While breast augmentation continues to be the most requested cosmetic surgery procedure, mastopexy (breast-lift) procedures are also now growing exponentially. In fact, in the last 18 years, the number of women opting for breast-lift procedures has risen over 600 percent according to the American Society of Aesthetic Plastic Surgery. This upward trend in cosmetic breast surgery isn’t so much about what you’re lacking but instead what you’ve actually lost.
So, what exactly causes breasts to migrate south? A woman’s breasts change in size, shape and position on her chest throughout her life and because the breast is composed of mammary glands, fat and ligaments it is highly vulnerable to the effects of gravity and sadly, no amount of exercise, weight lifting or expensive topical creams, can boost the breast.
Several factors contribute to breast sagging (ptosis) including pregnancy, age, heredity, significant weight gain or loss and large breasts which are disproportionate to body size. Essentially the skin that envelopes the breast and the ligaments within the breast stretch over time in response to the forces of pregnancy, breastfeeding and gravity. The end result is a breast that migrates downward with loss of breast shape and a lower nipple position. In the most severe cases the nipple ends up pointing down towards the ground.
Stages of Ptosis
- Grade I: Minor ptosis—The nipple is at the level of the infra-mammary fold and most of the breast tissue is above the fold.
- Grade II: Moderate ptosis—The nipple and breast tissue are both located below the infra-mammary fold.
- Grade III: Severe ptosis—The nipple points downwards and most of the breast tissue is below the infra-mammary fold.
- Grade IV: Pseudoptosis—The nipple is located either at or above the infra-mammary fold while the remainder of the breast tissue has sagged below the fold. This can often be seen when a woman stops nursing, as her milk glands atrophy, causing her breast tissue to sag.
- Parenchymal Maldistribution—The lower breast tissue is lacking fullness, the infra-mammary fold is very high, and the nipple and areola are relatively close to the fold. This is usually a developmental deformity.
Lifting the breast can be achieved through a variety of incision patterns and techniques. The appropriate technique is determined based on your breast size and shape, size and position of your areolas, degree of breast sagging, skin quality and elasticity, as well as the amount of extra skin.
The “Donut” (Benelli) Lift
One incision is made around the areola and a second incision is made outside the areolar incision. The outer incision is close to the inner incision. The “Donut” lift can only achieve a limited amount of nipple repositioning and does almost nothing to lift sagging breast tissue. Therefore it can only be used for a limited number of breast shapes.
The “Lollipop” (Vertical) Lift
An incision is made around the perimeter of the areola and vertically down from areola to breast crease. This type of lift allows for greater repositioning of the nipple and elevation of the breast tissue. Because skin is only removed in a horizontal direction, the result is typically a much fuller lower breast pole and little or no change to the upper breast.
The “Anchor” Lift
An incision is made around the perimeter of the areola, vertically down from the areola to the breast crease and horizontally along the breast crease. The most powerful technique it is best for correcting more extensive degrees of breast ptosis.
Some incision lines resulting from the breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines result in scars which are permanent, but in most cases will fade and significantly improve over time. While most women desire the smallest scar possible it is very important that you do not diminish your results by demanding an incision that will not be appropriate for your breast shape.
Where Did My Boobs Go?
Once your breasts are back where they belong you may find that they have diminished in size. If so, a breast augmentation procedure may be recommended to further enhance your new, uplifted breasts and provide greater upper pole fullness.
One Stage Lift or Two Stage Lift?
There are times when staging the procedures is clearly the better choice to achieve the optimal and most durable result; particularly for patients who need a significant lift or who want a larger implant. For those that need minimal lifting and a smaller implant, good consistent results can be achieved in a single stage procedure. The combination of a simultaneous implant with a breast lift is a highly complicated procedure and is associated with a very high revision rate. That is not to say that in certain situations it can’t be done successfully as one procedure, but if not, the results can range from mediocre to disastrous and fixing it secondarily can be difficult and expensive. For that reason many patients are better off if the operations are done in two stages.
Staged Procedure; Anchor Mastopexy followed by Breast Augmentation 3 months later. Photo taken at 6 months post-op.
Can You Lift Saggy Breasts with Just an Implant?
In a word…NO! Breast implants do not lift breasts. An implant can give the illusion of a lift by creating more breast fullness in the upper pole as well as slightly rotating the nipple upwards so the breast shape may be enhanced but the breast tissue is not actually lifted and over time your breasts will continue to drop even further.