There are a number of reasons for breasts to sag. It can occur following pregnancy, with or without breastfeeding. It can be due to the ageing process, obesity, or menopause. Gravity always plays a role in the development of sagging. Some women’s breasts will simply develop that way at a very young age.
If you look at your breasts and have to ask yourself whether or not you require a lift, there is a good chance that you do not need one. It seems that most women who to need a breast lift are aware that it is necessary before they come to the doctor’s office. When I examine a breast it is sometimes very clear that a lift is not necessary, and sometimes clear that a lift is necessary. In a few instances, particularly when an implant is being used, it is difficult to determine whether or not a lift will be needed. In these instances the benefits and potential risks have to be weighed carefully against one another.
In general, if the nipple sits below the inframammary fold and a there is a significant portion of glandular tissue that lies below the fold, then a lift will be required. If the nipples are pointing downward, or there is no normal breast skin visible between the bottom of the areola and the lower contour of the breast, then a lift is needed. Sometimes lift techniques are used simply to reduce the size of the areola.
It is important to determine what the patient’s goals are with regard to a breast lift? Improved shape with increased volume. Improved shape with the same volume. Improved shape with decreased volume.
The patient should also be prepared to answer the following questions:
- Does the degree of lift justify the scar?
- Does the placement of an implant to fill the upper pole justify its risk?
- What is the desired size of the breast?
- What is the desired shape of the breast?
One condition in which I do not recommend a breast lift is the normal appearing breast that sits low on the chest wall. I do not to believe that I can predictably and consistently reproduce the breast higher on the chest wall for the long-term.
Also, I will not perform a breast lift in a smoker who is unable to quit before and after surgery. Also one will not be allowed to use nicotine containing smoking cessation devices, because it is the nicotine, not the smoke, which is harmful. If you are unable to stop smoking for two weeks before and two weeks after surgery, then it may not be in your best interest to seek a mastopexy. If you need help quitting smoking, you should contact your primary care physician.