Is breast atrophy the same as breast ptosis? (Photo)

I am scheduled for my BA on November 10. I am 37, breasted two kids and very very active. I am getting round, textured, silicone textured implants 375cc-400cc done through the dual plane technique. I have a board certified PS and he says that I do not require a lift. In my chart it is written as "atrophy of breast". Is this why I don't need a lift because it's not ptosis and it's atrophy? Or are they the same? My concern is that I'll go from small saggy breasts, to just bigger saggy breasts. Any advice?

Doctor Answers 8

Breast Ptosis and Atrophy - definition and treatment

Atrophy  refers to loss of volume which a breast implant will take care of. Generally as you age the upper part of your breasts tends to atrophy.

Ptosis means sagging. Often when you loose volume (atrophy)  the extra skins sags causing  ptosis. A breast lift corrects this.

It is possible to have atrophy, especially in small breasts, and not have ptosis (i.e. still perky). If you have both then in general a breast lift with an implant is recommended.

Ptosis and atrophy

Thank you for your pictures. Breast ptosis is actually sagging at the breast. Breast at your tree is a loss of volume. In my opinion you have both but you must trust experience and recommendations of your plastic surgeon and move forward.

Is breast atrophy the same as breast ptosis?

Thank you for the question and pictures.   Atrophy refers to loss of volume or mass; ptosis refers to “drooping”. Your pictures clearly demonstrate breast ptosis and hypoplasia.  In my opinion, you will benefit from breast  augmentation/lifting surgery.   You will do best by seeking consultation with additional well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.

Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.

Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation.

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  

The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air, while at the same time removing some of the balloons rubber surface.  I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.
I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. 
The use of the tailor tacking technique is very helpful.  Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other.  
Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.  Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.

Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.
 The attached link may also be helpful.
 Best wishes.

Is breast atrophy the same as breast ptosis?

There are medical terms that do not mean the same thing but have overlap in concepts, Atrophy is decrease of tissue in volume and shape. While ptosis is sag of tissue. Thus can you have atrophy along - YES. Can you just have ptosis alone - YES. And you could also have both... 

Breast Atrophy vs ptosis

From your photos, you have a little of both. The correction in your case will likely be both an implant and a lift together. Putting in an implant does not lift the breast significantly. If your nipple is too low on the breast to start, an implant will possibly make this worse (in appearance) since there will be more fullness in the upper aspect of the breast. Using a shaped implant will help, but the ideal situation to a "youthful" result will be the combination of an implant and lift around the areola. 

You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.

Best of luck, Vincent Marin, MD

San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 42 reviews

Not really

Atrophy usually refers to the loss of tissue such as the muscle loss that occurs when treated with a cast. Ptosis is a sagging of the tissues, and of course they can be combined. Many of us now refer to your condition as pseudo-ptosis or "false sag". This occurs when the anchoring ligaments of the breast are still intact but the breast has deflated from children. Pseudo-ptosis does very well with an implant and does not normally require a lift surgery.

Donald W. Kress, MD, FACS
Frederick Plastic Surgeon
4.1 out of 5 stars 12 reviews

Is breast atrophy the same as breast ptosis?

Atrophy is loss of volume and ptosis is droop. You cannot get the look of the wish photo without a lift but you can get a very attractive and natural look without the lift. Depends on your goals.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Atrophy vs Ptosis

I can understand your confusion.  Atrophy is usually applied to shrinking of tissues from lack of use like the muscles in the legs of someone whose legs are paralyzed or an arm that has been in a cast for weeks.  What you have is the shrinking and deflation of your breasts after pregnancy often called postpartum involution that can lead to ptosis which is sagging of the breasts. The first is the cause and the second the symptom. There are different degrees of sagging or ptosis and different ways of correcting it depending on how severe it is and what your goals are.  The first and most important thing I tell my patients is that augmentations do not lift the breasts; they only fill them out. I haven't the benefit of examining and measuring you, but based on your photos alone I would be hesitant to expect the result you are hoping for in the photo you provided with augmentations alone.  Your nipples are already much lower on the breast mound.  You obviously have reservations and should not go into surgery with them. You will get more opinions here, but none will replace an in person examination by one or two more board certified plastic surgeons in your area.  Your expectations need to be realistic or you will be disappointed.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 27 reviews

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.