Ptosis of the Breast: When Do You Need a Lift?

Ptosis is the medical term for anytime a body part is sagging or drooping out of place. You can have ptosis of the eyelids, but here we are going to be discussing ptosis of the breasts. Some women with full breasts that have sagged due to age or breastfeeding, need only a mastopexy, or breast lift. Other women may want a breast lift combined with breast augmentation to give them the full, upright breasts they desire.

There are varying degrees of breast ptosis and there are also different breast lift techniques that can be used depending on how extensive the drooping is. Some women may need a very limited breast lift for correction, while others may need a full mastopexy. We are going to discuss the most commonly described breast ptotic grades to help you determine what your needs may be, but remember, only a qualified medical professional can truly determine your needs after he or she examines you. Some procedures produce less scarring than others, but they are generally best when only a minimal lift is needed. Although you may qualify for a technique with less scarring, not all plastic surgeons may offer every method. You should consult with several surgeons so that you know all your options and are not forced to settle.

How to Tell Your Degree of Breast Ptosis

First, find a ruler. Now, take your shirt and bra off and find your inframammary crease. This is the fold line just under your breasts where your breasts meet your chest. Your inframammary crease may be higher under one breast than under the other. Now place the ruler in the crease, directly against the junction of the breast and ribcage. Let your breasts hang over the ruler and look at yourself in a mirror. The ruler shows you where your inframammary crease is.

grade 1 breast ptosis

If your nipple (not your areola) is slightly above or directly in front of the top of the ruler (your breast crease), you may have Grade 1 ptosis. Mild ptosis like this may need only a crescent lift. In this type of mastopexy, a crescent of tissue is removed from around the top of the areola and the nipple complex is pulled up a bit.

If the central point of your nipple (not your areola) is 1 to 3 cm below the top of your breast crease, you may have Grade 2 ptosis, which can be corrected using a periareolar lift. This surgical technique involves removing a donut-shaped piece of skin from around the areola (including some of the areolae itself if the areola is being reduced). The tissue of the breast is then drawn together as if it were a drawstring pouch. The periareolar lift is sometimes called a Benelli lift, a doughnut lift, or a circumareolar lift.

If the central point of your nipple (including your areola) is more than 3 cm below your breast crease, you may have Grade 3 ptosis. Often the best type of lift for this type of breast involves a vertical or keyhole mastopexy or anchor lift. This involves an incision (and subsequent scarring) from the inframammary crease to the nipple. Severely ptotic breasts will more than likely need an anchor mastopexy incision, where there is also an incision to the right and left under the breast, giving the whole incision the shape of an anchor.

breast pseudoptosis

Pseudoptosis is when the nipple is still above the inframammary crease, but the breast still appears droopy because of a large, flattened breast lobe. Usually women with pseudoptosis have smaller areola complexes that did not stretch during pregnancy or weight gain. Often, these women will need a vertical or anchor lift to reduce the amount of the lobe, however, some patients may need only augmentation to replace lost volume.

mild breast ptosis

Even if you do not have ptosis, you may still feel as though your breasts are too low on your chest wall or that your areolae have stretched out. My breasts sit low on my torso and my right areola is larger than the left. In fact, my right breast/and nipple sits a good inch and a quarter lower than the left. I am having an areolae reduction, which will reduce the size of the areolae, creating a minilift that will move my breasts higher on the chest and create the symmetry I was apparently not given after puberty.

low breast

Like I said, some women's breasts (like mine) actually sit relatively low on their chest. They have no ptosis, have good volume, and a proper inframammary crease, but their breasts are rather low on the torso.

saggy breast need mastopexy

Typical Patient Needing Breast Reduction with Lift
In this diagram, note the position of the nipple and areola complex and the low position of the breasts on the torso. This breast type would more than likely need a full anchor mastopexy incision.

sagging breast

Very Severe Ptosis Needing Significant Tissue Removal and Reconstruction
This breast type would need a full anchor mastopexy incision, which would result in a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola, and a scar around the areola itself. This type of breast may also benefit from the addition of breast implants.