Breast ptosis and breast atrophy are two different things that happen to breasts as the result of the natural aging process, time, and especially with the changes that breasts go through with pregnancy and breastfeeding.Breast ptosis, means breast droop - the nipple, and the gland with it, droop to a lower position. Breast ptosis occurs due to age with stretching of the elastic skin and breast tissue fibers, relaxing of breast ligaments, hormonal changes, rigorous exercise, and changes of the breasts with pregnancy and breast feeding. Breast exercises, fancy sports bras, and pushup bras do not prevent breast ptosis. As plastic surgeons we categorize breast ptosis into categories to define how severe the drooping is, and this gives us guidelines to what procedures are needed to restore a youthful look and shape. No ptosis is defined by a nipple that is above the crease under the breast (inframammary fold), grade 1 ptosis describes a nipple position at the fold and higher than the majority of the breast tissue, grade 2 ptosis describes a nipple position below the fold but still higher than the majority of the breast tissue, and grade 3 ptosis describes a nipple position well below the fold at the point of maximum breast projection. Some surgeons consider an additional grade 4 (or severe grade 3 ptosis), where the nipple position is at the bottom of the breast and points towards the floor. When women with ptosis are considering breast augmentation, the degree of ptosis is taken into consideration to determine whether or not a breast lift is also needed to create a nice shape. For grade 0 to grade 2 ptosis, a breast augmentation alone will fill out the breast tissue and give a small lifting effect such that larger scars and a formal lift are not needed. Sometimes a dual-plane technique is used in these cases, which means that the muscle is separated from the breast tissue, allowing the breast tissue to rise to a more elevated position. For patients with grade 3 or more ptosis, often a formal breast lift is required along with augmentation to move the nipple into a better position and redistribute breast tissue into a more lifted position. Without a lift, in these cases, the breast implants will just make the breast look bigger and droopier.Breast atrophy, means thinning or shrinkage of tissue, a look that seems droopy because the breast appears deflated, even if the nipple is in a good position without actual ptosis. Breast atrophy occurs after pregnancy and breast feeding, when the breast ducts involute, it can also occur with hormonal changes after menopause or after ovaries are removed, and with anorexia. Breast atrophy also can occur with large implants that thin our the overlying breast tissue. Breast augmentation is a nice procedure that can restore lost volume and fill up the loose skin of atrophied breasts.Many women have both atrophy and also ptosis, but some have only one or the other - evaluating each of these two things together determines what type of breast augmentation is right for you.
