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Background: Besides asymmetry the most adverse breast shape encountered in the preoperative breast augmentation patient is sagging. More medically known as ptosis this poses numerous issues including whether augmentation will improve or worsen teh sagging as well as overcoming the patient’s expectations, often erroneous, that implants will lift sagging  breasts

Breast sagging comes in a wide variety of degrees from minor to major and has a classification system to describe its severity. This classification system its based on the position of the nipple relative to the inframammary fold. It is easy to see that the lower the nipple is compared the horizontal level of the fold in a side view the more severe the sagging is. There is also the condition known as pseudoptosis where the lower pole breast skin hangs below the fold with the nipple above it.

It is commonly perceived that implants will lift saggy breasts. It is easy to understand why the public has that perception although it is largely not true. From a biomechanical standpoint the inflation of the breast mound skin with an implant can only drive the nipple upward if the length of the upper pole breast skin is equal to or less than the length of the lower pole of the implant or the length of the lower pole breast skin. This is only true in the more minor degrees of breast ptosis.

Case Study: This 38 year-old female had sagging and loss of breast skin from multiple pregnancies. The nipple was basically at the level of the inframammary fold with some breast skin underneath it.

Under general anesthesia 350cc silicone gel breast implants were placed through transaxillary incisions. This resulted in the breast being lifted with the nipple ending up above the inframammary fold.

In grade 1 breast ptosis or n pseudptosis implants can have a lifting effect because there is enough skin between the nipple and the fold to be able to be stretched. This allows the nipple to be carried upward as the breast volume is increased.


1) Grade 1 ptosis is when the nipples are at the level of the inframammary fold.

2) Breast implants can have a lifting effect in Grade 1 ptosis sagging

3) In ptosis more severe than a Grade 1 breast implants will NOT have a lifting effect.

Dr. Barry Eppley

Indianapolis, Indiana

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