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.

In the US, only the saline- and silicone-filled implants are currently available for patients who want to undergo breast augmentation and breast reconstruction surgery.  However, this is expected to change since study investigators have recently claimed that the data and clinical trials on cohesive gel implants look promising.

This new type of implant offers countless of advantages, in fact, this can even outshine the saline- and silicone filled version in many aspects.

• Almost no risk of rippling

Because the cohesive gel breast implants are made of a solid silicone mass, the gel will not shift from one area of the shell to another, something that happens in saline-filled implants.  For this reason, these biocompatible materials are ideal for petite women who usually have a thin wall of breast tissue and skin.

• More natural “feel” and shape

This new implant provides a more natural feel and shape than the currently available silicone implant as it uses a highly cohesive silicone particle that can exhibit “shape memory,” for this reason, the shell can go back to its original form.

And because of the cohesiveness of this material, some doctors also call this as gummy bear breast implant.

• No risk of leaking

While the saline and silicone implants will leak in case the shell is punctured, this is not a concern when using the gummy bear breast implants.  In fact, its shell can be cut in half and still the gel stays in place.

For this reason, patients will not be required to undergo a regular MRI screening if they will choose the cohesive gel implants.

Meanwhile, MRI screening is a requirement for patients with silicone implants to identify any possible leak.

• Lower risk of capsular contracture

Capsular contracture is a disfiguring and painful condition which happens when the capsule-shape scar tissue squeezes the implants.  According to several studies conducted in Europe and Canada, this serious problem occurs less frequently on women with this implant compared to those with saline and silicone version.

While there is not yet any conclusive explanation on why the cohesive gel implant can lower the risk of capsular contracture, some experts believe that the most probable cause is the firmness and stability of this breast implant.

It is important to note that real gynecomastia is primarily caused by the excess tissue rather than the fats alone.  For this reason, men with large breasts due to overweight or obesity will most likely be required to shed their extra weight before they even consider having plastic surgery.

In severe cases of gynecomastia, a patient not only has overdeveloped breasts but also enlarged areola which is the pigmented part of the skin.  Fortunately, this problem can also be addressed with plastic surgery through a particular excision technique.

Since gynecomastia surgery is an invasive procedure, most plastic surgeons perform this using general anesthesia or intravenous sedation (rather than local anesthesia) to provide comfort to their patients.

Once the numbing effect of the drug takes effect, most plastic surgeons will start the procedure by performing liposuction through the use of a suctioning probe attached to a vacuum pump.  This instrument, which is inserted to several small cuts, is designed to dislodge and remove the fatty deposits from the body.

In most cases, the liposuction incisions are placed near the armpits and along the crease of the breasts.

Because liposuction can only remove the excess fats, plastic surgery specialists also use excision techniques to remove the excess tissue and skin to further reduce the size of the male breasts.  Meanwhile, the length and placement of the incisions largely depend on the severity of the problem and the expectations of a patient.

One of the most common gynecomastia surgical techniques is the U-shaped incision in which doctors create a continuous cut starting from the breast crease to the top of the areola, curving downward from the middle.  Another incision is made around the areola to free it from the skin.

With this approach, the scar falls along the breast crease which makes it almost unnoticeable.

Another common excision technique uses a diamond-shaped incision which starts from the breast crease to the top of the areola, curving upward from the middle.  With this procedure, a horizontal scar will form across the areola, making it more visible.

For patients who need a slight correction, they can benefit from a smaller incision placed below the areola where doctors can reshape the tissue and remove any excess skin.

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.

Most plastic surgeons use the tumescent liposuction technique when treating the female breasts.  In this procedure, they inject the fatty deposits with a solution which can make these firmer and swollen for an easier and faster removal, and can reduce bleeding by constricting the blood vessels.

And because the solution already contains lidocaine which is a type of local anesthesia, this liposuction technique does not use general anesthesia which makes it significantly safer compared to the previous fat removal method.

If performed to the right patients, this plastic surgery approach can reduce the size of female breasts by more than 50 percent and may even slightly lift them particularly for patients with a naturally elastic skin which can shrink and tighten on its own after the fats have been eliminated.

Perhaps the most notable advantage of breast liposuction over the traditional breast reduction surgery is that there is no risk of visible scarring.  This has become possible with the use of micro-cannula, a slender probe (about 1 to 2mm in diameter) that is used by plastic surgeons to suction out the fats.  (See picture below.)

And because of the small size of this instrument, it can fit into a tiny incision in the skin, about 1mm in diameter which can heal faster without forming any visible scar.  However, some dark-skinned patients may develop pigmentation in the incision sites, although this will usually fade one to two years after their plastic surgery.

Another advantage of female breast liposuction is the faster recovery.  In fact, many patients can return to their normal activities within several days, significantly shorter compared to women who will undergo excision-based breast reduction surgery in which the downtime may take several weeks or sometimes even months.

It is important to note that breast liposuction does not significantly change the shape of the bust but only makes it smaller.  In some cases, this plastic surgery approach also lifts a slightly sagging breast especially among younger patients who usually have a more elastic skin than older individuals.

Meanwhile, plastic surgeons do not recommend this procedure for thin women with large breasts since their condition is primarily caused by the excess tissue rather than fatty deposits.

One of the most effective ways to create a cleavage is to place the implants higher up on the chest wall, thus increasing fullness in the upper pole of the breast.  These synthetic materials may also be placed closer to each other to achieve a more prominent medial cleavage, a feature which naturally occurs on women with larger breasts.

However, one common downside of naturally large breasts is the lack of upper pole fullness because of their own weight, according to plastic surgery specialists.

Another important consideration is the implant dimension.  The general rule is that the larger the implant is, the better cleavage a patient can get—both the upper pole fullness and medial cleavage.  (This is because bigger implants can occupy more space on the chest wall.)

But for women who want to have a good cleavage but do not desire to get large-sized implants, it is still possible to achieve this feature with the use of certain types of implant dimension.  To date, plastic surgeons are using high-profile implants that have a smaller diameter (ideally for petite patients), or moderate- to low-profile implants that have a larger diameter (recommended for individuals with moderate to large body frame).

While there are plastic surgery techniques that can improve the appearance of cleavage, it still boils down to a person’s anatomical feature particularly in terms of natural bust position and chest wall.  For instance, it is relatively difficult for people with breasts that are placed wide apart to achieve a good medial cleavage.

On the other hand, patients with a pronounced or mild hollow on the middle of their chest usually get a good medial cleavage unlike those individuals whose chest cage center is very prominent, according to plastic surgery experts.

For patients who have sagging breasts with nipples pointing downward, it is usually difficult—if not impossible—to create fullness in the upper poles of the bust.  Fortunately, this aesthetic problem can be treated with breast lift surgery complemented with implants.

Aside from the right implant placement and type of implants, plastic surgeons suggest that wearing a good-fitting bra which can provide a reliable support to the breasts will also create a good cleavage while preventing sagginess in later years.

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.

For women who have undergone a very extensive mastectomy, they are most likely left with a small amount of tissue and skin that makes reconstructive plastic surgery more difficult.  In this case, usually the best approach for them is the tissue-based method in which their plastic surgeons use their own muscles, skin, and fats to recreate their breasts.

Meanwhile, some patients can have breast reconstruction surgery at the same time of their mastectomy.  In this way, they can expect a more convenient recovery instead of having to undergo two separate procedures.

But in some cases, plastic surgeons perform breast reconstruction a few months or years after mastectomy to reduce the risk of complications and limit the surgical trauma for certain patients.

As with any extensive plastic surgery, tissue-based breast reconstruction is usually performed under general anesthesia in which the patients are pain-free and asleep during the entire operation.

Currently, there are several ways to reconstruct the breasts using a patient’s own muscle, tissue, skin, and fats, although the two most common techniques used by plastic surgeons are the latissimus muscle flap with breast implants, and transverse rectus abdominous muscle flap (TRAM).

In latissimus muscle flap with implants, doctors make an incision in the upper back to the side of the breast to loosen the fats, skin, and muscles from this area.  After this, they connect this tissue under the skin in the breast which has undergone mastectomy in order to recreate it.

To prevent the risk of skin necrosis and other complications, doctors make sure that the blood vessels remain connected to the area where the tissue is taken from.

Once the tissue is reshaped to simulate the natural appearance of a breast, plastic surgery specialists will place silicone or saline implants under the chest muscles.  If needed, they will also reconstruct the nipple and areola to further achieve a more natural look.

On the other hand, TRAM involves an incision across the lower abdomen (from hipbone to hipbone) to loosen the fats, skin, and muscles in the area which can serve as the tissue to recreate the breasts.  The blood vessels also remain attached to their original site, although some doctors prefer to completely remove the tissue from the area and reconnect this to the blood vessels under the arm.

Once the tissue is shaped to recreate the breasts, surgeons will then close the abdominal incision using sutures.

For women who want to achieve a more natural appearance, most plastic surgeons recommend the silicone implants which are filled with a cohesive gel material noted for simulating the “feel” and “bounce” of a real breast tissue.  This may not be the case for saline implant which feels like a water-balloon, according to some patients’ description.

In general, the silicone implants provide a slightly better result compared to the saline version, although the outcome may still depend on the amount of skin and tissue, surgeon’s skills, and other factors.

Petite women who usually have limited amount of breast tissue and skin are usually advised to have silicone-filled implants which are less likely to ripple than the saline version.  To further reduce the risk of rippling to this type of patients, plastic surgeons place the implants under the chest muscles rather than over them so that more amounts of skin and tissue can cover the shell and provide a reliable “bra-like” support.

Because the silicone implants are less likely to ripple, many experts also believe that these materials have a lower chance of leaking.  (Rippling may affect the durability of the shell which may result to breakage.)

Another advantage of using silicone implants is that women can maintain their breast volume unless if there is a leak.  This is not the case for patients with saline implants which have a natural deflation rate—due to evaporation and other factors—of 1 percent every year.

During the previous years, there were claims that silicone breast implant can increase a patient’s risk of autoimmune and connective tissue diseases.  However, extensive studies did not find a strong link between this type of implant and the risk of developing such conditions.

Despite the advantages of silicone implants, some plastic surgeons warn that these biocompatible materials still have some downsides.  For example, women with this type of breast implant are required to undergo a regular MRI screening—ideally every two years—to detect any possible leak.  (Because a silicone leak just stays around the tissue, the condition may sometimes go undetected for months or even years.)

In contrast, this is not a requirement for patients with saline implants.  This is because the saltwater filling is immediately absorbed by the surrounding tissues in case of a leak, and as a result, the breasts will appear deflated just four hours after the shell breaks.

To address the aesthetic problem and physical effects of having inordinately large bust, plastic surgeons use a specific procedure called breast reduction surgery which typically involves several incisions that will let them manipulate the surrounding tissue and remove any excess skin.

Since every patient has a varying amount of excess skin, tissue, and fats, plastic surgery specialists have developed different breast reduction techniques in order to achieve the most desirable outcome.

For women with larger breasts that have moderate to significant sagginess, and patients with medium-sized bust that severely sags, the anchor-shaped incision is usually the best approach.  But since it uses the most extensive excisions, plastic surgeons warn that this technique involves longer recovery compared with other breast reduction procedures.

As its name suggest, this technique involves a surgical cut that resembles a nautical anchor as it uses an incision that surrounds the edge of areola, another one starting from the areola down to the fold of the breast, and another excision that covers the entire breast crease.

Through these surgical incisions, plastic surgery specialists can access and manipulate the glandular tissue and remove the excess skin and fats.  If needed, they will also reduce the size of the areola to make it appear more natural on smaller breasts.

Despite the effectiveness of the anchor-shaped incision, plastic surgeons usually find this as too extensive on medium-busted women with moderate to severe sagginess.  For this reason, they have developed a modified breast lift technique called lollipop lift.

In this minimally invasive, plastic surgery doctors use the same incision sites in the anchor lift, minus the excision that covers the crease of the breasts—the area which usually takes the longest time to heal.  And because of this, most patients can expect not just one less scar but also shorter recovery period.

But regardless of which technique is used, breast lift involves risk of complications, post-operative pain and discomfort, and recovery.

For most patients, they can return to work within two to four weeks after the procedure, although they should avoid strenuous activities and heavy lifting for up to six weeks to promote faster healing.