What grade of ptosis do I have? What treatment is recommended? (Photo)

Im not very happy about my saggy breast. How bad is the ptosis? What treatment is recommended ? I have a 40 b cup what size would you recommend? Can i also get larger nippels?

Doctor Answers 20

Breast Lift Options


Thank you for your question and photos. These are not straight forward photos so it is difficult to say. Your level of sagging would be best evaluated in person with a board certified Plastic Surgeon. They will assess your tissue, take measurements and talk about your aesthetic goals with you. You could consider a breast lift with or without Implants.

All the best

Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Breast Ptosis

While you seem to have grade 3 ptosis, it is difficult to say for sure from your photos taken from above.  That said, you are certainly a great breast lift candidate.  You may or may not want to have implants- they are certainly not necessary but are a personal preference that you can discuss when you see a surgeon.  I would recommend a breast lift with or without a small implant (an implant only if you want to be larger) for a very nice result.
Best wishes, 
Dr. L

Adam David Lowenstein, MD, FACS
Santa Barbara Plastic Surgeon
4.9 out of 5 stars 56 reviews

Breast lift for grade 3 ptosis

Thank you for your question and helpful photos.
I'm not sure you are actually a 40 B. I recommend you have yourself professionally measured. You will be delightfully surprised at your actual size. You do not need implants. Please view the short video attached to see what can now be achieved with more current techniques. The patient featured did not require implants or fat grafts to achieve her lift. I would not recommend increasing your nipples or areolas.
I hope this helps.
Best wishes and kind regards,

Gary Horndeski M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

What grade of ptosis do I have? What treatment is recommended?

Based on your photos alone you will require a breast lift. A breast lift will re shape your breasts and re position your nipples. Please consult with a board certified plastic surgeon to discuss your surgical options. 


Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Breast ptosis

Yes, you do have breast ptosis, because the level of your nipples are below the crease under your breasts.  The procedure to correct this is a breast lift, not implants.  However, it requires a incision around the areola, down the lower part of your breast, and an incision in the crease under your breast.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

What grade of ptosis do I have?

It appears from your picture that you have Grade 3 breast ptosis meaning the nipples sit below the inframammary fold. A mastopexy or breast lift can improve the shape and improve the symmetry. If you are hoping to go larger a breast implant can also be added to the lift. I am not sure if you are asking about the nipple or areola size. I would not recommend trying to doing anything to make your nipples larger.

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 24 reviews

What type of Ptosis

From your photos you have at least Grade 3 Ptosis. One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask, “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Unhappy about saggy breasts

Hi Lilatenny,

Thanks for your question and photos.  Sorry to hear that you are unhappy with the appearance of your breasts. From the photos you attached, it appears that you have Grade 3 ptosis which can certainly be corrected with a lift to give you a great result.  Depending on your preference, that lift could also be combined with the addition of a breast implant to give you fuller breasts, or a breast reduction if you feel that your breasts are too large.  Typically this type of procedure would reduce the size of your areola, and not change the size of your actual nipple at all, but this is something that you can discuss at length with the surgeon that you choose.

I would recommend that you schedule several consultations with board certified plastic surgeon in your area who have expertise with the above breast enhancement procedures, and that have before and after photos of results that you like.  Make sure to have a list of questions ready so that your consultation goes smoothly and review your treatment options with each surgeon. 

Best wishes!

Dr. Brown

Daniel Brown, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 22 reviews


Based on the photos, it appears that you have grade 3 ptosis.  For aesthetic improvement, you will likely to need to have breast lift with or without augmentation depending upon the size and the shape you desire.  Lift and augmentation are one of most challenging procedures in breast cosmetic surgery.  You should seek for a board certified plastic surgeon who is experienced with complex breast surgery.  


Alex Kim, MD

Alex Kim, MD
Beverly Hills Plastic Surgeon
4.6 out of 5 stars 23 reviews

What Grade Ptosis Do I Have & What Treatment Is Recommended?

From the pictures you provided, it appears you have Grade III ptosis, that is to say your nipples are pointing at the ground.

With reference to treatment, that would depend on how far the nipple is from the inframammary fold.  I believe you need a standard mastopexy, but depending on the position of the inframammary fold vis-a-vis the nipple, a periareolar (Benelli) lift might be sufficient.

At this point, it would be appropriate to contact a Board Certified plastic surgeon experienced in both breast augmentations and breast lifts. 

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.