Does a breast lift involve muscle and reattaching ligaments to help prolong sagging again over time? (photo)

Sagging after a breast lift is a real challenge to avoid, especially with an implant.  It is my practice to attach the breast tissue to the chest wall fascia or muscle to try and keep it in place.  In the end, it is the tissue strength and weight of the breast (or implant) that mainly determines how much the breast will sag over time.

There are many techniques that have been used in an effort to prevent or delay recurrent drooping or ptosis after a mastopexy. Most are unsuccesful as aging and the effects of gravity cannot be controlled. While most techniques involve tightening skin and repositioning the nipple in a higher position, few techniques use muscle or ligaments to hold the breast in position. I would discuss these details with your surgeon prior to your mastopexy. Please select a surgeon board certified by the American Board of Plastic Surgery and better yet, a member of the American Society of Aesthetic Plastic Surgeons. 

Thank you for your question. In breast lift we do not usually touch the muscle and also  ligaments. We excise and re arrange breast tissue , so that it gives fullness and up lifting look. Please consult with a board certified PS for evaluation.

No, a breast lift typically does not involve manipulation of the muscle.  Occasionally, acellular dermal matrix may be used to help suspend the weight of the tissue.

My preference is to re-suspend the breast back to the position higher on the chest wall. I use a 'wedge' technique to also provide and restore fullness to the upper pole of the breast. Over time the breast should adhere in this position, diminishing the likelihood of sagging to the position prior to surgery. 

There are natural suspensory ligaments that attach between the breast parenchyma and the underlying muscles.  Some women are poorly supported and sag early.  Part of a breast lift is to re-position the breast back to the elevated position. Some surgeons will sew the parenchyma back to the fascia of the muscle in order to support the tissue rather than lifting by excision of excess skin alone.

In general ligaments are not "reattached" nor is any muscle repaired.  Now, this can be somewhat of a definition issue.  When I think "reattach", I would find the ligament and then suture it back to its broken component (such as a tendon in the hand).  However, it is true the breast lifts that use breast tissue to help hold the breast (such as cross flaps, simple excision of central tissue) do help improve long term results by supporting the breast with deep tissue and scar formation.  However, I wouldn't personally call this reattachment, although some ligaments will be repositioned.  Most techniques in the literature where the entire breast is elevated and repositioned on the chest wall have not shown much better long term success than routine breast tissue based lifts.  However, there are cutting edge absorbable meshes on the market now that allow the breast to be suspended, like an internal bra.  When the mesh absorbs, it leaves behind tissue that is 4 times stronger than normal tissue. There is promise that this technique may give longer lasting results, although it is too new for long term data as of yet.  Hope this helps.  If you are still confused, be sure to speak to your plastic surgeon to understand exactly what they mean.  If you don't feel comfortable with their explanation or feel like it is a sales pitch, go with your gut and find someone whom you trust.

  Thank you for the interesting question.  In general, most breast lifts use the breast tissue and the skin to lift and tighten the entire breast.  There are some techniques that also utilize the pectoralis muscle to help suspend the breast, but not all surgeons do their breast lifts in this manner.  There are tradeoffs to this and uncertainty if there is any long term benefit over other techniques.