Introduction The falling, sagging breasts (or “breast ptosis” in medical terms) is an anatomical occurrence that takes place at the level of the breasts often poorly tolerated by women. The breasts look like they are empty or deflated and the skin envelope collapses hence giving the appearance of sagging breasts. With the breasts being the symbol of womanhood, sagginess of the breasts is often perceived as an absence of femininity, and it can be the origin of emotional complexes that can put a stain on the quality of life of the patient. From a surgical point of view, mammary ptosis is linked to a gland that has lost its volume and a skin envelope that is too large for it. The correction can only be done by remodeling the gland and removing the excess skin, hence the inevitable presence of scars. The procedure used to treat saggy breasts is called a mastopexy or breast lift. How can breast ptosis be corrected and the breast volume increased? The only way to increase breast size during the treatment of breast ptosis is to add breast implants. It is important to know that elevation of the breasts and the centering of the gland causes a loss of about 20% of the volume of the breasts. Therefore, the question of the placement of an implant to restore volume is more frequent than expected. Are breast implants enough to correct the breast ptosis? The implants will fill the breast and give it a lifting effect but without actually raising them. The breasts will appear fuller and perkier, but this method (called breast lift surgery or mastopexy) can give excellent results only in the case of a mild breast ptosis. The scarring is also minor when this procedure is performed. What are the scars left behind after this procedure? There are now three types of scars possible after a breast ptosis surgery: The periareolar scar: this is a scar that goes around the areola. The vertical scar: it goes from the periareolar scar in a vertical line that descends to the inframammary fold. The inframammary fold scar: this is the scar performed at the level of the inframammary fold, hence hidden in the natural folds of the body. The periareolar scar is only intended for mild mammary ptosis. The vertical scar is intended for medium breast ptosis. The inframammary fold scar is necessary in case of severe mammary ptosis. Will the scars fade over time? By definition, scars never really disappear, but they will fade within the first year after the surgery was performed. They look like fine lines in the beginning that will get red and thicken for about a month. From the second month, they will become thinner and gradually fade to become a color closer to the surrounding skin tissues after six months to a year. The most visible scars are the periareolar and vertical ones since the tension is most significant at this level. The horizontal scar of the anchor is the least visible due to the lack of tension at this level. What types of anesthesia can be administered? We recommend the breast ptosis correction surgery to be performed with the patient under general anesthesia. Local anesthesia is not feasible in this case as the procedure can be quite lengthy and the patient should be comfortable during the intervention. What are the surgical risks associated with breast ptosis surgery? Hematoma: this is a collection of blood at the level of the surgical area that usually occurs within 24 hours of surgery. This complication may require surgical intervention if it is of a big size. However, if drain tubes are placed on either side of the breasts, this risk can be eliminated in some cases. Infection: it generally occurs from the third day, the breasts becoming red and painful at the level of the surgical wound. The treatment is usually local, but antibiotics will also be prescribed to avoid or treat the infection. Delayed wound healing at the level of the areola: this happens especially when the patients smoke or in the cases where the breasts are very saggy. The recommendation for smokers is to quit smoking for at least three weeks before surgery to allow for the wounds to heal properly. Can the breasts become saggy again after a mastopexy procedure? An experienced plastic surgeon will do the correction of the breast ptosis in such manner that it will be as durable as possible over time. It is reasonable to expect that the satisfactory result will last for ten years. However, keep in mind that the procedure corrects but does not resolve permanently the process of sagging of the mammary gland and altering the skin over time. The result is therefore not definitive and also depends on the quality of the skin of each patient. Additional factors might influence the sustainability of your results in time such as the natural aging process, weight fluctuations and ulterior pregnancies. Is there any effect on the sensitivity of the breasts? The intervention may have an impact on the sensitivity of the breasts but this repercussion is most often temporary. A recovery of sensitivity is observed after a few months in the majority of cases. In very rare situations, the recovery of initial breast sensitivity may be incomplete. Is breastfeeding possible after surgery? Many patients who want to undergo this procedure often ask this question. However, there is no “yes” or “no” answer to it. Before scheduling the procedure consider that your breastfeeding abilities might be compromised. Usually when there is a case of mild or moderate breast ptosis, the breastfeeding can still occur after surgery, but it all depends on the techniques used during the procedure. However, it is strongly recommended to wait at least one year before getting pregnant again to stabilize the result. It is also important to keep in mind that breast sagginess can occur again after childbirth. How do I know if I need a breast lift surgery? During the first consultation, the plastic surgeon will ask about your medical history to rule out any contraindications of the procedure. He will also examine the chest and evaluate the degree of breast ptosis. In some cases, he might suggest the use of breast implants during the breast lift surgery to add more volume to the breasts. Lipofilling can also be used – it involves injecting the patient’s own fat into the breasts to increase the volume. The fat is harvested with liposuction from other areas of the body where there is an excess of fat deposits. In most cases, if your nipple and areola complex is facing down and a significant part of the mammary gland is under the normal level, then you might need to undergo a breast lift procedure to correct saggy breasts. This first appointment must provide the patient with the necessary elements to make an informed decision. Often a second appointment might be needed to get all the information and the recommendations for the surgery. It is always a good idea to choose a plastic surgeon that is board-certified and highly experienced to play out your intervention if you want to achieve superior aesthetic results. The breast lift surgery is a complex and delicate intervention that should only be performed by a plastic surgeon in an accredited medical facility. Conclusion The mastopexy or breast lift is the surgical procedure that is used to treat breast ptosis or the sagginess of the breasts. The breast sagginess can occur as a result of multiple pregnancies, weight fluctuations, the natural aging process, genetic predispositions or a large volume of the breasts that puts tension on the ligaments. The only efficient method to treat saggy breasts is with this plastic surgery intervention. During the breast lift, the plastic surgeon will remove the excess skin at the level of the breasts which can lead to a loss of approximately 20% of its initial volume. The patient needs to understand that the breasts will look smaller after the breast lift surgery. However, if you want to add more volume to the breasts, implants can be introduced during the procedure. This will result in bigger, perkier, and more elevated breasts right after the surgery. The breast implant surgery on its own can correct breast sagginess. However, this is only possible if the degree of breast ptosis is mild. For moderate and severe breast ptosis, the breast implant surgery will be associated with a breast lift. Otherwise, the result might be even saggier breasts that look like sand bags due to the volume added by the implants. The results of the procedure can be maintained for a long time, but whether they are permanent or not depends on many factors such as the age of the patient, ulterior pregnancies or weight fluctuations.