Pregnancy, breastfeeding, weight loss and aging all have an adverse effect on the appearance and shape of the breasts.

Breast sagging or breast ptosis occurs.

If the situation is serious enough, the patient will look for a way to give her breasts back their youthful appearance, with the nipples in the right place, a firmly stretched skin and sufficient fullness in the upper portion of the breasts. 

Causes of sagging breasts

The breasts begin to sag when the skin has been distended for a long time as a result of a growth in volume of the mammary gland during pregnancy and especially during breastfeeding.

Afterwards part of this distension of the skin remains; the glandular tissue diminishes again in volume and is partly converted into fatty tissue.

Finally, the suspensory ligaments between the skin and the gland become extended.

Weight loss and aging produce the same kind of evolution.

Mechanism and grades of breast sagging

The distension of the skin and the reduction in breast volume gradually cause the mammary gland to extend and sag.

There are different grades of breast sagging or breast ptosis, depending on the position of the nipple in relation to the infra-mammary fold or IMF.

• Grades 1 and 2 ptosis: the nipple is level with or below the IMF, but above the most protruding part of the breast curvature.
• Grades 3 and 4 ptosis: the nipple is below the most protruding part of the breast curvature.

Breast lifting techniques

Excess skin has to be removed to bring the mammary gland back into a smaller and firmer covering.

The mammary gland is made firmer by attaching it higher up the underlying muscle and giving it a new and more conical structure.

The nipple is positioned higher up so that it is restored to the most protruding point of the breast.

SKIN REMOVAL

The most commonly used technique combines a circular skin excision around the nipple with a vertical elliptical skin excision in the lower portion of the breast.

This results in a circular scar around the nipple which is placed higher up, and a vertical scar running down the middle of the lower portion of the breast and stopping at the infra-mammary fold.

The frequently used “short scar” technique avoids making a horizontal scar in the infra-mammary fold. This produces a keyhole-shaped scar instead of the conventional anchor-shaped scar.

Combination with breast augmentation

Where there is too much excess skin, this may be reduced by placing an implant at the same time.