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Breast Ptosis: How & Why Breasts Sag

Ptosis: medical terminology used to describe the drooping or falling of the breasts.

It is natural for breasts to change shape and volume, which may lead to varying degrees of breast ptosis, or sagging. Breast shape, volume, and degree of breast ptosis is based on your individual genetics, pregnancy, nursing, weight fluctuation, or simply the natural aging process. Some girls will develop with breasts that naturally sag and have downward pointing nipples. Other women may develop breasts that begin to sag overtime. The support structure of the breast can lose tone and elasticity overtime, but this process may also be accelerated by events such as pregnancy or weight gain/loss. The breast ligaments and skin will stretch to accommodate body changes, and breasts begin to sag when these tissues do not have enough elasticity to regain their shape.

A breast lift, or mastopexy, can restore nipple position and breast volume to a more flattering and more comfortable position on the chest by removing excess skin and lifting and tightening the breast tissue. Breast lift surgery is performed under general anesthesia.

Dr. Spiegel will help determine the best technique for you during your consultation. She will develop an individualized plan to achieve the best results, considering your goals, the size and shape of your breasts, the size of your areolas, and the degree of ptosis present.

Incision Options

There are several variations to the design of the incisions for breast lift surgery.

  • The periareolar incision (also known as a “donut” incision) is made around the perimeter of the areola.
    • This technique is best for patients with mild to moderate sagging.
  • The “lollipop” incision (also known as a “keyhole” incision) is made around the perimeter of the areola and vertically down to where the breast meets the chest wall.
    • This technique is used for breasts with a moderate degree of sagging when the periareolar technique is insufficient for the degree of correction needed.

Once the incision is made, excess breast skin is removed and the remaining skin and fat are reworked and shifted to a higher position, along with the nipple-areola complex.

Once the breasts have been reshaped, the incisions are closed. The areola size can also be reduced during this procedure, if desired.

Dr. Spiegel may recommend combining your breast lift surgery with an augmentation or reduction procedure, if a lift alone would be insufficient to achieve your goals.


You may be a candidate for breast lift surgery if:
  • You are unsatisfied with the position of your nipples or fullness of your breasts
  • You desire “perkier” breasts
  • You have realistic expectations about the outcome of your procedure and are in good general health.
Things to Consider
  • If you plan to have children, it is ideal to have breast lift surgery after you have had children and have completed breast feeding. Pregnancy and breast feeding can affect the volume and shape of your breasts.
  • It is also best to have achieved your ideal goal weight and have maintained this weight for at least two months, prior to having surgery. Weight fluctuations affect the volume and shape of the breasts.
  • For an optimal outcome, it is best to have stability in breast shape and volume before operating.


Benefits of a Breast Lift
  • Restored nipple position and breast volume to a more flattering and more comfortable position on the chest
  • Enhanced confidence and self-image
  • Improved fit of clothing

While complications from a breast lift are infrequent, they are possible. These risks can include reactions to anesthesia, changes in skin or nipple sensation, infection, and unfavorable scarring.


As with any surgery, some swelling, bruising, and soreness are to be expected at first. You will be administered pain medication to help control any post-op discomfort. This tenderness and swelling should begin to subside after a few days. Most of the swelling should begin to resolve after a few weeks and the new shape and position of your breasts will be visible.

Most patients can return to work within a week depending on the nature of their job, but strenuous activities should be avoided for at least a few weeks. Scars may remain red or pink for a few months but will eventually fade to be less noticeable.


The results of your breast lift surgery will be long lasting, as long as you maintain a stable weight. A breast lift cannot stop the natural aging process, but a healthy lifestyle will help you maintain your results.

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