Breast ptosis, pregnancy and breastfeeding: what you need to know

Breast ptosis, when the breasts “sag”

We talk about breast ptosis in case ofsagging chest, when the breasts fall below the breast base, that is to say the fold located under the breast.

Some plastic and cosmetic surgeons suggest breast ptosis when the patient can hold a pen between the base of the breast and the skin under the breast, although this criterion is not scientific.

«Ptosis is indeed a problem of shape and not of breast volume. It can exist for breasts of any size«, explains Professor Catherine Bruant-Rodier, professor of reconstructive and aesthetic plastic surgery at the Strasbourg University Hospital. “When the breast is very large, there is always an associated ptosis, due to the weight of the gland. But ptosis can also exist with a breast of normal volume. The skin that contains the gland is distended, stretched. Even a small breast can be ptotic. It seems “emptied”, she adds.

In breast ptosis, the skin that contains the mammary gland is distended, stretched, emptied. Surgeons speak skin case unsuitable for breast volume. The mammary gland is located in the lower part of the breast, and the nipple and areola reach the level of the inframammary fold, or even below. In colloquial language, we often hear the unflattering term “breasts” in “Wash cloths“.

The causes and risk factors of breast ptosis

There are different factors that increase the risk of breast ptosis, or that explain the appearance of this phenomenon:

• la genetic, this sagging is then congenital;
• of the weight variations (weight gain or weight loss) which lead to variations in the volume of the gland and distension of the skin sheath, which sometimes can no longer retract;
• pregnancy or breastfeeding, since both increase the size and the cutaneous pocket of the breasts, and are sometimes accompanied by a melting of the mammary gland a posteriori;
• a large chest (hypertrophymammary) which distends the skin sac containing the mammary gland;
• age, since the skin loses elasticity over the years.

Ptosis cure: how is the surgery to raise the breast?

The breast ptosis cure, also called mastopexy or breast lift, takes place under general anesthesia and lasts between 1 hour 30 and 3 hours.

Before the operation, the surgeon talks with the patient to determine what is possible and what she wants. Because the correction of ptosis corrects the size and shape of the skin, but also, if necessary, the glandular volume. Surgery can thus be associated with the fitting of prostheses or with lipofilling (via liposuction) if a breast augmentation is desired, or on the contrary with the ablation of a small gland if a breast reduction is desired. .

In all cases, a breast assessment is necessary to ensure the absence of pathology in the breasts (cancer in particular). “At a minimum, we ask for a breast ultrasound in young women, associated with a mammogram or even an MRI in an older woman.”, Explains Professor Catherine Bruant-Rodier, professor of reconstructive and aesthetic plastic surgery at Strasbourg University Hospital.

There is no major contraindication, apart from having poor healing quality yourself.

On the other hand, it should be kept in mind that the breast ptosis cure, like any surgery, involves risks, even if they are quite low (hematoma, necrosis, permanent loss of sensitivity in the nipple, infection, asymmetry, etc.). Note that tobacco increases the risk of complications.

A scar that depends on the degree of ptosis

The type of incision and the surgical technique performed in the case of a correction of breast ptosis depends on the degree of ptosis:

• if the ptosis is mild, in other words that the nipple arrives at the level of the submammary fold, the incision will be peri-areolar, that is to say around the areola (one speaks about technique of the “round block”);
• if the ptosis is moderate, the incision will be both peri-areolar, around the areola and vertical, that is to say from the areola to the inframammary fold;
• if the ptosis is severe, and the skin to be removed is very large, the operation will include a periareolar incision, to which will be added a vertical incision and an inframammary incision, in other words around the areola and in an inverted T. We also speak of scar in marine anchor.

Note that the intervention also depends on breast volume and the patient’s wishes: if she only wants a correction of the ptosis, or if she also wants a breast augmentation (with addition of prosthesis or injection of fat called lipofilling), or on the contrary a reduction in breast volume.

What bra can you wear after breast ptosis?

Postoperatively, cosmetic surgeons generally recommend wearing a non-wired bra, such as a cotton brassiere. Some surgeons prescribe a support bra, night and day, for at least a month. The objective is above all to hold the bandages, do not compromise healing and not to hurt. It is recommended to wear a bra until the scars are stable.

Breast ptosis: should you have an operation before or after pregnancy?

It is possible to get pregnant and carry out one or more pregnancies after a breast ptosis treatment. However, it is however strongly advised to avoid becoming pregnant during the year following surgery, for optimal healing. In addition, pregnancy and breastfeeding increase the risk of breast ptosis, it is possible that, despite the correction of breast ptosis, a new pregnancy causes sagging of the breasts. 

What about a correction of ptosis in the young girl?

In young women, the breasts must be stabilized at their size, the breasts must not have changed for one to two years, says Professor Bruant-Rodier. But if this condition is met, it is possible to have an operation for breast ptosis from the age of 16-17 years, if you are really embarrassed, if this ptosis is very important and especially since ‘it is accompanied by an enlargement which causes back pain …

Ptôse and breastfeeding: can we breastfeed after surgery?

You should know that, in some women, surgery for breast ptosis can lead to “loss of sensitivity in the nipple and areola”, Underlines Professor Bruant-Rodier. “If the mammary gland has been affected, especially when breast reduction has been performed because of an enlarged breast, breastfeeding may be more difficult than normal, but not necessarily impossible“. The importance of the ptosis and therefore the surgical procedure performed would inevitably influence the success of breastfeeding.

Milk production may be imperfect or insufficient because the milk ducts (or milk ducts) may have been affected, and the mammary gland insufficient if there has been breast reduction. In short, breastfeeding is not guaranteed after a correction of breast ptosis, and even more so if this surgery was accompanied by breast reduction. The more glandular tissue is removed, the more likely it is to breastfeed successfully. But, a priori, the correction of a slight ptosis does not prevent breastfeeding. Either way, breastfeeding can be attempted.

Ptosis, prosthesis, implant: getting good information for successful breastfeeding

In any case, it may be particularly interesting for young mothers who have already undergone breast surgery (for ptosis, breast enlargement or hypertrophy, removal of a fibroadenoma, breast cancer, etc.) to call on a lactation consultant. It will thus be possible to assess the tips to put in place so that breastfeeding goes as smoothly as possible, depending on the type of surgery performed. This will include see if the baby is getting enough food, and to set up optimal latching of the baby (breastfeeding positions, Lactation aid device or DAL if necessary, breast tips, etc.). So that even if the baby is not exclusively breastfed, it benefits as much as possible from breast milk.

Breast ptosis: what price to rebuild the breast?

The cost of a breast ptosis treatment depends on the structure in which it is carried out (public or private sector), any fees of the plastic surgeon, the anesthetist, the price of the stay and any additional costs (room only, meals , television etc.).

Breast ptosis: treatment and reimbursement

When it is not accompanied by a breast reduction, the breast ptosis cure is not covered by Social Security.

Seul removal of at least 300 grams (or more) of tissue per breast, as part of a ptosis cure associated with breast reduction, allows reimbursement by health insurance and mutual funds. When it comes to operating a mild ptosis without removing a gland, the health system considers it to be purely cosmetic surgery.