Over the years, diets or pregnancies, the breasts sag, lose their shape and volume. What are the techniques to remedy it? What are the risks of these interventions? How much is the bill? We take stock with Olivier GERBAULT, cosmetic surgeon at the Policlinique Esthétique Marigny Vincennes.

Breast ptosis is a sagging breasts in women. We distinguish:

Constitutive breast ptosis

It is generally familial. “Two risk factors are often identified: breast enlargement (ie having a large breast) associated with thin and / or not very elastic skin. For example, women with fair skin like redheads often have more fragile skin which sags, marks and stretch marks more quickly, ”explains Doctor Olivier Gerbault, cosmetic surgeon in Paris;

Acquired breast ptosis

“The breasts start to drop over time. The risk factors are those related to age, to unwanted weight changes (repeated diets), to menopause, and last but not least to pregnancies (and breastfeeding) “, specifies the specialist.

Breast hypoplasia

Breast ptosis can be accompanied by breast enlargement: in this case the breasts are large and sagging. Sometimes, on the contrary, it is associated with an insufficiency (or a loss) of volume (in particular after a diet or a pregnancy): “We speak of mammary hypoplasia. This is the washcloth effect, which is a real complex for patients who end up consulting for surgery, ”says Doctor Gerbault.

Sagging breasts may be related to:

A particularly voluminous chest

“In this case, the breasts can fall as early as puberty. Very often a very rapid increase in volume is characteristic ”, emphasizes the practitioner. The sagging is then linked to the inability of the skin to support the mass of adipose and glandular tissue: “The quality of the skin is decisive in breast support”.

Weight variations 

The breast is made up of glands and fat: losing or gaining weight adds or takes away the fatty component of the breasts. Diets but also weight variations related to pregnancy or menopause are the most common causes of breast ptosis. “Beware of rapid weight gain: when the chest begins to show some stretch marks, the skin is saturated”.

Hormonal variations

Like puberty, pregnancy or menopause.

The age

“Over time the production of collagen and elastic fibers becomes depleted, the skin loses its elasticity. The cleavage wrinkles and the breasts sag ”.

Breastfeeding during pregnancy

“It is a major risk factor for breast ptosis”.

“The only way to prevent the phenomenon of breast ptosis is to pay attention to the stability of your weight. Wearing a brassiere or adapted bras is also a means of reducing risks, ”according to Dr. Gerbault. Taking care of your healthy lifestyle is a guarantee of keeping the elasticity of your skin as well as possible. Moisturizers tailored to the cleavage can help. Exercises to firm the pecs (located under the fat) can help support the breasts. However, cosmetic surgery remains the only effective means of correcting proven breast ptosis ”.

The symptoms of breast ptosis are:

Breasts are large and too low

The tip of the nipple can descend very low, sometimes to the navel.

Asymmetric sagging breasts

Sometimes one breast “falls more than the other. Breast asymmetry is often associated with ptosis ”.

Sagging associated with a lack of volume

Also characterized as “breasts in washcloths”. “Generally the breasts can lose volume from above, hence the appearance of flat breasts”.

The other signs

Other signs may be added such as neckline wrinkles, stretch marks, the impression of a sagging nipple or strained…

Breast surgery is only possible once puberty is over (around 17 or 18 years old). The surgeon gives an estimate with the details of the intervention. Once the estimate has been made, a withdrawal period of two weeks must be respected before performing the operation. The nature of the surgical procedures differs depending on the defects that bother the patient. Three scenarios can arise:

Breast ptosis associated with breast enlargement

This is the case with very large breasts: “in this case the surgical intervention consists in reducing the breast volume and reshaping the skin on this new glandular volume (reduction mammary plasty)”.

Breast ptosis without breast enlargement

“In this case, the operation consists of ‘redraping’ the skin and reshaping the mammary gland without removing it: we speak of mastopexy”, according to the cosmetic surgeon.  

Breast ptosis associated with small breasts

“If they fall a little bit, it suffices to add volume using prostheses filled with silicone gel or physiological serum or by injection of fat (lipofilling). If they fall a lot, a mastopexy can be associated in addition to the prostheses and the addition of fat ”.

Before the operation, it is recommended:

• To quit smoking at least two months before the surgery: “if the patient smokes she will have much more difficulty healing properly and may have visible scars”;
• De stop the contraceptive pill a few weeks before the operation (this predisposing to the risk of phlebitis and embolism);
• De disinfect his skin with an antiseptic solution prior to the operation (biseptine® bath);
• To do mammogram before to detect a lesion of the breasts which could call into question a cosmetic surgery of the breast, at least initially.

“Contrary to popular belief, the risk of breast cancer is absolutely not increased with breast surgery. It is not incompatible with a subsequent pregnancy either, even if a pregnancy is not recommended in the months following surgery, ”says the expert. The possible post-operative complications are:

• Accidents linked to anesthesia (pulmonary embolism, phlebitis, etc.);
• Poor healing: necrosis, keloid scars (abnormal proliferation of skin tissue);
• A nosocomial infection or disease;
• A chronic expansive hematoma (increase and persistence of an initial hematoma for more than a month, it can generate swelling and require a second intervention).

“The patients are generally satisfied with the result which is in line with their expectations”, emphasizes the practitioner. The breasts are higher and have a firmer appearance, the neckline is lightened in case of hypertrophy or on the contrary gains in volume in case of hypoplasia.

“In the case of breast reduction and mastopexy, there may be a vertical scar which goes from the mammary areola to the breast fold and sometimes a second scar under the breast fold: we therefore have a T scar inverted. This is one of the obligatory normal consequences of these interventions. as soon as the breasts are notably sagging ”.

After the intervention, the result is maintained, if the patient maintains a healthy lifestyle and a stable weight.

 The prices of this type of intervention vary depending on the work to be done and the surgeon’s proposals to achieve a satisfactory result. They range from around 2500 to 6500 euros.

The reimbursement depends on the functional discomfort caused by the patient’s chest. “In practice, when the patient has a large breast and requires a reduction of more than 300 g of fat, there is a support”, explains the specialist. However, there is generally no reimbursement by social security when the intervention consists of an enlargement of the breasts or a simple masopexy.