After 3 kids and recent weight loss, my breasts are very saggy. I keep seeing pictures of after breast augmentation surgery and they still seem saggy. Why is this? Aren't the new ones supposed to stay up?
Why Do Some Breast Augmentation Results Appear Saggy?
Doctor Answers (25)
"Saggy Breasts" Augmentation vs. Lift
The appearance of "saggy breasts" following augmentation can be attributed to what I think may be --- the wrong procedure for the wrong patient. This can be avoided by making sure you understand all of the surgical treatment options available to you. Your plastic surgeon needs to listen to your concerns carefully to be able to tailor an operation which will satisfy your expectations.
Certainly, there are----the wrong procedures for the right patient. What I mean by this is simply, some patients have realistic expectations when presented with procedures which may satisfy some, but not all of their concerns. Some women may be happy with the location of their areola on their breat ,however do not like the size or the shape of their breast. In this case augmentation alone may be the answer .
In some cases, issues related to size, shape ,projection, and position of the breast need to be addressed. In these women , another procedure such as a mastopexy(breast lift) or a mastopexy with implants is chosen.
The most important way to successfully accomplish your goals is to find a surgeon that can effectively understand your concerns and to then offer you an operation to meet your expectations.
Why do some breast augmentation results appear saggy?
The issue of sagginess has two components.
The first is related to the position of the implant on the chest wall. If the implant is placed low on the chest wall, even if it is in harmony with the skin envelope and nipple position, it will appear to hang too low, or sag.
The second has to do with the position of the nipple relative to the breast mass. If the nipple-areola complex is too low relative to the implant, the nipple appears to be pointing south.
In both cases the situation can be improved by performing a lift in combination with the breast augmentation. In my office, I stand the patient in front of the mirror and let her guide me as to where on the chest wall she wants the implant. Once I know what her ideal implant position is, then I decide whether a lift will help her.
For a link on the importance of implant position, see the link below.
Breast augmentation addresses volume not lift
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It's not a matter of the implants staying up. The issue is that skin is prone to stretching and sagging again. An implant adds weight to the breast and can cause further stretching. You should see a board certified plastic surgeon in your area to see if you would benefit from a lift in addition to an augment.
Saggy appearance after breast augmentation
If one is saggy to begin with, the placement of a breast implant on top of the muscle will cause further sagging as the added weight will stretch the skin out to a greater degree. If you are saggy and have an implant placed below the muscle, you will likely need some type of lift also to bring your own sagging breast tissue higher up on your ribcage so it will lie over the implant mound.
Protecting Implant Position
Sometimes breast implants can "bottom out" or change position. I put a great deal of effort into creating an enhanced breast profile that is natural-appearing, and I think it is absolutely critical to protect implant position postoperatively to ensure that the implants heal in the desired position. The implant pockets are made larger than the implants themselves, by design, so that the augmented breasts can move just like natural breasts do. We purchase a comfortable, custom-fit postop bra for our patients that is used for the first two to four weeks after surgery, and two 3-inch Ace wraps are used above and below the breasts as `breast bands' to help stabilize implant position. When the inframammary folds are lowered, we protect the new folds with tape applied to the skin that lasts for one to two weeks, so that the implants do not settle to a position lower than intended.
We see patients in the office three to four times in the first two weeks after surgery to ensure that their breast implant position is ideal and that no adjustments need to be made to the bra, breast bands or taping. In some cases the bra and bands are used into weeks three and four, based on each patient's individual needs.
Saggy Breasts after Augmentation
The appearance of the breast after augmentation is related to the preoperative look. Therefore, augmentation of a sagging breast leads to a fuller, but still sagging breast.
Some patients are fine with this. They can do their own lift with a great bra, and avoid the scars and expense of a surgical breast lift.
Secondly, placing implants that are too large will create sagging over time. This is especially true of saline implants, which are about 20% heavier than silicone gel devices.
Why breast augmentation or enlargments with implants look saggy (ptotic) with no lift (mastopexy)?
Yes, this is true and an accurate observation.'
The real problem is that many of the best breast lift techniques require multiple or lengthy scars. Becasue the healing of scars is unpredictable, many women elect to undergo a breast augmentation alone.
However, to answer your question on greater detail, there are many factors that can make a breast look saggy (ptotic) and include looking at:
- location of the breast tissue on the chest wall
- location of the nipple & areola relative to the crease
- location of the gland relative to the crease
- size of the areola
- amount of skin superior to the areola
- amount of skin from the areola to the crease
- degree of breast contriction and lack of lower pole fullness with a downward looking nipple & areola
Treating all or some of these factors come into play when considering a breast lift. In many cases a small scar may result in a nice improvement with minimal side effects. In other instances, the correction requires many scars and this is deemed undesireable by patients who prefer to have larger breasts that you can apppreciate in clothing. Unfortunately, you are judging the results in the nude and this is not the way the majority of paitents reveal their breast augmentation results to the rest of world.
Emphasize the look you desire during your consultation
You make a great point - with implants alone a saggy breast may just look like a larger saggy breast. Some women are perfectly satisfied with this look, however. If you choose to have an implant to give you more cleavage and upper pole fullness it is important that you explain to your surgeon that this is what you desire so a submuscular pocket can be developed to help maintain the position of the implant.
A breast lift was needed
Results after breast augmentations that apperar saggy come from two reasons. The first is that a breast lift with an augmentation should have been done rather than a breast augmentation alone. If breasts are sagging to begin with, adding an implant without doing a lift leads to a larger, sagging breast. Many women are leary of the scars from a breast lift, and either opt for an implant alone, or are advised to do this. Generally this is not a good way to go. The only way to lift a sagging breast to get a perkier look, is to do a breast lift.
The other reason is that the breasts can change after the enlargement. Usually this is due to pregnancy, weight loss, or lack of support for an enlarged breast. In terms of weight loss and pregnancies, there is a larger amount of skin supporting the breast (which may have become smaller) which causes it to sag. In women who have had breast augmentation, there is a greater weight to the breast, and a greater need for good support in a bra maintain this look. If someone who has large breasts routinely goes without a bra (or with minial support in a bra), the breasts will sag over time whether or not she has implants.
The only other thing to understand, is that -- generally speaking -- the mature breast, lifted or not, will not look like a young womens breast. As women age, the breast changes, and this can affect the look. But, this can also lead to a very natural, attractive look to the breast.
But the best advice to you, is to go to a board ceritfied plastic surgeon for a consultation. If needed, have a breast lift with the enlargement. Use an implant that gives you the fullness that you want, but don't overdo the size of the implant. Larger implants are heavier and add more weight to the breast with can lead to sagging over time. (You may also want to consider silicone implants.) Then, in your daily life, and exercise, wear good support in your bras. This should be seen as protecting your investment!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.