Ptosis Grade 1 No Lift? (photo)

I have been looking up ptosis grades because I've been told I would need a lift and other say I don't! So I looked up how to identify what grade I am and I think I'm only a level 1!! I am 22, 3 year old son who I breast feed for 23 moths. I'm 5'8 and 150lbs. I want to be a full D or small DD. do you think I can get away with only implants and no lift? Or a small lift and not a full lift?

Doctor Answers 20

Ptosis of the breasts after pregnancy usually requires some lifting

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It's great that you have been educating yourself about breast ptosis and the different degrees of ptosis as we think of it.  The importance of grading or classifying anything like ptosis really lies in the way that such a classification can help guide treatments so that results are optimal.  That is really the main issue.  I always try to encourage my patients to "play to win, and not play to not lose."  In other words, we should focus on what our expected/desired result is and do whatever it takes to achieve that result as opposed to simply deciding ahead of time "I don't want this procedure or that procedure" for whatever reasons.  With regard to breast lifting, the obvious downside with some of the procedures is that there will be more scarring and they are more invasive than others.  However, in those instances of more "comprehensive" procedures, they will also deliver a more "comprehensive" result.  That is more lifting and repositioning of structures, more tightening of the breast envelope, more projection of the breast shape, and in some instances a better ability to correct asymmetries.  It's up to each patient and her surgeon to decide which procedure then fits her needs overall the best.

Having said all of that, with respect to your breasts, from the images that you show, I would agree that the degree of ptosis of your NIPPLE is relatively mild, perhaps at or slightly below the fold, but you have a fair amount of what we would call glandular ptosis.  That is the breast glandular mound rests below the fold to an appreciable degree, and the arc length from your nipple or areolar edge to the fold is long.  This comes from loosening of the supportive ligaments in the breast and of the skin.  It is important to recognize this because without any tightening of these structures, simply putting a breast implant in may cause the appearance of just a bigger sagging breast.  If we use a large enough implant to "fill up" the loose tissue and put those ligaments back on a little tension, then this may give a satisfactory appearance, but sometimes this requires an implant that is way larger than a lady prefers with regard to volume and size preference.  In those instances our only options are to put in the size of implant that we like from a size perspective and do no lift and accept whatever increase in tone and fullness of the breast as well as the position of the nipples that we get from just that, or we put in the size implant that we like AND do some form of lift to create the proper tone and fullness as well as put things like the nipple and breast mound in the proper location.  I hope this all makes sense; I know it can be confusing sometimes.  As for your breasts, I would have concern that unless you went with a fairly large implant and a dual plane technique, you may still have the appearance of ptosis of the breasts.  You may be happier with a periareolar lift or even a small vertical, or lollipop lift, in the end, because those would allow for some tightening of breast tissues and prevent the implant from settling into the  bottom of what is a loose breast envelope and leaving you with persistent flattening of the upper part of the breast and all of your breast volume at the bottom.  

This should at least give you some background information to take with you to a consultation with a board certified plastic surgeon who is experienced with all types of lift techniques and is comfortable allowing you to decide what your goals and personal expectations are.  With this, hopefully you can discuss your issues intelligently and arrive at a plan with your surgeon that will make you the happiest.  In the end, if you decide that all you want is a breast enlargement, even if you didn't get the fullest breasts on top, I think you should have that option offered to you as long as you understand the implications and have realistic expectations.  Good luck!

San Diego Plastic Surgeon

How do I know if my breast droop needs a lift or just implants

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Although your droop is grade one by nipple position, the lower breast has droop.  If you are OK with a little droop of the gland you may be a great candidate for implants alone without a lift.  I would recommend using 3D imaging to help your plastic surgeon communicate the degree of droop that would remain after implants alone to help you with this decision. 

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 185 reviews

Breast Lift or Not?

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-Although your nipple position might be in an acceptable location, you do appear to have a fair amount of glandular ptosis, which is not uncommon after pregnancy and breast feeding. Glandular ptosis refers to an excess amount of sagging breast tissue below the nipple and inframammary crease.  

-Therefore, breast augmentation without a lift would likely necessitate the need for a very large implant, and if a large implant is not used, chances are your breast shape will not be as pleasing as it could be with a breast lift.

-Thanks for providing your photos, but I would definitely recommend meeting in person with a board certified plastic surgeon.  He/she will examine you thoroughly and will be able to provide more information to guide you towards the breast size/shape that you desire.

-Best of luck to you!

Ptosis Grade 1 No Lift?

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Hi KristyRae!  You have a great question, that does not have an easy straight forward answer.  But yes, you could definately have a breast augmentation without a lift, but it all depends on what result you are looking for.  You have glandular ptosis, and implants alone without a lift will give you more fullness, but your breasts will still be low on your chest wall, just larger.  If you are looking for perky breasts with upper pole fullness, then you would be better served with a lift and augmentation.  You need to go in for a consultation where you can be shown examples of before and after photos of breasts similiar to yours so you can see what either choice would give you.

Ptosis Grade 1 No Lift?

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Thank you for the pictures.  You have psuedoptosis or glandular ptosis.  This means your nipples are OK but the gland is sagging below your crease.  Given the fact that you want to be a D or DD, your should be fine with just implants.

Breast augmentation can sometimes camouflage breast ptosis.

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A breast augmentation will probably obviate the need for a mastopexy based on the photograph provided. The larger the implant the more likely the ptosis is to be camouflaged.

Ptosis Grade 1 No Lift?

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I am not surprised that you have gotten different advice--by the photos this looks like a borderline call. 

Your breasts are a bit low set on the chest wall, but if that is not a problem for you, I would lean toward implants alone. Areolar position looks to be quite normal on the breast, with the lower pole of the areola above the breast fold. 

Should you decide later that you wanted a lift, it would not be a problem to do. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Ptosis Grade 1 No Lift?

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Dear Kristy,

thank you for your question and photos.  While technically speaking, you may have grade I ptosis (can only really be verified on exam), I think you would still need a lift to have a 'perky' result.  The reason why is you have a lot of skin under your nipple with the nipple pointing on side profile.  Your nipple probably does not need to be lifted, but the tissue under the nipple does.  The best lift for your would be a vertical or 'lollipop' type lift.

Best Wishes, 

Pablo Prichard, MD

Implants with no lift

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You may not need a breast lift, however to determine this you would need a consultation with a surgeon who has experience with performing breast augmentation on breasts affected by mild to moderate sagging. You can consider Allergan Inspira Truform 2 implants with a narrower base width for more projection.

Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate. Best of luck.

To lift or not to lift

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Dear Kristy Rae,

As pointed out, you have a condition known as glandular ptosis.  I usually recommend a lift along with augmentation for this condition.  You can augment without the lift, but your breasts will remain low lying on your chest wall.  Good luck!

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.