulting scars may form part of a claim.

Your rights if your scars were avoidable

If you believe your scars were caused by a breach of your surgeon’s duty of care, you may be able to bring a cosmetic surgery negligence claim.

A medical negligence claim will generally need to establish:

• Breach of duty: the treatment or surgical care fell below the standard expected of a reasonably competent surgeon.
• Causation: the surgeon’s failure caused or materially contributed to your avoidable scarring or other harm.

Causation is central to medical negligence and cosmetic surgery claims. It must usually be shown that the injury would probably have been avoided, or would have been less severe, if appropriate care had been provided.

Evidence that may support your claim

The first practical step is to gather evidence. This may include:

• photographs showing how your scars developed over time
• consent forms and information provided before surgery
• hospital, clinic and GP records
• correspondence with the surgeon or clinic
• details of any corrective treatment or further procedures
• notes describing how the scarring has affected your physical health, confidence, wellbeing and daily life

An independent medical expert will usually review the evidence and provide an opinion on the standard of care and the cause of your scarring. We will only pursue a legal claim where the available expert evidence supports doing so.

What compensation can cover

Where a claim succeeds, compensation aims to put you back in the position you would have been in had the negligence not happened. It has two parts. General damages reflect your pain, suffering and how the injury has affected your life. Special damages cover your financial losses, including the cost of any corrective treatment, revision surgery or further surgery needed to put things right.

Scars you did not expect after this procedure, or additional surgery you never planned for, can affect your confidence and wellbeing, and this psychological damage is what you can claim compensation for.

Our verified case studies show what this can look like. We settled Carla's claim for £15,000 after a breast enlargement surgery and uplift left her with a poorly positioned nipple and further problems; her damages covered physical and psychological injury, corrective surgery and therapy. We recovered £36,000 for Ms E's breast surgery case study, whose surgeon failed to advise that both breasts needed correcting, and £35,000 for Sandra. You can read more about how we handle breast surgery compensation claims and the kinds of complications that lead to a claim.