Drooping breasts (breast ptosis)

Dr Mark Kohout
Thursday, October 13, 2005

Breast drooping (ptosis) is a result of multiple factors. Ageing, pregnancy, breastfeeding and weight loss all take their toll. It is the result of softening and stretching of the ligaments responsible for keeping the breast up and of tissue stretching due to breast enlargement during pregnancy.

Breast droop after pregnancy is often accompanied by loss of breast tissue, together giving the characteristic, sagging look with flatness in the upper pole of the breast. Minor degrees of breast droop can be adequately corrected by breast augmentation alone. However, once the breast droop has reached a point where the nipple is at or below the level of the breast crease, mastopexy is the only way to restore the youthful, high nipple position.

Mastopexy, or breast lift, also tightens the skin to give the breast a firmer feel. Mastopexy is often combined with augmentation if decrease in breast volume is also a problem. Together, these procedures can restore the breast into its natural fullness, shape and position. Whilst the breast lift will restore the youthful higher nipple position, insertion of an implant will give the breast more fullness and firmness. The operation can be done either under intravenous sedation or general anaesthetic depending on the individual situation.

Is mastopexy for me?
Mastopexy may help if you are happy with the overall size of your breasts but unhappy with their shape in terms of sagging or drooping. You may have noticed this "ptosis" with time or following breast-feeding, loss of weight or with ageing. Mastopexy lifts and restores the breast into its position and helps improve your overall appearance.

You may be a good candidate for breast lift surgery if you have one or more of the following conditions:

  • Breasts that are pendulous, but of satisfactory size
  • Breasts that lack substance or firmness
  • Nipples and areolas that point downward especially if they are positioned below the breast crease

Sometimes these conditions may be inherited traits. In certain cases the breasts may have developed differently so that one breast is firm and well positioned while the other is not. There may be differences in the size of your breasts as well as their shape. Breasts that are large and heavy can be lifted but the results may not be as long lasting as when the procedure is done on smaller breasts.

What happens on the day of my surgery?
Surgery is usually performed on an outpatient basis. If this is the case, make certain you have someone to drive you home after surgery and to stay with you at least the first night following surgery.

Your surgeon will mark your skin before the operation and if you have not already done so, you will need to sign the consent form for your operation. You will also be seen by the anaesthetist, who will go through your medical history with you again and will explain the anaesthetic procedure to you. Medications are administered for your comfort during the surgical procedure. During the anaesthetic, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

What happens in the operation?
There are currently several techniques for mastopexy. They all aim to lift and reshape the breasts, and reposition the nipples. If the breast sagging is minimal and the breasts are small, ptosis can be corrected with augmentation mammaplasty. This method causes fewer scars on the breast than mastopexy.

During mastopexy the nipple and areola are repositioned to a higher position and excess skin is removed from beneath the breast. Closing the remaining skin lifts the breast mound to a higher position and re-contours the breast to give it a more projected and youthful appearance. If there is inadequate breast tissue to fill the skin and achieve the desired size, a breast implant may be placed beneath the breast at the same time achieving the desired size, shape and projection.

When can I resume my normal activities?
It is often possible to return to work within two weeks, depending on your job. In many instances you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. It is important not to do any strenuous exercise of the upper body and chest as these increases the chances of bleeding. Severe pain should be reported to your doctor.

Any sexual activity should be avoided for a minimum of one week, and your surgeon may advise you to wait longer. After that, care must be taken to be extremely gentle with your breasts for at least the next six weeks.

What results can I expect after surgery?
As the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your breast surgery. Incisions will fade over a number of months until they become barely visible.

Dr Mark Kohout FRACS
Plastic Surgeon
Ph: 1300 551 151
Leichhardt — Bondi Junction — Orange NSW

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