Do breast lifts repair Cooper Ligaments to correct sagging?

Question

Or do they simply tighten the skin and change the position of the nipple? And what damages the Cooper Ligaments in the first place? How important are they to the overall "perkiness" of the breasts? If the nipple was pointing in the right direction and the only problem was deflation due to overstretched skin and weight loss and (theoretically, of course) there was a way to tighten the skin without surgery, could that replace a lift? Thanks!

Nelson Castillo, MD · Answer

Thank you for your excellent and unique questions and nice job on the research!  Breast lifts do not repair Cooper ligaments, they are procedures designed to remove excess skin, tighten the remaining breast, and elevate the nipple.  Coopers ligaments stretch with time, gravity, and size changes to the breast tissue during pregnancies, weight fluctuations and menstrual cycles.  Theoretically, if the nipple position was acceptable, and the sagging skin was the only issue, then a maneuver to tighten the skin without surgery could replace a lift.

Michael J. Weinberg, MD · Answer

Thanks for your questions.The essential parts of a breast lift are nipple repositioning, breast envelope tightening and glandular repositioning. There are several different procedures and they each use these different elements slightly differently.Thus Coopers ligaments are not an essential part of a breast lift. in addition one cannot see them.

Martin Jugenburg, MD · Answer

During a breast lift, the skin envelope holding the breast tissue is tightened, and the breast tissue itself is repositioned and reshaped.  Cooper Ligaments are not 'repaired' as that is impossible.  Same was as stretched skin is not repaired, but tightening of stretched skin is done by trimming the excess

Michael Kreidstein, MD, FRCS(C) · Answer

Breast lift (also called a Mastopexy) involves a variety of techniques depending on the surgeon and the patient's needs.  Barbed sutures have been tried to replace stretched-out Cooper's ligaments, but tissues will pull through these sutures and thus attempts at repairing Cooper's Ligaments are not generally used.An operation that only  repositions the areola and tightens the skin will look good initially, but will result in 'bottoming-out' or pseudoptosis, in which the areola position is fine but the volume of the breast sags below the areola.  Several techniques exist to control the shape and position of the parenchyma (gland and fibrofatty tissue of the breast), and these are most effective at restoring an ideal and lasting shape to the breast.

Nathan W. Patterson, MD, FACS · Answer

A mastopexy does not repair Cooper's Ligaments.  Cooper's ligaments stretch over time like most soft tissues in the body.  Weight gain/loss, breast engorgement with pregnancy, and gravity all affect that process.  Unfortunately there is no way to lift the breast nonsurgically.  There are several mastopexy techniques but they all involve removal of excess skin and therefore result in scars.

Robert S. Houser, DO · Answer

Wouldn't it be great to just tighten those little cables and put everything right back where it was with no scars? The problem is, we can't do it.  If the nipple position is ok, you may just need an implant.  "Perkiness" can be defined 2 ways -- it's either a forward-facing nipple or it's the umph in the upper pole of the breast.  The nipple position comes with a lift and the umph comes from an implant.  There really are no non-surgical options -- gravity is too strong!  Good luck!

Steven Wallach, MD · Answer

A breast lift operation usually incorporates a remodeling of the glandular tissue, excision of redundant loose skin and elevation of the nipple areola complex. It does not tighten Coopers ligaments.

Brian J. Lee, MD · Answer

Great question. Once Cooper's ligaments are stretched they cannot be repaired. During a breast lift the excess skin from the lower breast is removed, the breast tissue itself is raised and anchored in a more superior position. The breast is held in this position by deeper sutures and tightening the skin, not by Cooper's ligaments.

F. True Lansden, MD · Answer

Breast lifts do not repair the ligaments, but rely on sutures in the breast tissue, as well as the reduced skin envelope to hold the breasts in place.

R. Stephen Mulholland, MD (retired) · Answer

Dear ladytalulah,

Thank you for your excellent clinical post and obvious
research on the subject of breast deflation and descent.  Cooper’s Ligaments are the fascial
attachments to the pectoralis fascia and the skin-like facial ligaments descend
and elongate with time.  During facelift
surgery we elevate and remove skin to reshape the face and the cutaneous fascial
ligaments are repositioned.  With breast
lift procedure the inferior pole of the breast, extra skin and breast tissue is
removed to reshape the breast and the nipple is elevated.  However, the Cooper’s Ligament attachment to
the pectoralis fascia and the parenchyma is not addressed.

In general, if you have refill position of the nipple areolar
complex on the chest wall and it is a matter of deflation with weight loss and
age then the skin can be tight with non-surgical techniques such as bulk
heating radio frequency energy.  Devices
such as the Forma, Venus Freeze and Exilis are excellent ways to tighten the
skin envelope.  Fractional infrared
devices such as the 1540 and eMatrix and the Fractora can also provide some
tightening.  Subdermal heating with
devices such as Thermi RF and FaceTite can also elevate the nipple areolar
complex and tighten the skin.  Finally,
if you’re opposed to the concept of an artificial breast augmentation, unwanted
fat from other areas of your body can be injected into the breast to provide a
lift effect and slight volume increase, perhaps half a cup size, in combination
with these skin tightening techniques.

So, in answer to your question there are some non-excisional
techniques to improve skin tightening without the breast lift scars and slight
modest increase in volume without breast augmentation and artificial implants.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below also view
the skin tightening sections of the website.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Do breast lifts repair Cooper Ligaments to correct sagging?

Answers (11)

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