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Saggy Breasts? With a Breast Lift, Breast Implants or Both?

How to tell if you need a Breast Lift, Breast Reduction or a Breast Augmentation or a combination?

Need to know how to fix saggy breasts? Are your nipples pointing south? How to best fix your saggy breasts!

Overly saggy breasts or droopy breasts are known as breast ptosis. A breast lift is one of the common requests from women with sagging breasts.

Why do breasts sag and droop over time?

  • The most noticeable sagging occurs due to the process called “breast involution.”
  • Breast involution is a process where the milk-making system inside the breast shrinks because it is no longer required.
  • This happens either after weaning or not long after pregnancy if the woman did not breastfeed. It also occurs during menopause.
  • When the tissues inside your breast start to shrink, your breast can look “empty” and saggy

Breast Ptosis: What causes Saggy Breasts?

There are many causes of Breast Ptosis including:

  • Effects of gravity
  • Bouncing on unsupported breasts (not wearing a good bra)
  • Smoking (causes thinning of the skin or dermis)
  • Significant weight loss or pregnancy – ‘over-stretching’ of skin that doesn’t bounce back
  • Number of pregnancies – ‘stretched too many times’ – weakens collagen
  • Larger breast cup size even before pregnancy
  • Ageing of the breast glandular tissues ‘breast laxity’

The amount of ptosis or degree of sagging is partly determined by your inherited characteristics like skin elasticity and breast density.

Some patient’s breasts are denser than others as breasts are made from both heavy breast tissue like mammary glands and body fat. The ratio of these two components influences your breast density and your Breast density can influence the degree of sagging, or Ptosis as denser breasts may sag faster and further over time but other factors may also play a factor.

How to classify Ptosis of saggy breasts

  • Grade 1 Ptosis – MILD – Shape Malformation
  • Grade 2 Ptosis MODERATE – No Bra Support/running is a problem
  • Grade 3 Ptosis SIGNIFICANT – Size change (Stretched post-pregnancy or after significant weight gain/loss)
  • Grade 4 – 5 Allotrophic Skin – Poor collagen strength

Most patients seeking a breast lift are at the moderate or more severe stages of drooping.  Others feel they’ve been left with ’empty bags’ for breasts after breastfeeding.

Others with milder to moderate drooping may decide to combat droopiness for a period of time with a suitably-sized Breast Implant or Lift with Implant (Masto-Aug).

There are several surgical solutions for the Ptotic Breast:

  1. Breast Lift without implants (Mastopexy)
  2. Breast Augmentation (BA) – inserting an implant without re-positioning
  3. Breast Lift with implants (Masto-Augmentation, Masto-Aug or MA.
  4. 5 are severe and require variations of above surgeries and depening upon the individual needs of the patient, occassionally multiple surgeries

Surgeon Experience and Scar Minimisation, the keys to any great.

All invasive surgery leaves a scar, our experienced surgeons use advanced surgical procedures and are specially trained to minimise the extent of any breast surgery scars.

Scars also usually fade away over time and may settle even further over 12 to 18 months to fully settle.

Solution 1 –  Breast Lift without Implants (Mastopexy)

A breast lift repositions the breasts back into a higher position. It’s similar to being in a Bra without being in a Bra.

The Downsides of a Mastopexy

  • Breast Scars (Skin is soft and scars will fade over time).
  • A breast lift will NOT increase fullness or firmness
  • A breast lift will NOT increase breast size (would need a breast implant or additional fat transfer to the breast)

The Upsides of a Mastopexy

  • Your breasts are back where they should be – up higher
  • You’ll look better and feel better in your clothes

Solution 2 – Breast Augmentation Surgery

If your breasts have too much skin and NOT enough internal ‘filling’ tissue, then you CAN correct sagging or drooping with just a Breast Implant under certain guidelines.

There are three specific guidelines for choosing this Surgical Option.

For this option to be best for you, you should ideally pass these criteria tests (and discuss ALL best breast lift surgery options with your Plastic Surgeon):

  1. The Finger or Pencil test – A Breast Augmentation (BA) alone is NOT suitable if you can fit 2 fingers behind your Breast at the crease or inframmary fold (IMF).
    Or if you place a pencil along the breast crease and behind the breast, and it falls, then you PASS the test – but if it stays in place by the weight of the sagging breast, the ‘pencil’ test is failed and there is sagging that will likely require a Breast Lift not solely a Breast Augmentation.
  1. The ‘Hands-on Head’ Test – A Breast Augmentation is NOT suitable if your breasts are still droopy when your hands are on your head. If Breasts still droop when you have your hands over your head, then you’ll likely need a Breast Lift or a Breast Lift with Augmentation.
  2. The IMC Test –  A breast augmentation alone is usually NOT suitable if your nipple falls (droops) below your IMC – inframammary breast crease.

If the implant required is bigger than, for example, a small container of ice cream (e.g., a 400ml+ implant) – then that is TOO big for a BA — and a Breast Lift should be considered.

  • You can get a less-desirable aesthetic result –  re nipple positions & breast shape.
  • There are small incision scars – usually under the crease of the breast.
  • This is a complex operation requiring a very experienced Plastic Surgeon but the advantage is a better result aesthetically.

Solution 4 – Multiple Breast Procedures

Sometimes to get the best result for ptotic breasts – especially if breasts are uneven or asymmetric it is better to do more complex surgery or multiple surgery rather than having multiple costly and ongoing surgeries. After you provide photos of your chest as requested and your medical information, at Nip Tuck Holidays we discuss with you the options so you have realistic expectations about what Breast Surgery can and cannot accomplish for your body or breasts t you may look like after Breast Augmentation Surgery or Mastopexy.

Cosmetic surgeon applying protective bandage round client breasts after surgery


If you have a breast implant, large heavier breasts or just dense breast tissue, it’s like having a bowling ball inside a thin shopping bag. And no matter what you do, our Surgeons believe you’ll need to wear a good bra ALL the time (except for sleeping) or further sagging and re-drooping of your breasts is likely.

Gravity will always win.

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