“How do you LIFT my breasts?”

This was a question posed to me recently by a patient unhappy with the state of her breasts – her post-pregnancy, breast fed, sagging breasts.

The answer? Not with magic. But with consideration for each anatomical component of the breast, and the state at where they are compared to where they ideally should be. To break it up into simple terms to understand, let’s consider three components of the sagging breast:

1. The nipple

“Droopiness” of the breast is often termed breast ptosis. This relates to and is classified by the position of the nipple in relation to the breast it lies on. In the ideal breast, the nipple should be pointing forward, and positioned above the inframammary fold (the breast crease). With age and especially after breast feeding, the breast substance is reduced, and the supporting tissues of the breast begin to weaken, causing the nipple to sag and move south. One part of a breast lift (mastopexy) is to reposition the nipple back up to where it should be.

 

2. The breast tissue (parenchyma)

The size of the breast can wax and wane, influenced by weight changes, pregnancy, as well as normal hormonal variations throughout the menstrual cycle. Some women who have lost significant weight find that they’ve lost substance to their breasts. Post breast-feeding women experience a similar deflation of their breasts. A breast lift on its own will NOT correct loss of breast substance. The volume can only be restored through an augmentation, of which implants are the most common and preferred method.

 

3. The breast skin

The key factor here is to consider the elasticity of the breast skin. To help understand the correlation between skin elasticity and sagginess, here are two analogies:

Analogy 1: consider a brand new rubber balloon inflated and expanded with air. When a little bit of the air is released, the elastic balloon will reduce in size, but at all times maintain the general shape of the inflated balloon. Only when the air is nearly all out will the shape of the inflated balloon be lost. This is analogous to a youthful breast that for whatever reason has its volume reduced. When the volume reduction is minimal to moderate, the elasticity of the breast skin may be able to cope with maintaining the shape of the breast. However, if volume reduction is large (such as in massive weight loss), the skin will not cope, and sagginess results.

Analogy 2: consider a plastic bag similarly filled with air. When the air is slowly released from this, the inelastic nature of the plastic bag does not allow for uniform shrinkage of the bag, and the bag becomes loose and out of shape immediately. This is analogous to the skin of the ageing, post-menopausal breast. The breast has lost its elasticity and ability to expand and retract according to the volume of the breast. In effect, the skin of the breast no longer has the tensile ability to hold the breast in shape. Stretching occurs, and sagginess results.

A breast lift will frequently involve tightening of the breast skin and removal of excess skin. This will often mean a scar on the breast as a consequence. It’s a trade-off. A saggy breast for a shapely breast with a scar.The scar is in general around the areolar and down to the breast crease, and will usually fade over time. The patient however must understand, and accept, that a scar will always be a scar, no matter how faint.

Each patient’s breasts must be assessed according to what it has and what it lacks. Not too infrequently, the right and left breasts are not equal – in volume, shape, or both. What concerns the patient and what she wishes to have is of utmost importance. A combination of clinical assessment, patient’s desires and what is clinically possible is conglomerated to formulate a surgical plan.