Should I Have Mastopexy to Treat My Sagging Breasts?

Mastopexy, or more commonly known as breast lift, is usually the first one that comes to mind for those with breast ptosis or sagging.  However, you should bear in mind that the exact appearance of your chest determines if this procedure is the right one for you.

A board-certified plastic surgeon can help you determine the extent of the sagging and choose the surgical technique which can provide the most desirable result.

But take note that having a flaccid breast does not automatically qualify you for breast lift surgery.  To know if you can benefit from this procedure, first you should understand the three types of breast sag:

* Ptosis

This condition warrants a breast lift.  It is manifested by having nipples that fall within the breast crease (Grade I); nipples falling below the breast fold (Grade II); and nipples reaching below the crease and pointing downward.

The degree of the problem determines the type of breast lift technique is used.  But the rule of thumb is that the more sagging you have, the more extensive the incisions will be.

If your breasts are very large and/or your breast ptosis falls under the category of Grade III, you would likely need the anchor lift technique which places incision around the areola complex, within the breast crease, and vertically between the areola and crease.

But if your ptosis falls under the category of Grade I and/or if you have a small- to medium-sized breast, the incision within the breast crease can be removed, thereby leading to quicker recovery. 

If you have a small sagging breast that lack volume in the upper cleavage, you may benefit from breast augmentation performed at the same time of your breast lift surgery.  Take note that be combining these two procedures, your plastic surgeon will use fewer incisions, leading to lower risk of visible scarring.

* Empty Sac Syndrome

The condition happens when the breasts have lost their fullness and roundness, giving an impression of sagging.  But if you will look closely, the nipples have not yet reached the breast crease.

For empty sac syndrome, the best approach is breast augmentation surgery particularly with the use of round implants to create fullness.

* Pseudo-ptosis

This is almost the same with empty sac syndrome, although the difference is that the upper cleavage is the only area which lacks fullness and roundness.  For this reason, placing round breast implants can correct the flaccid appearance. 

Traditional Breast Lift Surgery Vs Surgical Mesh

Traditional breastlift surgery is conducted by making incisions around the areola, across the breast crease, and vertically down from the nipple to the fold, thus allowing plastic surgeons to excise some of the loose skin and tighten the tissue.  However, one tradeoff a patient should remember is that while it can raise and reshape the bust for a period of time, it cannot stop the effects of gravity and skin laxity.

But recently, plastic surgeons from South Africa have developed a new technique called Internal Bra System which uses a “support” to prevent future sagging.  This method is now also used in Europe.

The new breast lift technique uses a mesh-like device called Breform which is similar to the one used in hernia repairs.  Meanwhile, plastic surgeons who developed the method said the material can take the strain off the scars and skin, preventing the breasts from sagging.

While Breform has not yet been approved in the US, experts believe that it will be introduced to the market within the next coming years.

Breform is a cone-shaped polyester mesh that is placed underneath the breast skin and is attached to the fascia using internal sutures.  The procedure is conducted under general anesthesia that puts a patient to sleep.

Plastic surgeons in Europe who are using Breform said the device is incorporated into the breasts over time, with the body naturally producing fibrous tissue holding the new structure in place.  With this technique, they believe the result is like a permanent support bra under the skin.

However, patients should remember that the new technique also involves the same incision sites used by the traditional breast lift surgery.  This means that the risk of scar and the length of recovery of these two methods are almost the same.

While Breform is approved in Europe, it has not been permitted by the US Food and Drug Administration, which is noted for its strict regulations on medical instruments.  And because the breast surgical mesh is quite new, there is no long-term study proving its effectiveness and safety.

Some US plastic surgeons are also concerned if the mesh-like device may affect the accuracy of screening tests for breast cancer or if it may lead to serious complications.

However, a four-year study involving 170 patients in Holland found no serious complications following the procedure.  The trial also revealed that breast X-ray examinations were still possible after the internal bra surgery.

Can Silicone Breast Implants Correct Mild Drooping?

Silicone breast implants are increasingly becoming popular these days as they provide a more natural result than saline implants.  This is not surprising because they are filled with a cohesive silicone gel designed to replicate the “feel” and move of glandular tissue and fats; another bonus is that the filling does not evaporate—unlike the saline solution—which means the patients can maintain their breast volume unless in the event of leak or rupture.

The good news is that breast implants—particularly the silicone-filled versions—can correct mild or pseudo ptosis (sagging) which is caused by breastfeeding.  It happens when the mammary glands put pressure on some glandular fats, but after the enlargement resolves, the breasts somewhat “deflate.”

On the other hand, true ptosis is caused by stretched and damaged suspensory ligaments in the breasts.  Oftentimes, the problems can only be addressed by mastopexy or more commonly referred to as breast lift; this can be performed as a standalone procedure or as a complementary to breast implantsurgery.

To correct mild or pseudo ptosis, it is highly recommend to use small implants (300 to 350 cubic centimeters would be the right range) because introducing large ones can aggravate the problem as the tissue is forced to carry the extra weight.  And over time, the stretched tissues will worsen.

By using large implants, there is a higher chance that the patients will need breast lift sooner rather than later.

It is important to note that even small implants can provide upper pole fullness in the breast, the area which is often affected by childbirth and breastfeeding.  But as mentioned earlier, silicone implants are better than the saline versions because they do not have a natural deflation rate.

By contrast, saline implants have been found to lose about 10 percent of their volume after a decade because of evaporation and other factors.  This simply means that patients with these devices are more likely to need revisions sooner than those who have silicone implants.

Meanwhile, there is still a debate whether the subglandular or submuscular implant placement provides more lift.

In the subglandular implant placement, the device is positioned above the muscle which is believed to provide a more lifting effect.  But one downside is that only the tissue and skin support the implant, something which may aggravate the ongoing ptosis.

On the other hand, the submuscular implant placement is said to prevent future ptosis because the device, which is positioned under the pec muscle, is being supported not only by the tissue and skin but also by a thick amount of muscle.

Breast Implants with Lift for saggy boobs

Even small breasts can sag due to the natural effects of aging, weight fluctuations, and previous pregnancies.  Fortunately, plastic surgeons have come up with a new technique which combines the benefits of mastopexy (or breast lift) and breast augmentation in one operation.

The sagging of the breasts primarily happens when the amount of tissue decreases and the skin becomes lax.  Contrary to popular belief, breast augmentation surgery alone is less likely to provide a lifting effect especially if there is a severe case of ptosis (drooping).

Mastopexy with breasti mplants starts by making incisions to remove a small amount of skin, which in turn corrects the sagging appearance.  With this technique, less tissue is excised than if breast lift is performed alone; for this reason, patients will enjoy less scarring on their chest.

Because less skin is removed, plastic surgeons need shorter incisions to perform mastopexy-augmentation surgery.  In most cases, they use the crescent-shaped incision around the areola complex, although patients with severe breast ptosis may need the lollipop incision in which the surgical cut is made around the areola and vertically down the breast crease.

The good thing with mastopexy-augmentation is that most patients can get more cleavage, although they should bear in mind that the final result also depends on their chest width and rib cage.  For example, women with a concave chest are likely to enjoy more medial cleavage and upper pole fullness as the implants tend to settle toward the center.

On the other hand, patients with convex chest will achieve less cleavage because their implants will likely settle opposite with each other.  However, there is a solution to the problem: use breast implants that offer more projection off the chest wall.

While some surgeons prefer simultaneously performing breast augmentation and mastopexy, others would rather wait for three months before another surgery (augmentation) is conducted.

Some doctors argue that breast augmentation with mastopexy—if performed on the same day—can lead to higher risk of asymmetrical breasts and complications since the skin is being removed and tightened while at the same time the implants stretch it even further.  Another concern is the tension on the incision site can adversely affect the blood supply.

They also argue that it is challenging to position the nipple and breast crease if mastopexy and breast augmentation are performed simultaneously.

Regardless if breast augmentation is performed on the same day of mastopexy or at a later date, most plastic surgeons recommend placing the implants totally under the pec muscle which can provide good coverage and strong “support.”