Overview of Breast Ptosis
Breast sagging, or “breast ptosis” as it’s called in medical terms, can happen to anyone, regardless of their age or size of their breasts. It typically happens due to aging, larger breast size, weight loss, pregnancy, and hormonal changes. This condition changes the physical appearance and can greatly affect a person’s emotional health.
Here’s how it usually occurs: the skin around the breast starts to stretch and loosen. This also happens within the ductal structures and supporting ligaments of the breasts. Then, the volume of the breast tissue increases, which makes the supporting structures unable to do their job and causes extra skin. Breast sagging can also happen when the volume of breast tissue decreases, for example after substantial weight loss, and there’s more skin left compared to the amount of tissue.
Doctors classify the severity of breast sagging based on how much the lower part of the breast has dropped. Depending on the severity, there are different techniques that can correct this. Treatment of breast sagging involves clinical evaluation, surgical expertise, and open communication with the patient. All these factors help to reach the desired look and improve the overall quality of life for those who seek treatment.
Anatomy and Physiology of Breast Ptosis
The nipple and areola, the dark-colored area surrounding the nipple, get their blood supply from several arteries. The most important of these is the internal mammary artery, especially its second, third, and fourth branches. Other arteries that supply blood to the area on the upper outer side of the breast and the nipple are the lateral thoracic and thoracoacromial arteries. The inner sides of the breast get their blood from the intercostal arteries.
The droopiness of the breast, or “ptosis,” is classified using the Regnault system. This system grades ptosis based on where the nipple is in relation to the crease under the breast, also known as the inframammary fold (IMF):
- Grade 1: Mild ptosis — The nipple is at the same level as the crease.
- Grade 2: Moderate ptosis — The nipple is below the crease, but isn’t the lowest part of the breast.
- Grade 3: Severe ptosis — The nipple is below the crease and is the lowest part of the breast.
There’s also something called “pseudoptosis,” which describes when the nipple is at the same level as the crease under the breast or above it, but most of the breast is well below the crease. In these cases, the distance from the nipple to the crease is often more than 6 cm.
Why do People Need Breast Ptosis
Breast ptosis, or sagging breasts, can be corrected through several surgical procedures. The chosen procedure will depend on how severe the sagging is and whether the patient wants to improve the shape and/or size of their breasts. The main goals of these surgeries are to create an attractive breast shape, properly place the nipple, make both breasts similar in appearance, fullness in the upper part of the breasts, and tighten any loose skin.
Each surgical method has its pros and cons, including varying amounts of scarring which can be a common reason for complaints. To reduce the chance of patient dissatisfaction and potential legal issues, it’s important for doctors to clearly communicate with patients about their expectations, build trust, and make sure patients thoroughly understand and agree with the planned surgery.
When a Person Should Avoid Breast Ptosis
Breast lift surgery, while helpful for many people looking to improve their appearance or comfort, isn’t right for everyone. Some situations need careful thought before going ahead with the surgery. If you have breast cancer that hasn’t been treated, cosmetic breast surgery isn’t a good idea.
People with illnesses that aren’t under control such as diabetes, heart diseases, immune system problems, or blood clotting issues could have a higher chance of complications from surgery and taking longer to heal; in these cases, surgery might not be the best option. If you’re currently dealing with an infection or you’ve experienced problems with the healing of wounds in the past, this could increase the chances of problems after the surgery.
Women who are pregnant or breastfeeding should wait before having the breast lift surgery, as the hormonal changes during these times can impact the results of the surgery. People who smoke, those who expect unrealistic results from the surgery, or those who might not be able to follow the care instructions after the surgery might not be the right fit for this procedure.
Having a detailed check-up by a professional surgeon is crucial to ensure that patients are properly checked and given the necessary information about whether they are suitable for this intricate surgery.
Equipment used for Breast Ptosis
To perform safe and effective breast or plastic surgeries, certain specific tools are necessary. These include instruments like the Tebbetts Retractors, which are types of retractors used for better visibility during the surgery. Some retractors even have fiber-optic lights to make the operating area clearer for the surgeon.
Another important tool is a suction device, which is used to maintain a clean work area by removing excess fluids from the surgical site. The electrocautery units are also vital, as they help to control and stop any unwanted bleeding during the operation.
If the surgery involves breast augmentation (increasing breast size), breast implants would be required. Lastly, appropriate suture materials, which are threads used to stitch up wounds, are necessary for closing the surgery site and ensuring the best possible result.
Who is needed to perform Breast Ptosis?
Having surgery to lift up sagging breasts usually involves a team of professionals. This includes a specialist plastic surgeon qualified to carry out breast operations, and an assistant. A doctor known as an anesthesiologist will also be there to make sure you are safely asleep during the operation, and to keep a close eye on your important body functions like heart rate and breathing. You’ll also have a couple of trained nurses present.
There are two types of nurses. The first is a circulating nurse. They help by getting what the surgeon and anesthesiologist need during surgery and by ensuring that all the medical instruments are where they should be. The second type of nurse is a scrub nurse. This nurse has a very important job. They assist the surgeon and make sure everything in the operating room stays sterile, which is a fancy word for extremely clean. This is crucial because it prevents any germs from causing infections during surgery. Having this team of professionals around you during the surgery contributes to a successful operation.
Preparing for Breast Ptosis
Before undergoing any breast surgery, a comprehensive check-up is necessary to understand the patient’s health, surgical history, and the specific characteristics of their breasts. This helps the patient and their doctor choose the best surgery options. Sometimes the patient might not be aware of any differences in their breasts or any irregularities in their chest. Taking ‘before’ and ‘after’ photos can help the patients understand these better and also provides a record of how the surgery changes their appearance.
The doctor will ask about the patient’s overall health, smoking habits, medications, previous surgeries, and any other relevant details. Patients will also be asked about any changes in their breast size during pregnancy or due to weight fluctuations, any family history of breast disease, recent mammograms, and plans for breastfeeding in the future. The decision to have a screening mammogram – a type of breast exam – would depend on national guidelines and the patient’s risk for breast cancer. If the patient has previously had complications from breast implants, the doctor might use additional tests like an ultrasound or an MRI. Any past breast surgeries can affect the blood supply to the breast and nipple; therefore, getting as much information on these, including notes from previous surgeries, can help plan the current surgery better.
During the physical check-up, the doctor would examine the quality of the skin and tissues of the breasts and measure various distances, such as between the breasts and nearby landmarks. This helps to objectively identify any differences between the two breasts and to compare how these measurements change after surgery. The doctor would also measure specific distances on the breasts; these measurements help the doctor understand the impact of different surgical techniques on the shape of the breasts.
It’s also important for the doctor to understand if the patient’s breasts are naturally lower compared to the collarbone and arm bone. This is because these ‘low-breasted’ patients might be mistakenly thought of as having droopy breasts. For such patients, it might be better to enhance the upper portion of the breasts rather than lifting the breasts. This can be done through breast enlargement surgery or by transferring fat from another part of the body to the breasts.
How is Breast Ptosis performed
Mastopexy, or a breast lift, is a surgical procedure for women who want to improve the shape of their breasts and achieve a more youthful and lifted appearance. It’s not recommended for those who smoke or want to increase their breast size. There are various types of breast lifts, and the best one for you depends on the amount of droopiness of your breasts and the quality of your breast tissue.
The periareolar mastopexy is suitable for women with minor to moderate sagging or uneven nipples and minimal excess skin under the breast who have decent skin and breast tissue quality. This method primarily shifts the nipple position, up to about one inch. Traditional mastopexy removes some skin around the nipple to lift the breast tissue. Although the scar is disguised at the edge of the areola, some women are not satisfied with the final shape of the breasts and may require additional procedures. The Benelli periareolar mastopexy has become more popular because it reshapes the breast tissue to support the breast.
Vertical mastopexy can be used for any degree of sagging but may slightly reduce the breast size. The SPAIR mammaplasty and Hall-Findlay mastopexy are two advanced methods. The SPAIR method lifts the nipple and trims unnecessary breast tissue to elevate it. Extra skin at the lower part of the breast is then removed. A drawback is that it might lead to altered nipple sensation and widening of the areola. The Hall-Findlay method trims and reshapes the breast tissue differently. The incision made will lift upward as the breast heals, so it must be made above the crease under the breast to avoid scarring on the stomach. Both techniques require several months for the final shape to be apparent as the tissue settles and the lower part of the breast regains its fullness.
The inverted-T mastopexy is used for severe sagging or when the quality of the breast tissue or skin isn’t that great. It involves additional scarring along the crease under the breast. A common method used is the Wise Pattern, which effectively lifts the breast. Less scar-inducing methods are available depending on individual needs. Despite the resulting scars, this method is widely used due to its predictable results.
Breast augmentation/mastopexy combines breast lift with augmentation, increasing the size of the breasts. If you are considering this type of surgery, your surgeon can help you understand the details and risks involved.
Possible Complications of Breast Ptosis
After getting surgery to either lift (mastopexy) or enlarge (augmentation) the breasts, or a combination of both, a small number of patients (1.15% for mastopexy, 1.40% for augmentation, and 1.86% for combined surgery) may experience serious complications. These complications commonly include blood clots known as hematomas and infections (1% and 0.25% risk respectively). Minor hematomas can simply be monitored, but larger, growing hematomas need emergency treatment to remove the clot, stop the bleeding, and close the wound. Factors increasing the risk of infection and hematoma include being overweight (with a body mass index over 30) and being over 60 years old.
Less serious complications that might occur after a mastopexy alone include sutures (stitches) coming undone or ‘spitting’, the surgical site sinking or ‘bottoming out’, and excess scarring. ‘Bottoming out’ refers to when the breast implant drops too low, causing the breasts to appear uneven. Different types of surgery may have a higher risk of certain complications – sutures spitting is more common in the ‘SPAIR’ technique, bottoming out is more likely in ‘inferior pedicle-based’ and ‘inverted-T’ mastopexies, and excess scarring is more frequent in ‘periareolar’ mastopexies. Other possible complications could include changes to the nipple and problems relating to the implant, such as implant misplacement and asymmetry, capsular contracture (hardening of tissue around the implant), and visible wrinkles in the skin over the implant.
If additional surgery is needed to address these complications, it usually waits until the breast tissue has fully adapted to its new shape and size, typically 6 to 12 months after the initial operation. A survey of plastic surgeons showed the ‘inverted-T’ mastopexy to be their most popular technique, though vertical mastopexy techniques were becoming more popular and had high satisfaction rates. In contrast, the periareolar mastopexy had lower satisfaction rates and a higher need for additional surgery (50% compared to 21% for ‘inverted-T’ and 29.9% for ‘vertical’ mastopexy). The most common reasons for needing a secondary operation were recurrence of sagging (ptosis), bottoming out, excess scarring, and misplacement of the implant.
What Else Should I Know About Breast Ptosis?
Breast sagging, also known as breast ptosis, can be influenced by many factors. To make sure each patient gets the best possible care, doctors need to understand these factors so they can tailor the treatment to each person’s specific needs. This not only ensures a successful procedure but also increases satisfaction for both the patient and the doctor.
There are different methods a doctor may use to correct breast sagging:
1. Periareolar mastopexy: This is a surgical technique used for mild to moderate sagging, when there is little excess skin at the bottom of the breast. It’s a good option if the quality of your breast and skin tissue is still reasonably good.
2. Vertical mastopexy: This method can be used for any degree of sagging. It often involves removing small amounts of breast tissue and re-positioning the skin surrounding the breast. This technique can also slightly reduce breast size.
3. Inverted-T mastopexy: This is a more extensive procedure used for severe sagging, usually when there is too much skin compared to breast tissue, or the breast tissue is fatty or the skin quality is poor.
Sometimes, if the sagging and loss of volume in the breasts are significant, a combined treatment may be necessary. This could involve augmentation (using implants to increase breast size) along with mastopexy (a lift to correct sagging). This combination is only recommended when the conditions are severe enough that neither procedure would be enough on its own.
