The breast that has a moderate to a significant amount of sag is commonly seen by plastic surgeons. Often such a patient is seen who is seeking breast augmentation. It is commonly perceived, although largely erroneous, that a breast implant will lift a sagging breast. Despite the wonders that an implant can do to reshape and rejuvenate a breast, it does not have the ability to move a nipple or the breast mound higher up on the chest wall.
Breast sagging, also known in plastic surgery terms as ptosis, is defined by where the nipple sits in relation to where the lower breast fold (inframammary crease) is. There is a ptosis classification system with four types which precisely defines the nipple-fold relationship. From a patient’s perspective however, what matters is at what point will an implant alone not work well and I have to consider some form of a breast lift? The simplistic answer is when your nipple is at or just below the level of the fold. At this nipple position on the mound, a breast implant alone is not going to lift the breast. While it will make the breast much fuller and give the mound a nice shape, the nipple will still be located on the lower pole of the breast pointing downward.
Many wonder about the use of no implant and a breast lift alone in the sagging breast. While a lift will move the nipple up higher and provide breast reshaping, it will not in most cases make the breast look bigger. This is another erroneous perception. In fact, in some patients it may even make the breast look smaller due to less of a breast skin sleeve.
The consideration of the need for a breast lift with an implant is often a painful discovery when one is seeking breast augmentation. Scars on the breast create a new cosmetic deformity that must be balanced against the sagging that it is replacing. For some, that trade-off is an easy one. For others, it is a more difficult decision. Often times, a breast augmentation simply can not be satisfactorily done without a concomitant breast lift.
Combined breast augmentation and breast lifts can be done several ways. The degree of lift that can or should be done is controlled by the amount of scarring that a patient can tolerate. The scar burden must be balanced against how severe the sagging is. The use of a breast implant definitely helps a sagging breast and often may lessen the degree of breast lift that may be needed. Larger breast implants help fill out loose skin but will still not lift the nipple any appreciable amount. The stark reality about breast lifts is that the more scar that is created, the greater amount the nipple is lifted upwards,
With a breast augmentation some patients may find that some sagging is more acceptable than any type of breast scar. For others, the scars are more acceptable and the desire to improve the sagging supercedes any scar concerns. Looking at photographs of both fresh and mature breast lift scars can really help a patient better appreciate what degree of scarring that is involved.
Dr. Barry Eppley
Indianapolis, Indiana