INTRODUCTION

Saggy breasts are corrected, i.e. lifted and reshaped by a procedure called Mastopexy (raising of breasts, breast tightening, suspension, breast lifting).

The sagging breasts phenomenon is actually a gradual process of breast tissue sagging down the chest wall, accompanied by stretching of skin and visible lowering of nipples. This is called Breast Ptosis and it may occur both in large and small breasts. In time, this sagging lead to the change of not only their position, but also their shape and size. The upper half of the breast gradually becomes “empty”, i.e. flat or sunk, and the nipple is positioned low in the lower half of the breast. There are 3 main types of sagged breasts:

  1. ptosis with glandular hyperthrophy (large and sagged breasts)
  2. ptosis with glandular atrophy (small, “empty” and sagged breasts)
  3. ptosis with normal or slightly enlarged gland

Sagging of breasts is primarily a consequence of gravitational force, which pulls them down. To put is simple, the extent of saggy breasts depends on two main factors:

  1. the weight which pulls them down (this isn’t always associated with the size since small breasts can be relatively heavy, while large breasts can be relatively light)
  2. skin quality (its thickness, elasticity, stretching ability, etc.).

Additional factors which can significantly influence this dynamics are pregnancy and breastfeeding, as well as episodes of major weight gain or loss and of course biological skin aging processes. A significant factor is considered to be whether the woman has a habit of wearing a brassiere constantly or she doesn’t wear one at all.

After breastfeeding, the breasts can change their shape and size in different ways. Three options are possible:

  1. breasts become larger, but after breastfeeding they go back to the previous state
  2. breasts become larger and stay that way
  3. breasts become larger, and then smaller (“emptier”) and saggy after breastfeeding

PREPARATION

In addition to standard preoperative preparation, it is recommended to perform ultrasound breast examination or mammography. It is up to the physician to determine the sagginess degree, nipple position, possible asymmetries, how much is the skin stretched and its overall quality, possible stretch marks, size, shape and breast consistency, glandular and fatty tissue ration, shape and width of the chest and the appearance of the whole body frame.

The degree of breast sagginess can be determined in several different ways, and one of the main ones is the Georgiade system:

  • I ptosis degree (low)  – the nipple is in the level of inframammary fold, or just below
  • II ptosis degree (middle) – the nipple is up to 3cm below the fold
  • III ptosis degree (high) – the nipple is over 3cm below the fold

Also, the physician is obliged to explain to the patient the different variations of this procedure and to suggest the one which he considers the best for the patient and their condition:

  1. breast lift without additional reduction or augmentation – (the patient must be explained that there is a possibility for the breast to appear smaller after the procedure, although they weren’t reduced!)
  2. breast lift with simultaneous augmentation – (breasts which are saggy and “empty” sometimes require silicone implant augmentation in addition to lifting in order to have better appearance of the upper half of the breast)
  3. breast lift with simultaneous reduction – (large, saggy and heavy breasts, this is actually a surgery where breast reduction is the primary procedure)

OPERATION

It is performed with general anaesthesia and lasts 2-4 hours.

There are many surgical techniques, but the main ones are the following three:

  1. “Anchor” incision technique (reverse T), where the final scar will have three components: the circular section around the areola, the vertical section on the lower half of the breast of 5-8cm in length and the horizontal section in the inframammary fold of 5-10cm in length
  2. The so called Vertical technique, as well as Circumvertical, where the final scar will have only the first two components: the circular section around the areola and the vertical section on the lower half of the breast
  3. Periareolar technique, where the final scar will only be the circle around the areola

None of these techniques can, nor should be used for each individual case, it is up to the surgeon to assess each individual case and use the appropriate technique which will have the most optimal result. The primary consideration should be the quality and quantity of the breast tissue, both glandular and fatty, the quality and the condition of the skin, as well as the nipple position. During the operation, the excess of skin is removed, the breast tissue is repaired and the nipples are elevated to the desired position.

RECOVERY, COMPLICATIONS

The patient stays in the hospital for one day, sometimes two. It is recommended to wear a special brassiere for the next 4 weeks. The stitches are removed after 10-14 days. The pain and the tightening sensation are present for the first several days and they are regulated with analgesics. The breasts are more or less swollen, taut and hard, and bruising may occur. Sometimes, the appearance of the breast is unnatural at first, but in time it gets the desired shape. The skin around the incisions may be wrinkled (the so called “folds”), but they will get smoother in time. Physical activities, heavy lifting and sports are prohibited for a moth, sometimes longer. In some patients, the recovery is quicker, while in some it is slower, and this can’t always be predicted. Possible complications are: widening and thickening of scars, temporary loss of sensitivity, necrosis, asymmetry, infection, etc. Usually, the breastfeeding capabilities are preserved, but cannot be guaranteed.

The scars fate and soften gradually and can be considered aesthetically acceptable, but if necessary, they could be corrected later on for an even better result. It is important to explain to the patient that the result of the procedure is not life-long because the aging processes, as well as the gravitational force continue to influence breasts.