Sagging breasts: How to perk things up

An unavoidable consequence of aging is the loss of elasticity, or tone, in skin and soft tissues. This process, which may be compounded by changes, which occur during and after pregnancy, will ultimately lead to 'drooping' of the breasts. A variety of surgical breast surgery  techniques can be used for restoring the breasts to a more youthful position and shape. The goal is to both relocate the nipples to a higher position, and to restore breast projection (and to maintain projection for the long term).

Having abreast lift operation involves making a decision to trade an improved breast shape and contour for some (well-placed and concealed) surgical scars on the breast. For the patient who is displeased that her nipples are downpointing, it may be a relatively easy decision. The surgical incisions are strategically placed to be as minimally noticeable as is possible. One component is around the areola, which is usually well concealed by the color difference between breast skin and areolar skin. The second component extends vertically from the '6 o'clock' position of the areola to the fold below the breast, and as the majority of this scar faces downward, it is usually quite acceptable.

Traditionally, breast lift or mastopexy surgery has involved a long, horizontal incision below the breast (in addition to the circumareolar and vertical scars), but a relatively new technique allows elimination of this incision completely.

The 'vertical scar' breast lift

For several years I have been using a 'vertical scar' technique for most breast reductions which eliminates the long, horizontal incision in the inframammary fold below the breasts. I have also adapted this technique for breast lift surgery, and have been extremely pleased with the results. As with breast reduction patients, this new technique not only eliminates the horizontal incision, but also creates more impressive breast projection and maintains it better over time. The breast lift procedure I perform not only removes breast skin but also moves some lower pole breast tissue to a higher position, increasing the projection of the nipple/areola area.

Breast lift surgery works well for patients with enough existing breast tissue to build a projecting 'breast mound'. However, in most patients it is difficult to create sustainable fullness in the upper poles of the breasts by means of a mastopexy alone. This is particularly true in patients who have experienced significant deflation following pregnancy and lactation. For patients who indicate that they wish to achieve a fair amount of fullness in the cleavage area as a result of their breast lift surgery, I recommend that they undergo augmentation mastopexy This surgery combines a breast lift with the placement of a breast implant usually of modest size, which produces the most youthful breast profile possible.

Perking the breast up usually means that you had nice breasts at one time and now, perhaps after children, the nipple is lower and the area from your collar bone to your nipple is relatively flat. A breast lift (mastopexy) can help but usually you are still left with a flat upper pole of the breast. Sometimes you can get perky just with an implant and somtimes you need a combination of implant and lift. Your surgeon will go over all of this with you.

There are several ways to treat sagging breasts. I try to choose the best option with the least amount of scarring. 

Sometimes, the best thing to do is insert a breast implant to fill the breast envelope.  This usually will limit the incisions the most. 

As we move up the ladder, so to speak, of least to most incisions, I try to offer a circumareola lift (incision only around the border of the areola), then a vertical limited inicison lift, "lollipop incision" (incision around areola and then from the bottom of the areola to the breast fold, vertically, and then if the patient has severe laxity and sagging,  an anchor-type incision is used which incorporates the vertical incison as well as a transverse incision along the inframammary fold.

In my extensive experience I find that sagging breasts can be lifted WITHOUT the need for the additional scarring of conventional breast lifts. When implants are placed in front of the muscle, they will lift the breasts quite adequately; under the muscle they will not.

Breast sagging can consist of two things:

1. Loss of volume
2. Downward descent of the nipple and areola

The volume loss is treated by using an implant. The downward position of the nipple requires some form of a breast lift to place it back on the front of the breast mound, well positioned above the crease below the breast.

Unfortunately, an implant does not lift the breast; it only makes it bigger. There are several kinds of lifts that can be performed depending on how much of a lift is needed to get the proper shape back in the breast.