Breast ptosis is often aggravated by major weight loss and pregnancy, although the most common contributing factor is aging.  As women age, their tissue and skin becomes lax which often leads to low-lying breasts with nipples pointing downward; unfortunately, even an underwire bra with good support cannot correct this problem.

For women who have sagging breasts that lack in volume, they are an ideal candidate for breast lift surgery combined with breast implants.  In this approach, doctors often use the areola incision (sometimes combined with excision from the nipple down to the breast crease) in order to remove or tighten the loose skin tissue; the same incision site is also used in the implantation of the device.

By combining these two procedures, doctors can remove less amount of skin which means less risk of visible scarring.

However, the areola incision, sometimes referred to as donut lift, may not be enough to correct a more pronounced ptosis.  In this problem, most plastic surgeons will create another cut starting from the areola down to the crease, a technique which is also called as lollipop lift.

In order to achieve fullness particularly in the upper poles of the breasts, most doctors complement breast lift with round implants which have symmetrical shape.  When placed on top of a table, their contour is almost similar with an M&M candy.

In the hands of a skilled plastic surgeon, round implants do not result to an augmented, “fake” look which is just a common myth.  In fact, they can turn into a teardrop shape (just like anatomical implants) if they are being hold at one side because the gravity will pull the filling at the bottom.

To prevent the recurrence of breast ptosis, doctors often placed the round implant under the chest muscle rather than behind the tissue.  In this way, the top two-thirds of the device is covered by muscle and its lower one-third is supported by a thicker amount of connective tissue.

On the other hand, behind the tissue placement of the implants is not a good choice for women with ongoing breast ptosis since the weight of the device may further aggravate the problem.

Contrary to a popular belief, the recovery period in breast lift with implant surgery is almost the same with breast augmentation performed as a standalone procedure.

To treat this aesthetic problem, breast lift surgery is the most recommended solution as it provides a long-lasting result.  But still, it is important to note that the aging process may slightly affect the outcome of this procedure in the long run, although the breasts will not experience significant sagging.

Meanwhile, significant weight fluctuations and pregnancies may affect or even reverse the result of breast lift.  For this reason, most patients are advised to postpone this cosmetic procedure if they are 25 to 30 percent heavier than their ideal weight and if they are planning to have children in the future.

As with most cosmetic breast surgeries, this procedure involves the use of incisions which can lead to permanent scars.  But as much as possible, doctors will place the surgical lines in areas in which these will not be seen even if a patient will wear a low-cut top.

For women with large breasts and severe ptosis, the most recommended incision pattern is shaped like a nautical anchor: a horizontal cut across the breast crease, an excision around the perimeter of the areola, and a vertical incision starting from the areola to the breast crease.

However, there are cases in which the horizontal incision across the breast crease can be removed particularly if plastic surgeons only have to excise a small amount of skin and tissue.  With this minimally invasive technique, which is called lollipop lift, most patients can enjoy shorter recovery and one less scar.

Meanwhile, some women not just want to lift their sagging breasts but also desire to make their bust appear fuller.  For these patients, the most recommended approach is the donut lift (only the skin and tissue around the areola is excised) which is complemented with breast implants, preferably the silicone type in order to achieve a more natural result.

Because the weight of the implants may aggravate the ongoing breast ptosis, these devices are generally placed under the chest muscles so more amounts of skin and tissue can provide a better support.  On the other hand, placing the implants behind the tissue is not recommended since it can worsen the sagging in the long run.

These are the types of plastic surgery performed to aesthetically improve the breasts:

• Breast lift

Due to pregnancy and natural effects of aging, the breasts may drop due to their own weight and gravity.  To treat this problem, plastic surgeons use breast lift which often involves an anchor-shaped incision—the first one is around the areola, the second travels downward from the areola to the breast fold, and the third covers the entire crease of the bust.

While the anchor lift is very effective in removing the excess skin and manipulating the underlying muscles, this approach is relatively extensive for women with small- to medium-sized breasts.  With this consideration, plastic surgery specialists have developed modified breast lift techniques which are less invasive than the traditional approach.

In some cases, breast lift is combined with breast implant surgery if a patient wants to have a more prominent cleavage.

• Breast augmentation

Traditionally, this plastic surgery procedure is performed using saline- or silicone-filled implants to increase the bust size and create a good cleavage by making the upper poles appear fuller and rounder.

But for patients who only want to slightly increase their breast size (or less than a cup), fat grafting is usually considered as a better option.  In this procedure, plastic surgeons collect fats from the abdomen (or any area where there is a significant amount of fatty deposits) and then transfer these to the bust.

• Breast reduction

For women with an extremely large bust, they can have breast reduction surgery which uses an anchor-shaped incision, allowing plastic surgeons to remove the extra skin and fats and manipulate the surrounding tissues.

In some cases, breast reduction is not only treated as a cosmetic procedure but also as a way to address the physical symptoms such as back problem, chronic pain in the shoulder and neck, skin irritation in the breast crease, and difficulty to engage in sports and other rigorous activities.

If breast reduction is used to treat the physical symptoms stated above, it is important to note that it may be covered by some insurance providers.

Meanwhile, this procedure may also involve areola reduction to make it appear more natural to the breasts.

To correct the hanging, flat-looking breasts, mastopexy or breast lift surgery is the most recommended long-term solution.  In this procedure, surgeons create several incisions to remove the loose skin, tissues, and fats.

But since every patient has a varying degree of breast ptosis (sagging), there are different incision patterns and techniques used in this procedure.

• Anchor lift technique

This technique, which is recommended for women with large breasts with severe sagging, involves making an incision around the perimeter of the areola, or the pigmented part of the skin; another one that runs vertically from the nipple to the breast fold; and a third horizontal cut across the breast crease.

The anchor-shaped incision is the oldest breast lift technique and is often used in conjunction with breast reduction surgery.

• Lollipop incision

The incisions used in the anchor lift are also the same with this technique, minus the one that horizontally travels across the breast crease.  Consequently, patients can expect shorter recovery and one less scar.

This approach is suitable for patients with a moderate degree of breast ptosis.

• Donut lift

Also called as “Benelli” lift (named after the surgeon who pioneered its use), this technique only involves incisions made around the areola.  Meanwhile, this is usually ideal for women with minimal breast ptosis, although this can also be used for patients with a moderate sagging as long as it is performed in conjunction with a breast implant surgery.

• Crescent lift

This breast lift technique, which is not as commonly used as the three incision patterns stated above, involves making a surgical line just along the upper half of the areola.  After this, a crescent-shaped segment of skin is excised and the remaining part is tightened and reattached to the areola.

The crescent lift is suitable only for women with a very minimal degree of sagging and is usually complemented with breast implant surgery.

• Breast implant surgery as a standalone procedure

Breast implant surgery is sometimes used as a standalone procedure for creating volume and slightly lifting the breasts to a higher position.  But with the weight of the implants, most surgeons do not recommend this surgery for patients who have already developed noticeable sagging.

And since the implants can create more projection and volume, breast lift combined with these materials is also ideal for women who want to achieve a more noticeable cleavage.

To date, this approach is increasingly becoming popular among women who want to raise and increase the size of their sagging breasts.  But to fully enjoy the benefits of breast lift with implants, the bust size should not be too large and the ptosis should not be too severe.

Most cosmetic plastic surgeons perform this procedure through the use of an incision around the areola which is the pigmented part of the skin; in this way, they can excise the extra skin before they can insert the breast implants.  However, this excision technique may not be enough for women with a more pronounced ptosis which is why doctors may create a second incision that travels from the areola down to the breast crease.

After removing the excess skin around the incisions, doctors will then insert the breast implants.  Many of them will most likely recommend the silicone implant rather than the saline version to achieve a more natural outcome, something which is possible because it uses a cohesive gel filling designed to simulate the “feel” of a real tissue.

The average weight of implants is about 12oz or 350 which may aggravate the ongoing breast ptosis.  Fortunately, plastic surgeons can address this concern by simply placing the synthetic materials under the chest muscle instead above it so that a thicker amount of tissue and skin can support their weight.

Aside from providing a “bra-like” support, doctors in US plastic surgery also believe that the submuscular implant placement also prevents rippling which is a common concern of thin women with limited glandular skin and tissue, reduces the risk of capsular contracture, and creates a more natural result.

Meanwhile, some women are concerned that combining breast lift with implants may result to longer surgical period which means higher risk of complications and also prolonged downtime.  But according to plastic surgeons, the length of recovery and operation of this approach is almost the same with breast lift or breast augmentation when performed alone.

Contrary to popular belief, sagging breasts not just occur among large-busted, older women.  Some individuals with smaller breasts also have this aesthetic problem caused by major weight loss, several pregnancies, or just simply because of hereditary predisposition.

In US plastic surgery, most doctors prefer the anchor-shaped incision when dealing with large-busted women who have severe sagging.  As its name suggests, this technique involves a set of excisions that resembles a nautical anchor—one around the perimeter of the areola, another incision that starts from the areola to the breast crease, and one more that covers the entire breast fold.

Through the incisions, doctors can lift and reshape the underlying tissue in order to improve the breast contour and firmness, and then reposition the areola and nipple to a higher place without completely removing them from their original blood supply and nerve to preserve the sensation in the area.

If needed, cosmetic plastic surgeons will also reduce the size of an enlarged areola by excising the skin around its perimeter.

To compensate for the loss of elasticity, the excess breast skin is carefully removed and the sutures are layered deep within the tissue in order to support the newly shaped bust.  Once the necessary changes are completed, doctors will close the surgical wounds using skin adhesives, surgical tape, and/or sutures.

While the anchor-shaped incision provides a dramatic result, this approach is viewed as too extensive for small- to medium-busted women who have less sagging.  With this consideration, plastic surgery specialists will likely use a new breast lift techniques which involve fewer incisions which means faster recovery and shorter scars.

For medium-sized breasts with severe sagging and large bust with moderate drooping, most plastic surgeons recommend the lollipop lift which uses the same incision sites found in the anchor lift minus the one that covers the entire breast crease—the area which typically takes the longest time to heal; for this reason, patients can expect faster recovery.

Another minimally invasive technique designed for women with smaller breasts is the doughnut lift which only uses one incision around the areola.  And according to plastic surgeons, this approach is best complemented with implants to address a more pronounced sagging and to make the breasts appear fuller.

In the traditional breast lift approach, doctors create three separate incisions that resemble an anchor; it travels around the circumference of the areola, another vertical cut starting from the nipple to the breast crease, and a horizontal one that covers the entire crease.

But during donut mastopexy, plastic surgeons only use the incision around the perimeter of the areola, allowing them to remove the excess skin and manipulate the tissue surrounding this area and place the nipple to a higher position.  If necessary, the size of an enlarged areola will be reduced to further improve the breast’s appearance.

Because this plastic surgery procedure only uses one incision site, most patients can expect a relatively faster recovery compared to the traditional breast lift technique.  Additional advantages include unnoticeable scar, less post-operative pain and discomfort, and less risk of complications.

Despite the countless advantages of the donut lift, plastic surgeons do not conduct this to large-busted patients with a severe sagging because it only involves a limited amount of tissue and skin.  In general, only women with small to medium breasts that have a mild to moderate drooping can benefit from this technique.

As with any breast lift technique, the donut lift does not guarantee a lifetime result due to the natural effects of aging and gravity, although majority of small-breasted women can maintain it for many years as long as they will avoid pregnancy and significant weight fluctuation which can weaken the tissue and skin.  It can also be helpful if the patients will always wear a good-fitting bra that provides a great support.

Some plastic surgeons complement this procedure with breast implant surgery particularly for patients who want to increase their bust size and/or achieve a fuller upper pole to create cleavage.  Combining these two plastic surgery procedures may also correct a more pronounced sagging as long as the implants are placed under the muscles (rather than behind the tissue) so that more tissue and skin can support their weight, thus preventing premature sagging.

As with any cosmetic procedure, the donut lift has some risks such as unnecessary scarring, asymmetrical appearance, and infection.  To be on the safe side, patients should choose a board-certified doctor who has an extensive experience with this particular technique.

Because of the physical changes brought by pregnancy and childbirth, most women will end up having a sagging abdomen due to skin and tissue laxity.  While this problem may be treated with exercise and diet, there are some cases in which the only effective solution is plastic surgery through a procedure called abdominoplasty or tummy tuck.

In this procedure, plastic surgeons create an incision near or along the pubic hairline that will allow them to remove the excess skin and tissues and reshape the muscles which have become separated due to pregnancy.  The length of the incision greatly depends on the severity of the excess tissues, although the general rule is that patients who need the most correction will need a hipbone-to-hipbone incision while those who have minimal droopiness will benefit more with a shorter cut.

In some cases, tummy tuck surgery can also remove or at least reduce the appearance of stretch marks in the abdominal area.

Another popular “mommy makeover” procedure is breast augmentation in which plastic surgeons use silicone or saline implants to increase the bust size, improve a slightly sagging breast, and make this appear fuller.

In this plastic surgery procedure, doctors make incisions below the breast crease, around the circumference of the areola, in the armpit, or within the navel where they can insert the implants.  After the materials have been secured inside the breast pocket, surgeons will then close the incisions using sutures and put compression garments around the chest of their patients.

To prevent or at least postpone sagginess, plastic surgeons generally prefer the under-the-muscle implant placement which provides a reliable bra-like support to the implants.  In addition, this technique creates a gentle slope which makes the breasts appear more natural.

However, breast implant surgery is not the right approach when dealing with moderate to severe sagging of the breasts.  In this problem, breast lift surgery is the best way to correct the drooping bust caused by the skin and tissues becoming less elastic after breastfeeding.

For women who want to have “mommy makeover” plastic surgery, they should postpone this if they are considering having children in later years since pregnancy, childbirth, and breastfeeding will have an effect to the result of the procedure.

To correct breast ptosis, plastic surgeons use breast lift which typically involves three separate incisions that form an anchor-shaped scar which will enable them to remove the extra skin and fats and manipulate the underlying tissues.  (See the incision pattern below.)

In some cases, this procedure is performed in conjunction with breast implants to further create volume especially in the medial and upper poles of the bust that will lead to a more prominent cleavage.

If breast implants are combined with breast lift, plastic surgeons would only use the areola incision instead of the extensive anchor lift; as a result, patients can also expect less scars.

As with any cosmetic surgery, breast lift involves risk of complications which can be reduced by following the pre-operative guidelines that typically include avoiding “blood-thinning” medications, smoking, alcohol, and herbal supplements.

According to several studies, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can inhibit blood clotting and healing which means that patients can experience excessive bleeding during and after their surgery.  For this reason, most plastic surgeons recommend to stop these medications at least two weeks prior to the procedure and during the recovery.

Certain herbal supplements such as those containing green tea, vitamin E, and gingko biloba have also been found to inhibit blood clotting.  Just to be on the safe side, patients should tell their plastic surgeons about all the medications and supplements they are taking.

For smokers, they will most likely be advised to stop the bad habit at least two to three weeks prior to the surgery and during the recovery.  According to several studies, skin necrosis or death of skin tissue is 1,500 times more likely to occur among smokers than non-smokers.

It is important to note that skin necrosis is associated with prolonged healing and unnecessary scarring.  And because of these risks, plastic surgeons conduct random blood testing prior to surgery to determine the presence of nicotine in the blood.

Meanwhile, preparing for breast lift also means planning for one’s recovery.  This will include assigning a companion for the first two days after the surgery, securing supplies needed during the recovery, and securing all the medications and special garments that will be used during the healing period.

In the traditional technique, plastic surgeons conduct the procedure with the use of an anchor-shaped incision which involves one around the perimeter of the areola, a vertical cut from the areola to the breast crease, and another one that horizontally runs across the crease.  Although this approach can provide a dramatic result, it is only ideal for large-busted women with a severe case of breast ptosis (or sagging).

On the other hand, women with small- to medium-sized breasts are not a good candidate for the anchor lift because they can also achieve a great result with the use of less invasive techniques that involve fewer scars, shorter downtime, and lower risk of complications.

Nowadays, perhaps the most common modified breast lift techniques are the lollipop lift and donut lift which are named because of the shape of the incision lines they are using.

According to plastic surgery specialists, the lollipop breast lift is a compromise between the invasive anchor lift and donut lift and can provide a great result for women who meet specific breast criteria.  Ideally, this technique is performed on medium-busted patients with a moderate to severe ptosis or large-busted women with a mild to moderate sagging.  (See picture below.)

This breast lift technique, which is also called as Benelli lift named after the plastic surgery specialist who developed this procedure, requires two separate incisions that are placed around the areola and another one that travels downward to the breast crease, thus creating a surgical scar that is shaped like a round candy on a stick.

Meanwhile, plastic surgeons consider this surgical approach as too extensive on patients with smaller breasts and less noticeable case of sagging, and not enough for women with larger bust with a significant ptosis.

Another type of modified breast lift technique is the donut-shaped incision in which plastic surgeons tighten the area and raise the nipple through an incision made around the circumference of the areola (which is why some doctors call this as peri-areolar lift).  But due to the limited incision, this approach is only recommended for women with small- and medium-sized breasts with a mild to moderate sagging.

For women with a more pronounced sagging, the donut lift may also provide a good result as long as it is complemented with breast implants.