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Background: Breast ptosis is a well described sagging of breast tissue over the inframammary fold. Based on the amount of tissue overhang different degrees have been described to it. The anatomic basis for breast ptosis or sagging is when loss of breast tissue volume occurs with a resultant excess of enveloping skin, which allows the breast mound and nipple to sag.

While some breasts have ptosis naturally, most are caused by life’s changes from weight loss to pregnancy. A less commonly recognized cause is primary breast implant augmentation. This is when a patient presents for breast augmentation and already has some ptosis. They fear the breast scars that will result from a needed lift and are willing to accept less of an ideal breast shape (nipple on the south side of the breast mound) for a larger breast size.

What often happens long term in these implanted breast ptosis patients is that the breast sag worsens. The breast tissue falls further off of the implant (which is a fixed structure on the chest wall) due to gravity and/or weight gain. This, in essence, creates an appearance and symptoms more commonly seen in patients with macromastia that present for breast reduction surgery. The one difference is the latter has a flat upper pole breast profile while the former has a fuller upper pole due to the indwelling implant.    

Case Study: This female had large breast implants (saline of 500ccs volume) placed eleven years previously She undoubtably needed a lift at that time but understandable that was not appealing at that time. Over time the breast tissue fell further off the implants. Besides their appearance they now caused some beck and back pain. 

Under general anesthesia full breast lifts were performed with replacing the saline implants with new ones with lower volume. (350ccs)

Her six week results showed a dramatic improvement in her breast shape and more centric nipple position.

Breast implant size reductions (and implant removals as well) with lifts are a form of breast reduction surgery. The change in the implant size is the equivalent of the breast tissue removal in breast reduction surgery. The external lift is the same for both. In either case the shape of the breast is remarkably improved and the neck and back pain improved. 

Case Highlights:

1) Implant-induced breast ptosis occurs when the initial breast implant augmentation was done in breasts that really needed a lift initially

2) Secondary breast lifting with implant replacement can be done when the patient is more willing to accept the breast lift scars.

3) How much the implant volume should be reduced  depends on how much smaller the patient wants their overall breast size.

Dr. Barry Eppley

Indianapolis, Indiana

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