Breast droop or sag are everyday terms used to describe breasts that are too low or hang down. The formal medical term is breast “ptosis.” There is a grading system that rates the severity of ptosis based on where the nipple is located relative to the inframmary fold. If the nipple is located above the fold, no ptosis is present. If it is at the level of the fold, mild ptosis exists. If the nipple is below the inframmary fold, moderate to severe droop or ptosis is present.
Breast droop or ptosis may occur naturally due to aging, pregnancy, or fluctuations in weight. It may also occur following breast augmentation. There are a variety of ways that breast implants cause or contribute to breast droop. The most common reason is using breast implants that are too large or heavy for the patients skin to support. Appropriate implant selection can tricky. Numerous factors such as the patient’s age, skin elasticity, breast dimensions, previous surgery, and a host of others must be taken into consideration. Improper implant selection during previous surgery is a set up for breast droop or sag. Other causes include imcomplete release of the muscle during sub-pectoral augmentation or capsular contracture, both of which can cause the breast implant to remain high while the breast tissue droops off of the implant. Another common reason is when the patient actually needed a breast lift (mastopexy) to begin with but instead just had a breast augmentation. Although some of these patients look good initially, many will go on to droop.
Correcting breast droop in patients who have had previous breast augmentation usually requires a combination of techniques. Much will depend on the severity of the breast droop and the amount of excess skin present. In some cases, breast implants are converted to a sub-pectoral position and may need an accompanying breast lift (mastopexy) to remove excess skin. Many patients also require internal suturing techniques (capsuloraphy) to help hold up the breast implants and reconstruct the previous implant space or pocket. It is common to move down in breast implant size in order to minimize the chance of drooping again. Dr. Ciaravino’s technique of in-office deflation prior to breast implant exchange has been a useful step in many of these complicated cases. In those patients who have capsular contracture or incomplete muscle release, surgically correcting these problems may allow the breast implants to move into proper position, thereby correcting the breast droop.