How Accurate is the Pencil or Ruler Test for Ptosis?

Question

I'm a 37 year old mother of 2 breasted children who currently lost 22 lbs. I am interested in an augmentation and/or lift to put back what I have lost! Three weeks ago, I visited a PS who immediately after looking at me said I needed an anchor lift. I went home a tried the ruler under my crease. My left nipple,is above the ruler, and my right is ever so slightly in line with the ruler. How can I need an anchor lift? I would be more open to a crescent, benelli or lollipop. Any advice?

John J. Corey, MD · Answer

The pencil test (can you hold a pencil underneath your breast or does it fall to the floor) and the ruler test (is your nipple above or below that line) are pretty good tests for a quick easy read...but there are always variations to this and if you can, send along some pictures too...That would give us a little help as well!!! But so far it sounds like there may be other options for you!

Gary M. Horndeski, MD · Answer

The anchor shaped lift was designed by Wise in 1956.  I have not used the anchor technique in over 15 years because there are superior techniques.  I NEVER use a vertical incision because the scars are impossible to hide, widen in time and weakens the skin envelope.  The best techniques result in scars around the nipple or hidden in the inframammary fold.  The breast weight is transferred to the underlying muscle and the breast tissue is elevated creating upper pole fullness. I highly recommend this new technique called The Ultimate Breast Lift.

	Best of Luck,

	Gary Horndeski, M.D.

Joseph Mele, MD · Answer

The decision on whether breast augmentation alone is enough, or if a lift is needed is best made in person. The type of lift is determined by the amount of lift needed, breast volume and the amount and nature of the breast skin.

	Best advice I can give you is to get another consultation from a Board Certified Plastic Surgeon. There is more than one way to most things in plastic surgery, another opinion may bring a better understood plan.

Steven Wallach, MD · Answer

Without an exam it is hard to say whether or not a lift would be appropriate for you.  I do not go by a pencil or ruler test.

Peter E. Johnson, MD · Answer

We find the pencil test, or the actual measurement from the nipple (the center) to the breast fold, very accurate and indicating the degree of skin envelope laxity. If you have a nipple that lies nearly at the fold we too would bet the around the nipple, or the vertical pattern would be the lift for you. Our advice is another opinion.

Donald Nunn, MD (retired) · Answer

You should seek a second opinion before committing to a lift.  This will give you peace of mind.  Donald R. Nunn  Atlanta Plastic Surgeon.

Ronald V. DeMars, MD (Retired) · Answer

I'm sorry but without photos it would be impossible to answer your question. But in general, when the nipples are at or barely below the IM line we find the Benelli lift to work very well as long as implants are also used. Many surgeons do not use the Benelli lift, so you would need to find a doctor that is experienced in that lift style. The crescent lift, if sone correctly, is used only for a minor lift, or else it creates a distorted areola. When the Benelli is properly done to include breast tissue support and not just a skin lift, the vertical aspect of the Lollipop lift is unnecessary.

How Accurate is the Pencil or Ruler Test for Ptosis?

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