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20th, March
” Do I have to have a breast lift if my breasts sag?”

” Do I have to have a breast lift if my breasts sag?” is the most common question we hear!   The answer is a little more complex than a simple yes or now and depends upon many factors!

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Keep reading because it’s about knowledge and arming with yourself with as much information as you can so that you can adjust your expectations of the outcome of your breast surgery to be realistic outcome due to the genes you were born with!

It is not about simply picking a size of implant off the rack that you want- you need the right procedure that gives you the best outcome so that you will be happy with the result. Sometimes could be a matter of adjusting your expectations.

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Breast ptosis, or sagging of the breasts is common in women with medium to large or huge breasts. Some women go through multiple pregnancies and breastfeeding with pert breasts that don’t have a degree of sagging needed for a lift and can have breast implants after children, whereas some teenage girls develop large breasts that need reduction and/or lift in their teenage years!

So it is mainly based upon your individual genetics and such factors commonly as a woman ages her breasts are likely to become more saggy, gains and looses weight,  pregnancy and breast-feeding.

There are  Normal – Grade 4 when grading the degree of ptosis or breast sagging, as well as other conditions or deformities that can be corrected with plastic surgery. There are varying degrees of breast ptosis and the degree of sagging can help you determine your cosmetic surgery options. We see a lot of ladies in our clinic that have Grade 2-3 breast ptosis who are unaware of this medical grading, hoping a breast augmentation with just an implant will “fill up their breasts”

 

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Unfortunately, if there is any degree of sagging before performing a breast augmentation, an implant alone will not magically “lift” or fill up their breasts and achieve a good result. In fact, we see lots of women for breast revision surgery that have had just implants achieving a very poor result they are unhappy with.

Then breast revision surgery needs to be performed including a breast lift with new implants, sometimes with the removal of capsular contracture at an additional costs.. Breast revision surgery performed by another surgeon is priced at 30% more in addition to the other costs of surgery.

We have a lot of women we see in our clinic that have varying degrees of breast ptosis however do not want to have a breast lift and implant as they are concerned about the scarring.

If you are concerned about saggy, drooping breasts, the first step is to determine the degree of breast ptosis, and the precise nature of the problem so you are not shocked by the surgeons recommendations and have reasonable expectations.

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The good old ruler test will show you if you have any degree of breast ptosis before you seek the opinion of a Plastic Surgeon so you have reasonable expectations.

Here’s how:

  • Find a ruler.
  • Take your shirt and bra off and find your inframammary crease (fold line just under your breasts where they meet your chest).
  • Place the ruler in the crease, directly against the junction of the breast and ribcage.
  • Let your breasts hang over the ruler, and look at yourself in a mirror. The ruler marks your inframammary crease.

 

Grade 1 Mild Ptosis

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If your nipple is slightly above or directly in front of the top of the ruler, you may have Grade 1 Ptosis which is considered mild.

This case a women is still a candidate for a breast augmentation.

Depending on her individual case and factors such as the size and symmetry of her breasts and the opinion of the surgeon she has the option of using round implants with varying profiles to achieve the best results or CPG implants (teardrop) is often recommended for women with mild sagging.

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Grade 2 : Mild- Moderate Ptosis

Grade 2 to is identified as the placement of the nipples to the breast crease. If the central point of your nipple is 1 to 3 cm below the top of your breast crease, you may have Grade 2 ptosis. This is considered mild to moderate ptosis

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For these cases a breast augmentation with internal lifting is recommended, especially if the patient is not willing to accept the scars from incisions from the traditional breast lift procedure.

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This procedure is performed with the incision in the same place as the breast augmentation, under the breast. The surgeon adjusts the position of the breast tissue and muscles and inserts an implant with volume to fill the empty breasts.

With this technique, the breasts will be fuller and firmer however there will still be some degree of sagging, unevenness and without being able to adjust the nipples they will remain in a low position.

 

Grade 3 Breast Ptosis- Severe sagging

Patients with Grade 3 as confirmed by a surgeon will require lift surgery, technically known as a Mastopexy correcting sagging breast tissue and low nipples back to their original position.

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A breast lift is usually performed with a breast augmentation, inserting implants to give the breasts a perfect shape and larger volume especially in the upper poles.

If the breasts are very large, a reduction/lift/implant may be performed to reconstruct the breasts by removing the excess breast tissue, placing nipples in proper position and inserting an implant to achieve perfect symmetry, shape and size.

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A breast lift is usually performed with a breast augmentation, inserting implants to give the breasts a perfect shape and larger volume especially in the upper poles.

If the breasts are very large, a reduction/lift/implant may be performed to reconstruct the breasts by removing the excess breast tissue, placing nipples in proper position and inserting an implant to achieve perfect symmetry, shape and size.

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Pseudo-ptosis 

Pseudo-ptosis is a condition which occurs when the nipple is in proper position however the breasts lack fullness.

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The breasts may appear full below the nipple but above the nipple are flat and appear to droop. In most cases because the nipple and areola are positioned correctly, a standard breast augmentation using round implants, even perhaps moderate to high profile will restore the fullness in the upper poles giving cleavage and restoring youthful appearance.

 

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Mild Ptosis , Asymmetry and Tuberous breasts

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Tuberous breasts

Tuberous breasts occur in many different degrees of severity and are caused by a tightness within the breast tissue which prevents the breasts from developing normally.

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This constriction can cause the breast to look deformed, preventing the development of the breast and can cause deformities of the nipple.

Surgery is available depending upon the severity including breast implants, a breast lift with implants or use of fat transfer.

 

Breast Asymmetry

Breast asymmetry is where the breasts are unequal in size and shape.

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While this is normal with nearly every woman has a slight degree of asymmetry with one nipple is slightly higher than the other or one breast is slightly larger than the other and so slight that the women hardly even notice.

When breast asymmetry is severe however, it can cause a great deal of psychological distress.  Imagine having one breast a B cup size while the other breast is a D cup size!  It makes it almost impossible to buy clothing or wear a swim suit.

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The surgical options are plentiful and determined by the individual needs of the patient. They can include a combination of breast reduction of one breast and an implant for the other. Implants are commonly used and sometimes fat transfer can be an option.

Low Breasts

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Your breasts may sit relatively low on your chest, with no sagging (ptosis) and be “long chested, low breasted.”

 

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A surgeon will explain if this is the case for you when he does a physical examination. Once you and your breast surgeon determine the extent (or if any ptosis), you can discuss which type of breast surgery will achieve the best results.

It could be a matter of adjusting your expectations to a more realistic outcome due to your genetics.

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