Sagging Breasts

Breasts sag when your skin, connective tissue, and supporting breast ligaments lose integrity due to the aging process, weight loss or weight gain, pregnancy, or breastfeeding. This diminished skin elasticity can create a loss of perkiness, and even excess skin.

A significant percentage of women experience breast sagging (or breast ptosis, in medical terms), so if your breasts aren’t where they used to be, you’re not alone, says Dr. Joshua Zuckerman, a plastic surgeon in New York City. “Plastic surgeons actually grade breast ptosis, and the most severe grade is characterized by a nipple positioned at the lowest part of the breast mound. In my experience, even this type of ptosis is actually quite common.”

One thing doctors on RealSelf say doesn’t cause breasts to droop is wearing a bra—a theory that’s been floated in the media. “Brassieres support the breasts and the breast tissues, and they can actually prevent or delay sagging by keeping the ligaments and skin from stretching out,” says Dr. Robert Tornambe, a plastic surgeon in New York City, in a RealSelf Q&A. “It’s not a guarantee, but going braless, especially with larger breasts, certainly contributes to the sagging process and can speed it along.”

Related: 5 Procedures for Higher, Perkier Breasts—From Least to Most Invasive

Plastic surgery is the only effective, long-term solution to restore the former perkiness of sagging breasts. The breasts are composed of fat, glandular tissue, and ligaments, but no muscle. While chest exercises—like chest presses—can develop the muscles under your breasts and make them appear somewhat larger, they can’t actually lift breast tissue. 

These are the treatments doctors and RealSelf members say deliver the best results.

	Breast Lift surgical	Breast Lift with Implants surgical	Breast Fat Transfer surgical
Worth It Rating	94%	91%	87%
Average Cost	$7775	$8900	$9250
Downtime	1 week of downtime	1 week of downtime	2–5 days of downtime
Anesthesia	General anesthesia	General anesthesia	Sedation, twilight, or general anesthesia

• A breast lift, or mastopexy, removes excess skin while reshaping and tightening skin, to provide a better shape and nipple position.  “Breast lift surgery can improve a woman’s breast shape by repositioning the breast higher on the chest and centering the nipple and areola on the breast itself. If there’s enough breast tissue, I can perform a highly aesthetic mastopexy, without the addition of further volume, by internally rearranging the breast tissue and removing excess skin,” says Dr. Robert Cohen, a plastic surgeon in West Hollywood, California, in a RealSelf Q&A. “If more volume is needed, especially in the upper portion of the breasts, we’ll discuss the possibility of fat grafting or silicone gel implant placement.”  Related: What to Look For in Breast Lift Before-and-Afters If sagging skin is a big concern for you and you feel that your breasts are too large, you may also consider combining a breast lift with a breast reduction. Breast lift surgery is performed under general anesthesia, and you’ll go home later that day. Depending on how active your job is, you can usually return to work after five to seven days.  You’ll see an immediate result, but it can take a year for all the swelling to resolve. Find doctors that offer breast lifts
• A breast lift with implants (aka mastopexy with augmentation) may be a better option if you need to both lift the breasts and restore volume. The breast is lifted via donut, lollipop, or anchor incisions, and implants are inserted.  “Breast lift surgery works well for patients with enough existing breast tissue to build a projecting ‘breast mound.’ However, in most patients, it’s 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,” says Dr. Michael Law, a plastic surgeon in Raleigh, North Carolina, in a RealSelf Q&A.  Breast implants filled with silicone gel or saline and can be placed above or below the muscle. Your provider will help you choose the right technique for you as well as the correct implant size, which is largely determined by your chest width. Find doctors that offer breast lifts with implants
• Breast fat transfer involves liposuction to harvest fat from one area of the body before it’s purified and injected into the breast. If you’re looking for a modest volume increase (about one cup size), breast fat transfer may be ideal. This procedure alone doesn’t lift sagging breasts or improve the appearance of stretched, crepey skin, so you may need to combine fat transfer with a breast lift, for optimal perkiness. You’ll also need good skin tone and elasticity.  Incisions and scars from fat transfer are minimal. Afterward, you can expect some swelling and bruising in the breasts, but most people return to work after a week.  Related: Top Surgeons Share the Ins and Outs of Fat Transfer Breast Augmentation Just be aware that the size increase can be unpredictable, because only about 50–70% of the transferred fat will remain after a year. If you lose weight, the transferred fat will also shrink and you’ll lose volume in your breasts. If you gain weight, the fat will expand and your breasts will get larger.  Find doctors who offer breast fat transfers

If you have only mildly sagging breasts, you may have some firming benefits from a nonsurgical breast lift treatment. Your results won't be as dramatic as what you'd get with a surgical procedure, but if you're a good candidate with realistic expectations, you may have enough of an improvement that you can delay or avoid surgery.

• Radiofrequency energy treatments, like Thermage or BodyTite, can tighten skin and give a lift of about an inch or so, says Atlanta plastic surgeon Dr. Elizabeth Morgan in a RealSelf Q&A. “The tightening takes months to appear, but [it] can be nice.” The procedure—which heats the skin, to stimulate collagen production—is done in the provider’s office, with sedation and local anesthesia. 

• Laser breast lifts, typically done with a Nd:YAG or Er:YAG laser, can mildly tighten and firm breast tissue via heat, which causes the existing collagen fibers to contract. It also stimulates new collagen production over the coming weeks and months, so you may see both an immediate and longer-term improvement—especially after a series of three treatments.

• Breast thread lifts use thin threads inserted just under the skin and pulled taut, to create some immediate lift and stimulate new collagen production. The threads are absorbed by the body after about two years.