Are my breasts too saggy for implants without a lift?

I think my breasts may be too saggy to get implants without what I think is called a breast lift. What are some of the clear symptoms of saggy breasts that I can apply to what I see at home? This way I can make sure I know what I am getting myself into before going into a doctors office.


F, 36, Utah

Tags:age 25-34 sagging breasts home treatment

It is hard to get a idea of the amount of sagging you have based on your photo, because of the shirt that you are wearing.  It does appear that you have some ptosis (sagging) but how much is impossible to tell.  The best thing for you to do would be to set up a consultation with a board certified plastic surgeon, who can examine you and decide which course of action is best for you to take. 

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Many women mistakenly think that a breast augmentation procedure on its own is capable of both lifting and enhancing the size of their breasts. Unfortunately, if your breasts are already showing signs of sagging or drooping, then it’s likely you need breast lift surgery or mastopexy performed in conjunction with a breast augmentation to achieve the results you desire.

Breast sagging or breast ptosis occurs as a result of gravity, age, and loss of skin elasticity. It can be exacerbated by factors such as wearing a bra that doesn’t provide adequate support, smoking, losing a significant amount of weight, or pregnancy. Your genetics will also govern the extent to which you experience breast ptosis, as skin elasticity and breast density are inherited characteristics. Some patients have denser breasts than others, which means they may sag faster and droop more over time.

Breast sagging can be classified according to the following categories.

  1. Grade 1 ptosis: Mild sagging
  2. Grade 2 ptosis: Moderate sagging. May be apparent during activities such as jogging.
  3. Grade 3 ptosis: Significant sagging. Stretching of the breast skin is evident and the size of the breast has changed as a result of weight loss or pregnancy
  4. Grade 4 ptosis: Severe sagging with the nipple position at the lowest point of the breast.
  5. Pseudoptosis. This is not true sagging, but occurs because the nipple lies above or at the level of the inframammary fold, while the majority of the breast has descended below the level of the fold.

In general, if you are seeking breast augmentation and have moderate to significant breast sagging a breast lift is usually necessary. Women with mild to moderate drooping can sometimes achieve beautiful results with implants alone but should be aware that further sagging is likely with the added weight of the implant and the passage of time. Most board-certified plastic surgeons will encourage patients who have sagging breasts to undergo mastopexy for the best possible result and greater longevity.

If you would like to test the extent of your breast ptosis at home, you can try these simple self-exams. If you can fit two fingers behind your breast at the breast crease, then you are probably not a good candidate for a breast augmentation alone. If you place a pencil at the breast crease behind the breast and it stays in place due to the weight of the sagging breast, then you most likely require both a breast lift and breast augmentation. Schedule an appointment with a board-certified plastic surgeon who specializes in breast surgery to determine the best option for you.

Breast sagging can be caused by a range of factors. It can be genetic or exacerbated by smoking, age, insufficient support during exercise, pregnancy, or extreme weight loss. Women with larger or dense breasts may be prone to more sagging. In most cases, women who want to undergo breast augmentation but present with sagging breasts will require a lift performed in conjunction with implant surgery to achieve an aesthetically pleasing result.

Occasionally some breast lift may be achieved with implants alone. Women with too much skin and insufficient glandular tissue can undergo augmentation and have a small implant inserted which will help to fill out the breast. To qualify for this procedure, the nipple should not fall below the inframammary fold. A board-certified plastic surgeon can determine after an initial examination if you are a candidate for breast augmentation without a lift.

If you would like to check for breast sagging at home, you can perform the pinch test. Use your right hand to check your left breast, and vice versa. Place the tips of your right middle and ring fingers in the center of the breast crease under the breast, in line with your nipple. Slide your fingertips up to the junction of the bottom of the breast and the abdominal skin without pushing the breast in an upwards direction. Your thumb should be at the front of the breast throughout.

Bring the thumb tip towards the tips of the middle finger and then lightly pinch the breast. If the thumb pinches below the nipple, a breast lift is most likely not necessary and an implant will provide adequate fullness while still supporting the nipple. If the thumb touches the breast above the nipple, a breast lift is probably needed. The nipple should ideally be positioned at the front of the breast, above the inframammary crease. If it is beneath, a breast implant will further push the nipple down the breast, which is aesthetically unattractive.

Augmentation increases breast volume, but only a lift can improve the breast shape and reposition the breasts higher on the chest wall to give the best results. Not only will your cleavage be fuller but you will look and feel better in your clothes. When performed by an experienced board-certified surgeon, the results can be beautiful.

Breast augmentation surgery can often deliver better results when performed in conjunction with a breast lift if you suffer from moderate to severe droopy breasts. A breast lift, also known as mastopexy, trims excess breast skin and sagging glandular tissue and raises the nipple areola complex to a higher position on the breast. Breast augmentation performed in conjunction with a breast lift is essential if you wish to have perky, youthful-looking breasts and upper pole fullness.

There are different degrees of breast sagging, ranging from mild to severe. One of the main symptoms indicating that your breasts are sagging is nipple position: nipples that point downward or are positioned below the breast fold are common in sagging breasts. There are straightforward tests you can carry out at home to check whether you require a breast lift in addition to augmentation surgery.

The pencil test is one of the most common tests--take a pencil and place it at the inframammary fold (the line where your breast finishes and your upper abdomen begins). If the pencil falls, it’s a sign that you don’t suffer from breast sagging. If it remains in place because it is held by the weight of the breast on top of it, then you may need to consider mastopexy and breast augmentation surgery.

There are different surgical methods to address sagging breasts, and your cosmetic surgeon will determine the best form of treatment for you based on the severity of your individual case. Beware of plastic surgeons who tell you that you can achieve good results with breast augmentation alone: if you already have sagging breasts and intend to augment your breasts with large implants, the sagging will only worsen.