What Causes Saggy Breasts?

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What causes ptotic (saggy) breasts?

Although breasts can be ptotic or saggy due to large size, breast ptosis usually occurs due to a combination of two things: loss of breast volume and compromise of the skin brassiere, basically the skin overlying the breasts. Loss of breast volume can occur after weight loss. Compromise of the skin bra basically means a decrease in skin elasticity. Aging comes with a decrease in skin elasticity.

Additionally, since the breasts are made up of fat, weight fluctuation can decrease elasticity due to the cycle of stretching and then shrinking. It can also occur after breastfeeding due to the expansion or engorgement and then subsequent letting of breast milk. The constant expansion and contraction of the breast skin wreaks havoc on the elastic fibers of the skin. Think of a rubber band that has been stretched for a long period of time or is stretched frequently. Eventually it loses its spring. The same can occur with the skin of the breasts, leading to sagging.

What are the components of the breast?

Breasts are primarily made up of fat. There are also supporting structures to the breasts. The skin of the breasts, as well as attachments called Cooper’s ligaments, are the supporting structures to the breasts. Cooper’s ligaments are tissue fibers that run from the layer of fascia covering the breasts to the skin overlying the breasts.

They act as a type of scaffolding. Just as with the skin, these ligaments can lose their elasticity and become attenuated, contributing to sagging of the breasts.

Are there different levels or degrees of breast ptosis?

Yes. First off, the breast landmarks need to be delineated. The two structures that determine just how much sag the breasts have are the nipple-areolar complex and breast crease, also known as the inframammary fold.

Specifically, the location of the nipple-areolar complex in relation to the breast crease as well as where the bulk of the breast tissue lies determines the grade of breast ptosis. There are different systems for grading breast ptosis, but one of the simplest is outlined below.

  • First-degree ptosis: With first degree ptosis, the nipple-areolar complex is located at or only barely above the breast crease. Additionally, the nipple-areola complex is positioned above the lower half of the breast.
  • Second-degree ptosis: In second-degree ptosis, the nipple-areolar complex has descended below the inframammary fold, but the nipple is still facing forward on the breast.
  • Third-degree ptosis: Third-degree ptosis is defined by having the nipple-areolar complex descend below the inframammary fold and the nipple is facing the floor.
  • Additionally, there is also pseudoptosis. This is defined as when the nipple-areola complex is above the inframammary fold, but the breast tissue lies beneath the inframammary fold.
    What can be done to fix breast ptosis?

    A breast lift, also known as a mastopexy, is a surgical procedure that aims to reverse the normal progression of breast ptosis. The goal is to give the breast a more uplifted, perky, and youthful appearance. The procedure repositions the nipple-areolar complex to a higher position. It also repositions the majority of the breast tissue above the breast crease. This is done by removing excess skin to tighten the skin brassiere and suspending the breast tissue internally.

    Are the results of a mastopexy permanent?

    Unfortunately, the results of a mastopexy are not permanent. Upon completion of the procedure, aging and gravity take effect and will cause the eventual of recurrence of ptosis.

    Are there any drawbacks to having a mastopexy?
    • Scars on the breast are inevitable.
    • The effects of the mastopexy procedure are temporary.
    • There may be a loss of skin or nipple sensation.
    • The breast will appear smaller in size because it is more compact after skin removal.

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