Breast Ptosis Levels and Safe Volume Removal

There are varying degrees of breast ptosis, or sagging, with some requiring only smaller lifts for correction and others that call for a full mastopexy. We are going to cover the most commonly described ptotic grades to help you better determine what you may need. This is for informational purposes only; only a qualified medical professional can ascertain your needs after a physical examination.

Also, please understand that although you may qualify for a less scarring technique, not all surgeons will offer every method. This is why it is important to consult with several surgeons to cover all of your options so you are not forced to settle.

How to Determine Your Degree of Breast Ptosis

First, find your mammary crease, which is directly underneath your breasts. The easiest way to find it is by placing a ruler so that its highest edge is directly against the junction of the breast and ribcage.

Very Mild Ptosis - Grade I

- Very Mild Ptosis

Notice where the central part of your nipple (not your areola) is. If it is just above or directly in front of the top of the ruler, you may have Grade I ptosis, a very mild to mild condition of sagging breasts that usually can be corrected by a partial breast lift, or mastopexy, called a crescent that can correct the position of the areolae up to approximately 4 cm. If planned in conjunction with a breast reduction, three options are a liposuction assisted volume removal, a crescent incision at the top if the areola, or possibly a periareolar incision with volume removal. Proper post-op support (i.e., a supportive bra) will help to prevent the scar from stretching during the maturation phase, which can last up to a year.

Mild To Moderate Ptosis, Moderate Volume - Grade II

- Mild To Moderate Ptosis, Moderate Volume

In Grade II ptosis the central point of the nipple is 1 to 3 cm below the top of the ruler. Considered mild to moderate, this condition can often be corrected with minimal scarring using the Benelli, or periareolar, lift. The surgeon removes a doughnut-shaped piece of skin from around the areola (and part of the areola itself in areola reduction cases) to draw the breast together as if it were a drawstring pouch. Any puckering in the sutured edges should flatten out over the next year. If breast reduction is also desired, liposuction assisted volume removal is one option. Another is the periareolar incision with volume removal, sometimes called a doughnut or circumareolar lift.

Severe Ptosis, Moderate Volume - Grade III

- Severe Ptosis, Moderate Volume

In Grade III ptosis, the central point of the nipple is more than 3 cm below the top of the ruler and requires a vertical (keyhole) mastopexy or anchor lift, oftentimes accompanied by an areola reduction. The resulting vertical scar would run from the crease to the bottom of the areola with an additional scar around the areola itself. If the anchor mastopexy incision is used, there is a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola and a scar around the areola itself.

Typical Patient Needing Breast Reduction With Lift

This breast type, with the nipple and areola complex position and the low position of the breasts on the torso, would most likely need a full anchor mastopexy incision. Patients who need an anchor incision often also need an areola reduction, resulting in a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola, and a scar around the areola itself.

Very Severe Ptosis Needing Significant Tissue Removal and Reconstruction

Severe ptosis such as this requires a full anchor mastopexy incision plus an areola reduction, with a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola and a scar around the areola itself. Surgeons often require at least an overnight stay in the hospital for these breast types.

Safe Volume Removal

Usually breast reduction can be performed in just one operation. However, the risks will increase as the removal volume is increased. The likelihood of a hospital stay also increases proportionately with the size of the breast(s) to be reduced. With gigantomastia, the amount of breast tissue can continue to grow until after the growth phase has ceased, requiring several procedures after the initial operation.

Breast reduction is major surgery. Fluid shifts (the movement of body fluids in the body from the blood vessels to the cellular tissue) are possible, as is postoperative hemorrhaging, seroma (a mass or swelling caused by buildup of blood serum) and pulmonary thromboembolism (blood clot in the lung). You will need to be under medical observation after the surgery. In the event that a complication arises, you must have immediate access to lifesaving medical care.