Sagging breasts (breast ptosis)

Sagging breasts, medically called breast ptosis, is the descent of the breast and the nipple-areola complex from their original position. It is one of the most frequent reasons for consultation in breast cosmetic surgery, especially after pregnancy and breastfeeding or significant weight loss.

Why breasts sag

Breast ptosis happens when the skin and ligaments that support the breast lose elasticity and the gland loses volume. Contributing factors include:

• Pregnancy and breastfeeding: the breast enlarges and then shrinks, leaving the skin stretched.
• Significant weight changes.
• Age and menopause: glandular tissue is partly replaced by fat and the skin loses firmness.
• Genetics, breast size and smoking: large breasts and thin skin tend to sag earlier; smoking worsens skin quality.

Grades of breast ptosis

Breast ptosis is graded by the position of the nipple relative to the inframammary fold, the crease under the breast (Regnault classification):

• Grade I (mild): the nipple is at the level of the fold.
• Grade II (moderate): the nipple is below the fold but above the lowest part of the breast.
• Grade III (severe): the nipple is at the lowest part of the breast and points downwards.
• Pseudoptosis: the nipple is in place, but the gland has dropped below the fold; typical after breastfeeding.

Treatment of breast ptosis

Sagging breasts cannot be corrected with exercises or creams: the pectoral muscles lie under the breast and do not hold it up. Treatment is surgical:

• Mastopexy or breast lift: repositions the gland, raises the areola and nipple and removes excess skin. The scar depends on the grade: around the areola, vertical (“lollipop”) or an inverted T.
• Breast lift with implants: when volume has also been lost, the lift is combined with an implant or the patient’s own fat.
• Breast augmentation alone: in mild ptosis or pseudoptosis, an implant may be enough to fill a deflated breast.

A breast lift does not prevent breastfeeding in most cases, although a later pregnancy can make the breast sag again. It is therefore usually recommended to wait until no further pregnancies are planned.