Introduction Breasts hanging low on the chest wall with an empty appearance? Nipples that are facing downward instead of forward with a large areola? Yes, we know how unpleasant this appearance can be; however, these are the signs of breast ptosis, and this condition tends to affect all women sooner or later in their lives. Saggy breasts are associated with old age and lack of sex appeal and youthfulness, and this is the reason why the breast lift is so in demand nowadays. Women from all over the world are scheduling their mastopexy each day in the hope of getting perkier breasts that are more elevated on the chest wall and with a pleasant-looking shape. When breast ptosis occurs, it is not just the position of the breasts on the chest wall that is affected, but also their shape. In this article, we will discuss the shape of the breasts during ptosis and what we can achieve with a mastopexy. Shape of the breasts affected by breast ptosis It is not just the sagginess that bothers women confronted with breast ptosis, but also the empty look of the breasts. When breasts are affected by ptosis, they tend to lose their beautiful shape, all the upper pole volume is lost, and the majority of the mammary gland is positioned below the inframammary fold. The base of the breasts is wide and the upper pole is just empty, saggy skin and not much else. This means that when not wearing a bra, the appearance of the breasts is an unwelcoming one. Women confronted with this issue tend to prefer bras with a lot of support and full cups and also tend to avoid getting their clothes off, even in intimate situations or when going to the beach. It is not easy for a woman to deal with a loss of breast appeal, especially considering the fact that the breasts are the most important symbols of femininity and sex appeal. When it comes to breast sagginess, there is little that can be done to prevent it as we don’t even know all the factors that could cause it. What we know for sure is that weight fluctuations, pregnancies and breastfeeding, as well as gravity, can have an effect on the breasts. Aside from these, there are also other factors that have been associated to a certain degree with breast ptosis. Among them are smoking, not wearing the right fit and size of bra, exercising or doing sports without proper support for the breasts, genetical inheritance, and so on. So, how can the breast lift help and how is it performed? How is mastopexy performed? The breast lift is a complex procedure that often requires the patient to be under the effects of general anesthesia to avoid feeling discomfort and pain during the procedure. The procedure can be performed in as little as an hour and a half, but can also last as long as four hours, depending on the complexity of each case, the expected results, and the level of breast ptosis. The first step is creating the incisions. There are different surgical plans that can be followed, and each patient will be recommended a specific type of procedure according to her unique anatomical characteristics, the severity of breast ptosis, and the amount of skin to be eliminated. In general, the incisions can be localized around the areola, vertically from the areola’s edge to the inframammary fold. The incisions can have different shapes, depending on the experience of the plastic surgeon and his preferred technique. After the incisions are performed, the skin envelope of the breasts is detached from the mammary gland tissue to allow the plastic surgeon access. The glandular tissue will be re-centered and elevated on the chest wall. Once this step has been performed to the doctor’s satisfaction, the skin envelope will be re-draped over the breasts. The excess skin is eliminated, the incisions are sutured, and dressings are applied over the surgical wounds. A special post-op bra will mandatory to be worn non-stop for a minimum of three weeks after the breast lift. Effects of mastopexy on the shape of the breasts The recovery period after mastopexy often takes no longer than two weeks. During these first two weeks, patients are advised to keep a strict hygiene on the incision site, not smoke, not sleep on the tummy, and avoid performing any strenuous physical activities. These instructions are given with the purpose of helping patients avoid complications after the breast lift. While the recovery period is rather short, this doesn’t mean that the final results will be visible after these first two weeks. It can take up to six and even nine months for the final results to be fully visible. The first month post-op, patients will notice that the breasts are still bruised and swollen as a result of the surgical trauma. Moreover, the incisions can change colors and look even worse than immediately after the procedure. This is a normal stage of the healing process and nothing to worry about. The patient will have to see the plastic surgeon the next day after the procedure, and then after a week and a month to allow him to monitor the recovery process and ensure things are going according to plan and complications are avoided. The results that are visible after three months after are close to the final results. At the three month follow-up with the plastic surgeon, he can assess the shape of the breasts as it is unlikely that it will change after this period of time. It is important for patients to know what to expect in terms of the shape of the breasts after the procedure so as not to be disappointed after undergoing the procedure. Before anything else, it is important to understand what perky breasts mean as many patients tend to associate perkiness with upper pole fullness. Perky breasts are breasts that are on the correct position on the chest wall and with the mammary gland situated above the inframammary fold. But this doesn’t mean upper pole fullness in all cases. The appearance and shape of the breasts will be determined by the natural shape of your breasts and their consistency. There are limitations to what the plastic surgeon can achieve as he works with your tissues. This is the reason why patients with clear expectations in terms of the shape of the breasts post-op can be advised to get implants at the same time with mastopexy. The benefits of getting implants with mastopexy are that we can fully control the shape of the breasts, especially when using the new Gummy bear implants that are the modern generation of implants. Using implants with certain characteristics such as profile and shape, we can help patients achieve exactly the shape they desire, despite their anatomical characteristics. Conclusion When it comes to the shape of the breasts affected by ptosis, often it is not a welcoming one as the breasts look empty, with a wide base and no upper pole fullness. The majority of the glandular tissue is concentrated on the upper part of the breasts, sometimes hanging low below the inframammary fold. Undergoing the breast lift will have an effect on the shape of the breasts too and not only their position on the chest wall; however, patients are advised to have realistic expectations. Some patients think that undergoing the breast lift is similar to a breast augmentation and they can choose the shape of their breasts as they desire. This is not possible, and during the breast lift, the plastic surgeon will elevate and re-center the mammary gland tissue and give the breasts a perkier appearance. The mammary gland will be re-centered higher on the chest wall, and it will be above the inframammary fold, but this is not a guarantee for upper pole fullness. If the patient has a strong desire towards a specific shape of the breasts, it is important to discuss this aspect in detail with the plastic surgeon during the pre-operative consultation as the doctor might recommend getting implants together with the breast lift. This is a popular option nowadays, and it allows for full control over the shape of the breasts post-op.