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Breast Ptosis (drooping breast) - Mastopexy

Explore what others have to say about breast ptosis (drooping breast) / mastopexy with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Subj: Need Mastopexy Revision

At the age of 37 I had a mastopexy to contour my sagging breast. I am now 39. I can not say that the sagging was due to pregnancies (2), because I've always had sagging breast. For the most part, I was please with the results although I developed some keloid scarring on the incision "anchor tips." There is NO scarring aground the nipple area or the vertical incision. I should mention that I am an African-American that tend to have a higher occurrence of keloid scarring. I've read that a pressure dressing or cortisone injections will help the scarring.

However in addition to the scarring which I would like revised , I still have "soft tissue," "boxy" or wide breast. Would an implant help to firm up my breast and create a more rounded contour? And....Can this be done without a significant increase in breast size. I currently purchase 34C bras. The C cup is mainly due to widenest of my breast instead of actual breast tissue. I'm 5'4 and current weight is 135 lbs(weight at initial surgery also). I exercise at least 40 min/5-6 days a week and trying to reduce to 125 lbs. I did gain 10 lbs after the initial surgery.

Please respond. I would like this surgery before my 40th birthday.

Dr. Bermant responds:

You seem to have 2 separate questions.

Different parts of the body scar to different degrees. The chest wall , especially by the central area near the sternum, is one of the most likely areas of the body to scar. It is not uncommon for the different incisions for breast ptosis surgery to scar differently. Dark skinned individuals, whether black or of Mediterranean heritage, tend to keloid scars. Keloid scars and hypertrophic scars are excessive body reactions to healing. Keloidss tend to extend beyond the normal limits of the original scar. Both can be thick, discolored, and get worse. Some scars (especially young ones still in the "red" phase" may improve with steroid injection. Pressure therapy may work for any scars although the greatest benefit comes while the scar is maturing.

I would have to examine your scars to make a recommendation for treatment. You may already have an optimal result. Scar revision may be appropriate. Scar modification may still be a choice (but that is a less likely option).

For advice on the shape of a breast, there are too many variables to comment on without an appropriate examination. Breast shape is a function of the material inside (breast tissue and fat) and the skin envelope. Your description sounds like you had a skin envelope operation. This is somewhat like tailoring material in a garment, however this tissue is harder to predict the outcome since tissue swells during surgery. Contour touch up surgery is sometimes necessary even in the most skillful surgeon's hands.

Adding a breast implant although an option, I rarely use any more after the controversy generated by lawyers and the media. Breast implant surgery is good surgery. My patients who had it were very happy. It is just now impossible to tell how a patient is doing. Patients tell me they are unnecessarily terrorized by the constant attention by the media. Most of what implant ptosis correction offers can be accomplished by the skin envelope operation. (All but the increase in volume which you ask not to have.)

I hope this information helps you. We are just next to Richmond Virginia. If you want to set up a consultation please call us at (804) 748-7737. If there are other questions, please let me know.

Michael Bermant, MD

Subj: Re: Your Website was most helpful

I am currently 17 years old. Due to a rapid increase of weight in the 6th grade, I began to form to what i thought at the time stretch marks on both of my breasts. After reading the e-mail sent to you by the 39 year old African American female who had similar problems, I found that the scarring had a name. Keloid scarring is an awful thing to have growing up. I am always covering up in the locker room and I can't wear the any trendy low cut shirts, afraid that the scarring might show. Currently, I wear a 38c bra and my breasts also sag. I was opting for reconstructive surgery to eliminate the scars. But is that possible? The sagging has also been a problem. Should i consider implants? I've tried everything to eliminate the sagging and reduce the scarring by exercising. I'm very much in shape. I'm 5'4 and weigh 123lbs. My parents understand that this is very important to me and are willing to grant any wishes I may have concerning this.
Needing your input

Dr. Bermant responds:

Scars from breast getting large and then small are usually stretch marks not keloids. A keloid extends well beyond the site of original injury. We have been taught that stretch mark scars have no reasonable cure but some papers have been more than optimistic with what resurfacing lasers have to offer. Depending on the type of scars, some patients may benefit from such intervention.

Sagging breasts, ptosis, involve a loose envelope and or deficient breast mass. For the former a resculpting of the skin envelope can restore more natural breast shape. For deficient breast mass, implants are a better option.

I would need to examine you to determine the better option for your breasts.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: some advice breast ptosis

Hello, I am a 25 year old with unbelievable saggy breasts .I have had three children and my nipples point to the floor literally. I have a significant amount of stretch marks also. I would like to have the mastopexy done, but am concerned about the scarring. how bad is it REALLY, and also, what are the usual costs. Please respond at your convenience. ...

Dr. Bermant responds:

The scars depend on the type of breast ptosis surgery your need. Sometimes we only need to do the reduction with a scar around the areola. Other patients need more skin removed to continue the scar under the breast. Still others need the full "anchor" type surgery with scars extending under the breasts. My patients tell me they are happy with their results but we discuss how the appearance is in and out of clothing. The scars are such that out of clothing some patients may not like the look after surgery.

Scarring also depends on the patients healing and the surgeon's skill. I will not publish breast photographs on the web until we get a better understanding how such issues will be handled. My patients in my office can see such patient education material. No that is not available to patients having surgery by other doctors.

Surgeon's fee can range from $1000 to $3500 depending on what needs to be done. This does not include anesthesia nor operating room. Our rates in Richmond tend to be lower than some other parts of the country.

Michael Bermant, MD

Subj: Re: Mastopexy/Breast Lift

Dr. Bermant,

I am interested in more information on the Mastopexy/Breast Lift procedure. I was wondering if this procedure can be performed and as successful if implants are not used. Also, what makes this procedure different than a regular breast reduction.

Because of the position of my breasts, with a reduction, I have been told that the areola would have to be detached and replaced once the extra tissue was removed. Would this be a probability with the Mastopexy also? And lastly, I weigh 230 lbs to date. I have recently lost 25 lbs and have noticed a reduction of 1-2 inches in my chest measurement. Although this has not necessarily reduced my actual breast size, will the toning and firming of the muscles behind the breast, aide in this procedure? Thank you for your time.

Dr. Bermant responds:

A breast reduction is an operation for making the breasts smaller. The skin envelope is usually readjusted to restore a more youthful appearance to the breast at the same time. The nipple areolar complex needs a blood supply to survive. If a breast is very long, folding tissue that maintains this blood supply can limit the size of the reduction. Extensive folding can also compromise the blood supply. Another option is to remove the nipple areolar complex and thin them into a graft and reattach this in a new site. This method permits a greater breast reduction but eliminates the connections to the underlying glands and can result in color changes.

Weight reductions usually result in smaller breasts. Exercise is usually good for you and excessive weight often increases medical problems. An examination an evaluation would be necessary before advising any patient.

Breast ptosis is a condition where the breast are sagging and no longer suspended on the chest. A mastopexy is for resuspending the tissue into more youthful proportions. This is not an operation for massive breasts. This operation can have similar scars to a breast reduction but smaller scars are possible depending on the amount of correction. A skin envelope operation can be supplemented by adding material such as an implant. You will need an examination before such a recommendation can be made. Usually breast augmentation does not make sense to someone asking about breast reduction. Most breast ptosis patients have reasonable pedicles for reconstruction with out converting the nipple areolar complex into a graft.

Michael Bermant, MD

Bermant Plastic Surgery
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