Breast sagging or ptosis, can be caused by a number of factors. I always advice my patients who see me for any type of breast surgery, especially uplift and reduction surgeries, to consider the following when deciding whether or not it’s the right time for them to undergo surgery:

• Have I reached my ideal weight?
• If a smoker, can I stop smoking?
• Have I completed my family? or when would I want a child?

It is important to note that weight loss, pregnancy and particularly multiple pregnancies are the major factors in causing breast ptosis. Smoking can also cause ptosis as it promotes breakdown of elastin, the protein that keeps skin firm and elastic, resulting in gradual sagging of the breast.

Contrary to popular belief, breastfeeding itself has no effect on breast sagging it is actually the hormones associated with pregnancy and childbirth that cause breasts to grow and swell and these hormones remain active until about 6-9 months after breast feeding stops. Then the breasts shrink back to their pre-pregnancy size, resulting in sagginess.

Lack of exercise is another risk factor. Some degree of ptosis is normal and natural with ageing but women with a higher body mass index or a larger bra cup size are more likely to develop breast ptosis at some point in their lives. Breast ptosis is also influenced by genetics, which determines a woman’s skin elasticity, breast size, and the balance of adipose (fatty) and glandular tissue, the heavier the bust is the more likely it will sag with time.

Although the natural ageing process and its effects on the breasts cannot be prevented, there are a few ways to prevent breast ptosis or at least, the degree of it.

These include:

• Stop smoking altogether and avoid second hand smoke
• Exercise regularly and maintain a healthy diet
• Avoid weight fluctuations
• Always wear an extra high impact sports bra when exercising

Breast volume and size are important considerations when planning a breast uplift procedure, sometimes, when enough breast tissue is not present to achieve an aesthetically pleasing appearance, or you wish to have a full upper breast pole or to increase the volume of your breast as well as reshaping them, breast implants are used in conjunction with uplift.

Many times, patients know in advance whether they want to increase their breast volume, but this is something that I thoroughly discuss with all my patients regardless, as I want to ensure they understand the type of results they should expect with each option.

Having breast implants has its pros and cons, yes it will achieve a fuller upper pole, maybe even a better aesthetic results but at the same time the weight of the implants will result in your breasts sagging faster than they normally would and also there is a greater risk for a minor revision surgery due to the fact that the implants will stretch the newly tightened skin and put tension over the incision areas causing areola size and shape asymmetry and irregularity during the healing process, specially if the patients has poor skin elasticity to start with. Although this does not always occur, the risk is there, and the need of a minor revision surgery should be accepted by anyone considering breast uplift with implant surgery.

Unrealistic expectations will lead to disappointment, even if a surgery is extremely successful, so make sure you understand ALL aspects of the procedure and outcome before making a decision to proceed.

The severity of breast ptosis is determined by the level of the nipple areola in relation to the inframammary fold (the breast crease). Plastic surgeons use the Regnault Classification to determine the degree of ptosis:

• Type I is considered Mild ptosis – The nipple areola is situated at the level of the infra-mammary fold and above most of the lower breast tissue.
• Type II is considered Moderate ptosis – The nipple areola is located below the infra-mammary fold and some breast tissue hangs below the nipple.
• Type III is considered Severe ptosis – The nipple areola is situated below or well below the infra-mammary fold and at the level of maximum breast projection. Sometimes the nipple even points downwards.
• Pseudoptosis – Is not a true ptosis as the nipple areola sits either at or above the infra-mammary fold but the lower half of the breast sags below the fold. This is most often seen when a woman stops nursing.
• Parenchymal Maldistribution – This involves a lack of fullness in the lower portion of the breast, a high infra-mammary fold and a relatively short distance from the fold to the nipple areola. This condition is usually a developmental deformity and is also known as tuberous breast.

Although breast uplift surgery results are usually good and patient satisfaction rate is high, scarring is unfortunately unavoidable. In most cases, scars heal and fade into fine lines within 1-2 years after surgery. But sometimes, this is not the case and you may develop keloid (raised and dark) or hypertrophic (wide) scarring. If your body has a tendency to develop such scarring, then it is inevitable regardless of how skilled your surgeon is or what aftercare measures are in place to reduce the risk of scarring. Some skin types are more prone to developing these types of scarring than others, and this can be assessed during your consultation, especially if you have had any previous surgery.

The type and extent of incisions created for breast uplift surgery depend on the degree of ptosis the patient suffers from. Here is a list of common incision patterns:

Peri Areolar Incision – this involves a half circle incision on the upper half of the nipple areola. It produces the shortest possible scar and is well hidden within the nipple areola. This option is suitable for women with minor degree of ptosis requiring minimal elevation of the nipple areola.

Circum-areolar, Donut or “Benelli” Incision– this type of incision runs around the full length of the nipple areola and is best suited to correct mild to moderate ptosis where the nipple areola requires minimal lift. This incision type is also used to reduce the size of the areola in Areola reduction and Tubular breast correction surgeries.

Keyhole or Lollipop incision – the lollipop/keyhole incision is made around the areola and then down to the infra mammary fold. This type of incision is suitable for patients with moderate to severe ptosis but who do not have too much excess skin horizontally.

Inverted T or Anchor Incision – the incision is made around the areola, down towards the inframammary fold and then continuing horizontally along the fold. The anchor or inverted T incision is recommended for patients with significant ptosis and a big breast size or significant excess skin.

Recovery after Breast Uplift is very individual and depends on the extent of the surgery and type of incision used. Many can return to work and resume their normal daily routine within 10-14 days post-op. However, strenuous activities, exercising, and heavy lifting should not be resumed until 6-8 weeks post-op, after you have the all clear from your surgeon.

In terms of outcome, it takes time for the breasts to settle into their final shape and position. The tissue needs time to recover and settle after surgery, your body needs time to heal but week by week you’ll start noticing positive changes, and the final result will become obvious in six to twelve months. If you do not have any problems with scarring, your incisions should fade into fine lines after one year.

Although both breasts will have same level and shape of nipple areola straight after surgery, healing process and the skin’s elasticity, will determine how the breasts heal. It is important to note that in some cases, minor revision procedure may be necessary within 9-12 months of initial surgery for optimum results.

Depending on what stage in your life you have the breast uplift surgery, further surgery may be needed at some point in the future, especially if you have breast uplift before completing your family. Breast shape can and most likely will change with pregnancy or significant weight fluctuations.

Here are tips that may help you maintain the results for longer:

• Wear a bra that gives your breasts adequate support, especially if you have implants.
• Wear extra high impact sports bra when exercising.
• Plan to have surgery after you complete your family
• Reach your ideal weight before undergoing surgery
• Stop Smoking, exercise and try to maintain a healthy diet.

To conclude, we asked Mr Allen Rezai to provide a list of what he believes to be the most important considerations to be taken into account when contemplating Breast Uplift Surgery and choosing a surgeon. The following was his reply in the form of a simple but comprehensive check-list:

For more information about Breast Uplift / Breast Lift Surgery, with or without breast implant or any other type of surgery, please call on +44 20 7580 8001.

RealSelf Patient Reviews of Allen Rezai, MD