Ptosis (breasts)
Breast sagging is natural aging, not caused by breastfeeding.
Ptosis, or sagging of the female breast, is a natural consequence of aging influenced by factors such as cigarette smoking, number of pregnancies, higher body mass index, larger bra cup size, and significant weight change. Post-menopausal women or those with collagen deficiencies may experience increased ptosis due to loss of skin elasticity. Contrary to common belief, breastfeeding does not increase sagging, and wearing a bra has not been found to prevent it.
Quick Facts
- Field
- Plastic surgery
- Treatment
- Mastopexy
Facts from the source article.
Signs and symptoms
Breasts change in size, volume, and position throughout life. In young women with large breasts, sagging may occur early due to gravity, often from a disproportion between breast volume and body size. During pregnancy, estrogen and progesterone stimulate development of the milk-secreting glands. Multiple pregnancies repeatedly stretch the skin envelope during engorgement while lactating, and breast size changes as mammary glands engorge with milk and as weight fluctuates. When milk production stops, the glands diminish but still add some bulk. Weight gain during pregnancy and breastfeeding are not significant risk factors for ptosis. In middle-aged women, ptosis results from a combination of factors: postpartum hormonal changes cause depleted milk glands to atrophy, and breast tissue and suspensory ligaments may stretch if the woman is overweight or experiences weight changes. The breast then prolapses forward; when standing, the inferior skin folds over the infra-mammary fold and lies against the chest wall. The nipple-areola complex moves lower relative to the inframammary crease, and the nipple may point downward. In post-menopausal women, breast atrophy is aggravated by inelastic, aged skin due to reduced estrogen, which decreases breast size and fullness and is essential for maintaining collagen. Plastic surgeons grade ptosis using a scale: Grade I (mild) has the nipple at the infra-mammary fold and above most lower breast tissue; Grade II (moderate) has the nipple below the fold but higher than most hanging breast tissue.
Causes
Research involving 132 women seeking breast augmentation or lifts identified several key factors for ptosis. A history of cigarette smoking breaks down elastin, a protein that gives skin its elastic appearance and supports the breast. The number of pregnancies was strongly correlated with ptosis, with effects increasing per pregnancy. As women age, breasts naturally yield to gravity and tend to sag over the inframammary crease, especially in larger-breasted women. Significant weight gain or loss of more than 50 pounds was another factor, along with higher body mass index and larger bra cup size. Many women mistakenly attribute breast changes after pregnancy to breastfeeding, but research shows breastfeeding does not adversely affect breast appearance. Weight gain during pregnancy and lack of regular upper body exercise were also discounted as causes.
Mechanism
Breasts contain no muscle; they are composed of mammary glands, milk ducts, adipose tissue, and Cooper's ligaments. Mammary glands remain relatively constant throughout life, while fat tissue volume normally varies. The amount and distribution of fat tissue, and to a lesser extent mammary tissue, cause variations in breast size, shape, and volume. Some experts believe Cooper's ligaments provide structural support, but there is no agreement on whether they support the breast or simply divide tissue into compartments.
Treatment
Because breasts contain no muscle, exercise cannot improve their shape. Many women mistakenly believe breasts cannot support themselves and that wearing a bra prevents sagging, but no evidence supports that bras slow ptosis; bra manufacturers state bras only affect shape while worn. Some evidence suggests bra use may reduce development of Cooper's ligaments, potentially leading to more sag over time, similar to limb connective tissue weakening in a cast. Studies have documented that after an initial adjustment period, women who forgo bras experience increased comfort and breast firmness. Some women choose plastic surgery for ptosis. Mastopexy is a procedure that surgically elevates breast mass, cuts and resizes the skin envelope, and transposes the nipple-areola complex higher. Women may also choose breast implants or both procedures. If sagging is present and mastopexy is not performed, implants are typically placed above the muscle to fill out the breast skin and tissue; submuscular placement can result in deformity where the implant appears high while natural tissue hangs over it.
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