We are all of us stars, and we deserve to twinkle. – Marilyn Monroe
You know what pregnancy, nursing, weight fluctuation, aging and gravity can do to your body contour. They make your breasts sag prematurely, as you may be experiencing right now. With nipples pointing downward and little to no forward projection, your sagging breasts may be affecting your self-esteem and self-confidence. These are similar issues that many of my patients have expressed concern about.
Lift your sagging breasts
Large numbers of patients have come to me, wanting to do something about their sagging breasts. Each patient has unique concerns. However, all share the same unhappiness in their appearance. This dissatisfaction negatively impacts their overall state of mind.
A breast lift (also known as mastopexy) reshapes your breasts to make them fuller in the upper portion. This gives them a firmer and more buoyant appearance. You can have the procedure performed on your breasts whether they’re small or large. Size doesn't matter. (However, results may not last as long in women who have heavier breasts.)
A positive change in appearance, and mind
I’m always amazed to see the difference in my patients before and after surgery. The difference isn't only regarding their improved appearance after they’ve recovered from surgery, but also in their attitudes. My patients used to think that they could never have the perkier breasts they once had in their youth. They thought it was a lost cause before they came to see me. When they got a breast lift, though, my patients no longer thought that way. They were able to see a huge improvement in their breast contour. The improvement was so great that they often experienced a positive boost in their self-esteem. It’s wonderful to witness and one of the reasons why being a plastic surgeon is so rewarding for me!
Unique point: improving on YOUR natural breast shape
Breasts come in different shapes and sizes. Your breasts are naturally shaped in a way that complements your body, but the sagging hides this original shape.
I believe in enhancing the natural beauty of your breasts. I don't go so far that it looks like you have someone else’s chest on your body, though. During your consultation with me, I’ll make sure to examine your breasts and overall body shape. I do this to determine the right amount of lift to give you a proportionate result. Like my other patients, you’ll experience far more satisfying results this way.
If your breasts are very small or have lost volume, combining a breast lift with implants can be a good way to increase firmness and size. I may suggest this option, but it’s totally up to you about what you'd like to do. You may choose to have the lift alone, or to have a breast augmentation lift performed for the ultimate breast makeover. Remember, it’s your body and I’m here as your plastic surgeon to help you achieve your aesthetic goals!-->
You should know
Sometimes, patients express concern about breastfeeding after a breast lift. You should know that breast lifts do not interfere with your ability to breastfeed. However, if you do get pregnant after having a breast lift, your breasts may likely stretch again. This will impact your results.
It's not about making someone else happy. It's about making yourself happy! – Dr. Leila Kasrai
What happens during your surgery
You’ll be placed under general anesthesia.
Depending on how much of a lift you need and how much excess skin needs to be removed, I will make one of two types of incisions.
|The "Anchor"||The "Lollipop" (aka vertical or Lejour)|
|Incision||Goes around the edge of the areola, straight down into the bra crease and then along the bra crease.||Goes around the edge of the areola and down to the crease.|
|Who it's for||Saggier breasts that require a dramatic lift.||Moderately to severely sagging breasts.|
Regardless of which type of mastopexy incision is made for you, the surgery follows the same format: excess skin is removed and the nipple/areola is placed in a higher position.
If you're having breast implants done along with the lift, the implants will be placed through your incision. Your implants may be positioned directly under the breast tissue (subglandular) or partially under the muscle (submuscular), depending on your body type and the results you want.
What happens during your recovery
- an immediate improvement
- the majority of swelling and bruising take a few weeks to subside
- you’ll be back to work in a week or so
After surgery, you'll wake up wearing bandages over gauze dressings. I will prescribe pain medication to increase your comfort. You will likely experience some numbness in your nipples and breast skin. This is caused by swelling. As the swelling subsides, you should regain feeling. Most of the swelling is usually gone after about six weeks, but for some patients, it will take longer for the feeling to return. On rare occasions, the numbness can be permanent. Some patients also report being more sensitive after surgery.
I recommend that you take at least a week off after your procedure to stay home and rest. Doing so will speed up your healing rate and improve your results. For that first week, move your arms as little as possible and avoid driving. If you have small children, you'll need to ask someone to help you with day-to-day activities. Unfortunately, you won't be able to pick up your children for a couple of weeks.
After a few days, you'll be able to replace the bandages with a soft support bra over a layer of gauze. You'll need to wear the bra 24/7 for about three or four weeks. This bra provides support for your breasts and the incisions.
You should be able to get back to your regular activities in about 7-10 days. Avoid heavy lifting and vigorous exercise (especially upper body workouts) for about six weeks. Your stitches will be removed after about two weeks.
Causes and Grades of Sagging Breasts
Sagging breasts, or breast ptosis, is a common part of the aging process that is caused by a variety of factors.
The shape of your breasts goes through several changes over the course of your life. For the majority of women, one pivotal point occurs when you're about 19 or 20 years old, when the breasts reach a primary stage of maturity. However, several factors contribute to further changes in shape and size. Sagging is one of these unavoidable changes.
Some features of sagging breasts include the following:
- a flattened, “pancake” shape
- no fullness in the area above your nipples
- nipples that point downward
- stretched out areolae
- stretch marks
- wider cleavage
Causes of sagging breasts
One or more of these factors will cause your breasts to sag:
Aging is a huge contributor to breast ptosis. Aging breasts have:
- less fibrous tissue
- less and softer connective tissues
- drier skin
These all contribute to ptosis.
Gravity pulls everything down, and over time, your breasts surrender to the persistent downward force.
Dramatic weight loss and weight fluctuations
Weight loss of more than 50 pounds is considered dramatic. While the health benefits of being at a more suitable weight for your body are numerous, your breasts may not be as supportive of the weight loss. That’s because some of the fat that comes off may be in your breasts. Think of it this way: if you blow up a balloon to its largest size, then deflate it, you’ll notice that the balloon will no longer be the exact same shape or size as before it was inflated the first time. It will be slightly stretched out. The more times you inflate and deflate the balloon, the more different it will be.
The larger the breasts, the faster they’ll sag. All the other factors contributing to sagging are aggravated with larger breasts.
85% of women who have had at least one pregnancy experience adverse changes in their breast shape, according to an Annals of Plastic Surgery study that surveyed a group of patients considering breast augmentation or a breast lift. A woman’s breasts will naturally start producing milk while pregnant. This causes the breasts to increase in size, something that is helped along with the weight gain that many women experience during pregnancy. The skin and tissues stretch out to accommodate these changes.
Upon giving birth, and after the production of milk is stopped, the breasts decrease in size. However, the stretched out tissues may not be able to bounce back to their original, pre-pregnancy state, leaving the breasts saggy. Sagging worsens with every subsequent pregnancy.
You may believe that breast feeding causes sagging but it’s actually pregnancy in general. Breast feeding is not considered a factor in ptosis.
If you’re a smoker and have been for a while now, you may have saggier breasts and skin than a non-smoker. Several studies suggest smoking is a major factor in breast ptosis, including one in a 2008 edition of the Aesthetic Surgery Journal. The many toxins in cigarette smoke destroy dermal connective tissues, namely elastin and collagen. This leads to tissues that are no longer as elastic and a weakened support of the breast against the chest wall.
Grading Breast Ptosis
Back in 1976, the plastic surgeon Dr. Paule Regnault from Montreal published a grading system for breast sagging. Known as the Renault ptosis scale, this grading or classification system is still used today by plastic surgeons. It is a convenient way to determine how extensive a patient’s ptosis is and the most suitable treatment. Classification is based on a side view of the patient’s breasts, and the position of the nipple and areola in relation to the inframammary fold.
Grade 1: Mild sagging, in which the nipple is roughly at the same level as the inframammary fold with the majority of breast tissue below it.
Grade 2: Moderate sagging, in which the nipple is located below the fold and majority of breast tissue concentrated in the bottom of the breast.
Grade 3: Advanced or severe sagging, in which the nipple is far below the fold and points downward to the floor.
Pseudoptosis: This isn’t considered true ptosis because the nipple is still at the level of the fold, but the majority of breast tissue is located below it. If you have pseudoptosis, you can rest assured that your breasts aren’t actually sagging. That’s just their natural shape.
I have saggy breasts. Can I just get implants to make them perkier?
It is possible to skip the breast lift and only get breast augmentation with implants to correct sagging. However, this all depends on how saggy your breasts are. Mild to slightly moderate breast ptosis can be corrected with the right implant size and profile. The goal is to have something that wil create enough projection from the body for the appearance of perkier breasts.
Unfortunately, Grade 3 ptosis can only be effectively treated with a breast lift. You can choose to have implants placed to replace any lost volume from the lift.
Frequently asked questions about breast lifts
What is a breast lift?
Also known as mastopexy, a breast lift is designed to reshape the breasts to make them fuller in the upper pole, which is the area above the areolae and nipples. Doing this gives the breasts more projection forward and a perkier appearance.
Am I a good candidate?
If you are relatively healthy and are aware of the risks involved with mastopexy, then you may be a good candidate. Your breasts should be affected by ptosis (sagging), with a loss of fullness in the upper part of your chest. You'll speak with me during your initial consultation to find out if the procedure is right for you.
How much does a breast lift cost in Toronto, Ontario, Canada? How much is mastopexy?
The price of a breast lift is set by the surgeon. Generally, it ranges from $7000 to $9000 in Toronto. The more complex the procedure, the higher the cost. This price includes surgeon's fees, anesthesia, surgical facility, staff, pre- and post-operative appointments as well as compression garments, if they're necessary.
Is it painful?
After surgery, some amount of pain may be felt. This can be alleviated with prescibed pain medication. The level of pain you experience depends on your tolerance as well as the extent of your surgery. Generally speaking, it is well tolerated by my patients.
What techniques do you perform?
I perform two types of breast lift: the anchor and lollipop. The anchor involves an incision around your areola and down to the inframammary fold. Another short incision is placed horizontally within the fold. This allows for the correction of moderate to severe sagging. If you only have mild to moderate sagging, the lollipop may be sufficient. The incision for this technique involves an incision made around the areola then vertically down to the breast fold.
Where will my scars be?
The resulting scars from surgery are based on the location of your incisions, as determined by the technique applied. Regardless, they typically remain well covered by a bikini or bra. To reduce their appearance, make sure to follow your post-op instructions closely during your recovery and keep the area covered up from the sun.
Are my mastopexy results permanent?
Aging, gravity, pregnancy and weight fluctuations can all impact the shape and size of your breasts. While the results tend to be long lasting, they can be affected by these factors.
Do I need a breast lift or breast augmentation?
If your sagging is mild to moderate, an implant may be enough to give you the perkier look you want. I'll determine this during your initial consultation. Your nipple should be sitting above the inframammary fold and there should not be too much of your breast hanging over either. Severe sagging can only be effectively corrected with a breast lift. It is common for a lift and augmentation to be performed together in a single surgery.
Will my breast size be smaller after a lift?
Probably not. During your breast lift, only a very thin layer of tissue (epithelium) is removed. This would weigh no more than 20 grams, making very little diference to your cup size. However, because the surgery reshapes your breasts to make them look perkier, you may actually find that your breasts fill out your bra a little differently.
Can I get a lift if I'm still in the process of losing weight?
A breast lift can achieve significant improvements in your appearance and well-being, according to one study conducted on a group of women who had bariatric surgery. If you're still working on losing weight, I suggest you wait until after you've reached your ideal weight before getting mastopexy. You'll have longer lasting results this way, since additional weight loss can further change the shape of your breasts.
I've just had a baby. When can I get a breast lift?
You'll need to wait until your breasts stop producing milk and your body has stabilized after giving birth. This can take about six months or so.
I’ve performed breast lifts over a hundred times and complications are very, very rare. You should still be aware of post-operative complications in the rare event they do occur, though. They can include:
- Bleeding and infection, which can cause scars to widen
- Poor healing and scars (more common in smokers)
- Loss of feeling in nipples and breasts (which can be permanent in rare cases)
There is a higher risk of these complications if you smoke, are diabetic or have poor circulation. You can reduce your risks by following the instructions I’ve designed to help expedite your recovery.