Breast lift (correcting sagging breasts): methods and what to consider

What is a breast lift?

Breasts can sag with childbirth and breastfeeding, changes in weight, and age. A breast lift is surgery that reduces stretched skin and reshapes the breast tissue to raise the position of the nipple and the breast.

A 2013 review explained that there are many skin incision designs and methods of handling the breast tissue (parenchyma) for a breast lift, and that each of the three incision patterns has important technical details ^[1]. Incision patterns are commonly divided into an incision only around the areola, an incision around the areola with a vertical incision running down from it, and an inverted-T incision that also extends along the breast fold. The more severe the sagging, the longer the incisions tend to be.

Who is it considered for?

The assessment before surgery begins with checking the desired result, the degree of sagging, the amount of breast tissue, the condition of the skin, and where the breasts sit on the chest wall ^[1]. This assessment determines the incision pattern, the method of handling the tissue, and whether implants will also be used ^[1].

After massive weight loss, the skin and tissue can stretch considerably, and the breasts may sag in a characteristic shape. A 2019 publication explained that for these patients, a lift that uses the dermis as internal support and repositions the breast tissue is useful, that the surgery is tailored to each person's deformity, and that it can be performed safely together with other operations ^[3]. The same publication reported that results lasted a long time and that most complications were minor and easily handled in the outpatient clinic, but this is based on the authors' experience ^[3].

Techniques used in breast lifts are also applied in other areas. A 2014 review explained that therapeutic mammaplasty, which uses breast reduction and lift techniques during breast-conserving surgery (breast cancer surgery that preserves the breast), can widen the use of breast-conserving surgery and improve cosmetic results in selected patients ^[5]. Lift techniques that correct the position of the nipple and areola are also used in surgery for male breast enlargement (gynecomastia) ^[6].

When combined with implants

If you also want to increase breast size, implant placement may be planned together with a breast lift. However, a 2013 review explained that the combination of implant placement and a breast lift carries the greatest likelihood of complications ^[1].

A 2017 review also stressed that a breast lift combined with implant placement is a difficult operation that should be performed by an experienced surgeon ^[2]. Many surgeons prefer to do it in two stages: either performing the implant surgery first to reduce scarring and deciding after seeing how satisfied the patient is, or performing the lift first and judging later whether implants or fat grafting are really needed ^[2].

Sometimes a person already has implants, and only the breast tissue sags over them. In this case, a breast lift, with or without replacing the implants, is usually the solution, and the literature notes that the results can be satisfying but scars remain ^[2].

Recovery and pain management

A breast lift is sometimes grouped with tummy tuck (abdominoplasty), liposuction, and lower body lift as body contouring surgery ^[4]. A 2019 publication explained that good pain control after surgery shortens the hospital stay and helps patients start walking earlier, which reduces complications ^[4].

Recently, rather than relying only on opioid painkillers, a multimodal approach has been used that combines continuous infusion of local anesthetic, regional nerve blocks, and non-opioid medications ^[4]. These methods aim to reduce the use of opioid painkillers in order to help bowel function recover sooner and lower the risk of addiction ^[4].

Scars, risks, and expectations

A breast lift involves cutting and reducing the skin, so it leaves scars ^[2]. The length of the scars depends on the incision pattern, and how the scars settle varies from person to person depending on skin condition and constitution.

A 2013 review pointed out that although a breast lift is an effective operation, it is the cosmetic breast surgery most often involved in legal disputes ^[1]. That is why it is important to discuss scars, the limits on the shape that can be achieved, and the chance of revision surgery thoroughly before surgery, and to set realistic expectations.

The research summaries reviewed here did not give figures for how often sagging returns after a breast lift or how often complications occur. In addition, the ethnicity of the study participants is not stated, so whether the same results can be expected in Korean patients needs to be judged separately.

What to check during your consultation

The plan for a breast lift varies greatly depending on the degree of sagging, the size you want, and how you feel about scars. It is a good idea to check the following during your examination and consultation.

• Your current degree of sagging and the incision pattern that suits it
• The location and length of the scars
• Whether implants will also be used, and whether to do everything at once or in two stages
• Pain management after surgery and the recovery schedule
• Changes that may occur over time and the chance of revision surgery