What Is Ptosis?
Ptosis is the medical term for breast drooping. It results from stretching of Cooper's ligaments and skin relative to the underlying glandular tissue, causing the breast to descend on the chest wall. It develops naturally with age, pregnancy, breastfeeding, significant weight loss, and is accelerated by large breast volume — whether natural or implanted. Ptosis is graded on a standardised three-grade scale based on the position of the nipple relative to the inframammary fold.
Ptosis Grading
- Grade I (Minor): Nipple at the level of the inframammary fold
- Grade II (Moderate): Nipple below the fold but above the lowest breast contour
- Grade III (Severe): Nipple below the fold and at the lowest breast contour; inferiorly displaced
- Pseudoptosis: Nipple at or above the fold but lower pole tissue descends below — common post-weight loss
Mastopexy Techniques
Multiple mastopexy techniques exist, differentiated by the incision pattern and degree of tissue repositioning. The periareolar (Benelli) lift addresses mild ptosis through a ring incision around the areola. The vertical scar (lollipop) lift addresses moderate ptosis. The anchor (Wise pattern) lift addresses severe ptosis and provides the most substantial tissue repositioning at the cost of the most scarring. Surgeons choose technique based on ptosis grade, breast volume, and skin quality.
Augmentation Mastopexy
Simultaneous augmentation and lift is technically demanding — the two procedures have competing objectives (implants create internal pressure that can stress mastopexy sutures; lift tightens tissue that the implant needs to stretch). Some surgeons prefer staging the procedures. The combination is popular because it addresses both volume and position in a single operation when carefully planned.
Mastopexy After Large Implant Removal
Explantation after extreme volumes predictably results in significant ptosis due to the extensive skin and ligament stretching the implants produced. Mastopexy is almost always required concurrently or following explantation to achieve an acceptable aesthetic outcome.
