Sagging breasts or Mammary Ptosis is one of the most common complaints women have after pregnancy. After pregnancy and breastfeeding feeding many women notice that their once firm and full breasts have lost their youthful look and are sagging.
The result is that often they do not feel as comfortable in bathing suits or revealing clothing. Some women say they feel less attractive or less “sexy” and some actually will not let their husband or significant other see them in the nude with the lights on.
Fortunately modern Plastic Surgical Breast Lift or Mastopexy techniques often coupled with Breast Augmentation or Implants can, when done properly by an expert, restore a post pregnancy breast to a youthful, firm beautiful appearance.
What Causes Sagging Breast (Mammary Gland) or Mammary Ptosis?
During pregnancy the Mammary Gland enlarges and becomes engorged with milk. This expansion stretches the skin around the gland similar to the stretching of the tummy during pregnancy. After pregnancy the Mammary Gland involutes or becomes smaller and shrinks but usually the skin does not tighten as much. The result is that the smaller Mammary Gland is now contained in a larger skin pocket. The result is that the Gland sags down on the chest. It is not like letting the air out of a balloon.
How Do We Define Mammary Ptosis or Sagging?
Mammary Ptosis is defined by the relationship of the nipple or Mammary Gland to the Inframammary Crease or Fold-the fold in the skin underneath the breast.
If the Nipple lies below the Inframammary Fold the condition is called Mammary Ptosis.
If the Nipple is above the Inframammary Fold but the Mammary Gland is below the Inframammary Fold, the condition is called Glandular Ptosis.
How to Decide If You Need a Breast Lift (Dermal Mastopexy) to Correct Sagging.
Most Plastic Surgeons agree that if the Nipple Areola Complex lies beneath the Inframammary Fold a Dermal Mastopexy is indicated.
Breast Augmentation or Implants alone will not correct Sagging . If Implants are placed into a patient who Nipple Areola is below the Inframammary Crease, the Implant will push the Nipple further down and the Implant will rest above the Nipple and create an unacceptable appearance called the “Snoopy Deformity.”
How to Decide If Augmentation or Implants Alone Will Help Your Ptosis
If you do not have Mammary Ptosis but have only Glandular Ptosis-your Nipple is above your Inframammary Fold- then Augmentation with Implants may be all that you need.
However if you have Glandular Ptosis the Implants will most often be placed under the Gland called Sub Glandular Augmentation Mammoplasty and not under the muscle. If the Implant is placed under the muscle-Mus muscular or Sub Pectoral Augmentation Mammoplasty- there is risk of the “Snoopy Deformity” described above.
What Are the Goals of Dermal Mastopexy?
All Dermal Mastopexy procedures are designed to achieve:
1. Elevate or move the Nipple-Areola to a normal pre pregnancy nipple position-this is usually defined as 18-22 centimeters below the notch in your breast bone below the neck, called the Suprasternal Notch (SSN). A simpler method is that the Nipple Areola should be level to the midpoint of your Humerus-that is your arm bone. When the Nipple Areola is lower than the middle of the arm bone it looks too low. In my experience a Nipple location 18 centimeters below the SSN is too high and the Areola can often show in a Tank Top. So I most always place the nipple at 20-21 centimeters below the SSN.
2. Remove excess stretched skin
3. Elevate or push the Mammary Gland upward to a normal level-that is, correct Glandular Ptosis.
Different Types of Dermal Mastopexy
• Full or Anchor Lift or Wise Pattern Mastopexy – the Anchor Lift or Wise Pattern Mastopexy is the classic or traditional method for lifting the Breast. It is effective and produces excellent results. It results in a scar around the Areola, down the Gland, and into a horizontal line running in the Inframammary Fold. This latter scar is called an inverted T because of its shape. When properly performed these scars become thin and white and do not detract from the appearance of the final result.
• Lollipop – Lollipop Mastopexy-Circumvertical or Vertical Scar Lift – This is a modification of the Anchor or Wise Pattern procedure which attempts to eliminate the horizontal incision in the Inframammary Fold. After the Nipple Areola is moved up to the new location, the excess skin on the gland is removed and an attempt is made to avoid the T limit of the incision in the Inframammary Fold. In my experience this procedure is best for patients with minimal Mammary Ptosis and realistically there is always a small incision in the Inframammary Fold.
• Peri-Areolar or Crescent Mastopexy – This procedure excises or removes a crescent of skin above the Nipple Areola and moves the Nipple Areola into a higher location and “cheats” the skin excursion around the Areola so that the scar is only around the top and sides of the Areola. This procedure is only useful in cases of minimal ptosis without significant Glandular Ptosis.
• The Donut or Circumareolar or Benelli Lift or Mastopexy – This procedure is another attempt to eliminate the vertical scar on the gland that occurs with the Anchor and Lollipop Mastopexy. A circle or “donut” of excess skin and Areola is removed from around the Areola and the surrounding skin is “gathered” and sutured to the Areola. The result is a scar that only runs around the Areola with no vertical line running down the gland. This procedure is also best for lesser degrees of Ptosis. One common problem is that the “gathering” of surrounding skin often leaves visible folds around the Areola. Most of these folds smooth out with time. However when this procedure is used on more different forms of Ptosis, the folds can be permanent.
• Freehand or Modified Wise Pattern Lift – This is one of the most common types of Breast Lift that I do. Because every person is different, the standard Wise Pattern is not always appropriate for each individual. I set and mark the ideal position for the Nipple and use the Wise Pattern to mark the new Nipple Areola position. I remove the skin from the new Nipple Areola site and move the Nipple Areola to the new location. Then I customize the amount of skin to remove from below the Nipple Areola based on what is needed for the specific patient. There is a vertical limb but I move it more to the side where it is better hidden. There is also often a small horizontal scar hidden in the Inframammary Fold but it is much smaller than the scar of the Anchor Lift or Wise Lift.
• SAM Lift (Simultaneous Augmentation Mastopexy) – Many, if not most women who have sagging after pregnancy can also benefit from Augmentation with Implants. This is because the Mammary Gland atrophies or becomes smaller after pregnancy a condition called Post-Partum Mammary Atrophy . Because the gland is smaller, even with a successful Dermal Mastopexy, the gland is still smaller and does not look or feel as firm or full as it did before pregnancy. Many surgeons recommend that these two procedures not be done at the same surgery. They recommend that the Implants be placed first and waiting six months before doing the Mastopexy. This allows the Implant to set into the proper position before lifting the Gland to the proper position on the new Mound created by the implant.
How to Decide if You Need a Dermal Mastopexy
If your breasts have sagged and become smaller after pregnancy you may be a candidate for a Mastopexy. Place your finger beneath your Gland into the fold under your gland. If your Nipple Areola is below this fold then a Mastopexy is usually indicated. Another way to check is to stand in front of a mirror and see if your Nipple Areola is below the midpoint of your upper arm. If it is it is probably too low and a Mastopexy is significantly indicated.
How to Decide if You Need a SAM Procedure with Implants
With your fingers grasp the skin of your Gland and pull the gland up to a position that looks good to you. This is similar to what it will look like after a Mastopexy. If there is enough fullness of the Gland so that it looks as full and firm as you want it then a Mastopexy alone will achieve your goal.
If however there is little Glandular Tissue left and you do not look firm and full enough for you, then a SAM Procedure or combined Mastopexy and Augmentation is indicated.
Important- See an Expert
The best results require significant expertise, skill, experience and knowledge on the part of your surgeon. Mastopexy and particularly the SAM procedure are technically precise and complex operations.
Done properly beautiful satisfing results are possible. Done improperly scarring and inaccurate Nipple Areola positioning can create an abnormal appearance and be devastating for you.
Only consult plastic Surgeons certified by the American Board of Plastic Surgery and surgeons who have experience and demonstrated skill at Cosmetic Breast Surgery. Check their websites, speak to people who have had surgery by the surgeon, and check reviews on a reputable website like Realself and Loveyourlook.