Pregnancy and subsequent breast-feeding can have a dramatic impact on the size and shape of a woman’s breasts. During pregnancy, the breasts increase in size in response to a changing hormonal environment. This phenomena is further accentuated by breast-feeding, as the glanduler tissue enlarges during lactation. To accommodate this increased breast volume, the skin envelope has to stretch as well. Once the process of lactation is completed, the glanduler tissue shrinks, and the breast decreases in size. This loss of volume is often accompanied by the development of breast sag because of decreased breast volume in the presence of stretched skin.
The response of the breast to pregnancy varies from patient to patient, and depends on a variety of factors. These include the starting size of the breast, the length of time spent breast- feeding, and the biologic tendency for the breast skin to stretch during pregnancy.Depending upon the degree of sag that is present, a multitude of surgical options exist to treat this problem. Every patient’s anatomic starting point and aesthetic goals may be different, and because of this, treatment plans need to be individualized.
In cases of mild breast sag, the problem may be handled with breast augmentation. This is a good alternative in patients who would like to have larger breasts as well. This also has the added advantage of increasing breast projection by increasing upper-pole breast fullness.
Patients with more significant levels of breast sag will need one of the variants of breast lift surgery. These procedures can increase, decrease, or maintain breast size depending upon the patient’s aesthetic goals.
Depending on the degree of breast sag and excess skin that needs to be removed, several treatment options exist. In mild cases, the excess skin and sag can be treated with a donut mastopexy. This procedure removes and tightens the excess skin around the areola. This leaves a scar at the junction between the areola and surrounding tissue.
In more severe cases of sag, a lollipop incision can be utilized to deal with the excess skin. This leaves a circular incision around the areola with a vertical extension that extends to the infra-mammary fold. When extreme breast sag is present, excision of excess skin requires not only a vertical incision, but an incision transversely in the infra-mammary fold as well. This results in a circular incision around the areola, a vertical incision, and a transverse incision hidden in the fold beneath the breast.
Each of these procedures can be performed in combination with breast augmentation when patients want larger breasts. This results in increased upper-pole breast fullness with increased breast projection.
When these procedures maintain breast size or reduce breast size, significant aesthetic improvement can be expected. Unfortunately, without implant placement, upper breast fullness and increased projection are not always possible.
It’s important to remember that every woman with breast sag is unique. Their anatomic starting points and aesthetic goals are always different. Any patient considering breast lift surgery should consult a board certified plastic surgeon. After careful evaluation, an appropriate treatment plan can be formulated.
