Ptosis (breasts)

Last updated
Breast ptosis
Other namesCooper's droop [1]
Ptosis.jpg
Specialty Plastic surgery
Treatment Mastopexy

Ptosis or sagging of the female breast is a natural consequence of aging. The rate at which a woman's breasts drop and the degree of ptosis depends on many factors. The key factors influencing breast ptosis over a woman's lifetime are cigarette smoking, her number of pregnancies, higher body mass index, larger bra cup size, and significant weight change. [2] [3] Post-menopausal women or people with collagen deficiencies may experience increased ptosis due to a loss of skin elasticity. Many women and medical professionals mistakenly believe that breastfeeding increases sagging. It is also commonly believed that the breast itself offers insufficient support and that wearing a bra prevents sagging, which has not been found to be true. [4]

Contents

Plastic surgeons categorize the degree of ptosis by evaluating the position of the nipple relative to the infra-mammary fold, the point at which the underside of the breasts attach to the chest wall. In the most advanced stage, the nipples are below the fold and point toward the ground.

Signs and symptoms

A woman's breasts change in size, volume, and position on her chest throughout her life. In young women with large breasts, sagging may occur early in life due to the effect of gravity. It may be primarily caused by the volume and weight of the breasts which are disproportionate to her body size. [2]

Impact of pregnancy

During pregnancy, the ovaries and the placenta produce estrogen and progesterone. These hormones stimulate the 15 to 20 lobes of the milk-secreting glands in the breasts to develop. Women who experience multiple pregnancies repeatedly stretch the skin envelope during engorgement while lactating. As a woman's breasts change in size during repeated pregnancies, the size of her breasts change as her mammary glands are engorged with milk and as she gains and loses weight with each pregnancy. [5] In addition, when milk production stops (usually as a child is weaned), the voluminous mammary glands diminish in volume, but they still add bulk and firmness to the breast. A 2010 review found that weight gain during pregnancy and breastfeeding were not significant risk factors for ptosis. [3]

Middle-aged women

In middle-aged women, breast ptosis is caused by a combination of factors. If a woman has been pregnant, postpartum hormonal changes will cause her depleted milk glands to atrophy. Breast tissue and suspensory ligaments may also be stretched if the woman is overweight or loses and gains weight. When these factors are at play, the breast prolapses, or falls forward. When a woman with sagging breasts stands, the underside or inferior skin of the breast folds over the infra-mammary fold and lies against the chest wall. The nipple-areola complex tends to move lower on the breast relative to the inframammary crease. The nipple of the breast may also tend to point downward.

Post-menopausal women

In post-menopausal women, breast atrophy is aggravated by the inelasticity of over-stretched, aged skin. [6] This is due in part to the reduction in estrogen, which affects all body tissues, including breast tissue. The loss of estrogen reduces breast size and fullness. Estrogen is also essential to maintaining a fibrous protein called collagen, which makes up much of the breast's connective tissue.[ citation needed ]

Ptosis scale

Stages of ptosis Stades de affaissement.png
Stages of ptosis

Plastic surgeons describe the degree of breast sagging using a ptosis scale like the modified Regnault ptosis scale below: [7] [8]

Causes

University of Kentucky plastic surgeon Brian Rinker encountered many women in his practice who attributed their sagging breasts to breastfeeding, which was also the usual belief among medical practitioners. [9] He decided to find out if this was true, and between 1998 and 2006 he and other researchers interviewed 132 women who were seeking breast augmentation or breast lifts. They studied the women's medical history, body mass index (BMI), their number of pregnancies, their breast cup size before pregnancy, and smoking status. The study results were presented at a conference of the American Society of Plastic Surgeons. [2] [10]

According to Rinker's research, there are several key factors. A history of cigarette smoking "breaks down a protein in the skin called elastin, which gives youthful skin its elastic appearance and supports the breast." The number of pregnancies was strongly correlated with ptosis, with the effects increasing with each pregnancy. [2] As most women age, breasts naturally yield to gravity and tend to sag and fold over the inframammary crease, the lower attachment point to the chest wall. This is more true for larger-breasted women. The fourth reason was significant weight gain or loss (greater than 50 pounds (23 kg)). [2] Other significant factors were higher body mass index and larger bra cup size. [11]

In Rinker's study, 55% of respondents reported an adverse change in breast shape after pregnancy. Many women mistakenly attribute the changes and their sagging breasts to breastfeeding, [12] and as a result some are reluctant to nurse their infants. Research shows that breastfeeding is not the factor that many thought it was. [2] Rinker concluded that "Expectant mothers should be reassured that breastfeeding does not appear to have an adverse effect upon breast appearance." [2] Also discounted as causes affecting ptosis are weight gain during pregnancy and lack of participation in regular upper body exercise. [11]

Effect of vigorous exercise

When running, breasts may move three-dimensionally: vertically, horizontally and laterally, in an overall figure-8 motion. Unrestrained movement of large breasts may contribute to sagging over time. [5] Motion studies have revealed that when a woman runs, more than 50% of the breast's total movement is vertical, 22% is side-to-side, and 27% is in-and-out. [13] A 2007 study found that encapsulation-type sports bras, in which each cup is separately molded, are more effective than compression-type bras, which press the breasts close to the body, at reducing total breast motion during exercise. Encapsulation bras reduce motion in two of the three planes, while compression bras reduce motion in only one plane. [14] Previously, it was commonly believed that a woman with small to medium-size breasts benefited most from a compression-type sports bra, and women with larger breasts need an encapsulation-type sports bra. [13]

Mechanism

Anatomically, a female's breasts do not contain any muscle but are composed of soft, glandular tissue. Breasts are composed of mammary glands, milk ducts, adipose tissue (fat tissue) and Cooper's ligaments.

Mammary glands remain relatively constant throughout life. Fat tissue surrounds the mammary glands, and its volume will normally vary throughout life. Although the exact mechanisms that determine breast shape and size are largely unknown, [15] the amount and distribution of fat tissue and, to a lesser extent, mammary tissue, cause variations in breast size, shape and volume. Some experts[ who? ] believe Cooper's ligaments, which are connective tissue with the breast, provide some support within breasts, [16] but there is no agreement on whether they provide support or simply divide breast tissue into compartments. [17]

Treatment

Bras

Since breasts are an external organ and do not contain muscle, exercise cannot improve their shape. They are not protected from external forces and are subject to gravity. Many women mistakenly believe that breasts cannot anatomically support themselves and that wearing a brassiere will prevent their breasts from sagging later in life. [18] Researchers, bra manufacturers, and health professionals cannot find any evidence to support the idea that wearing a bra for any amount of time slows breast ptosis. [19] Bra manufacturers are careful to claim that bras only affect the shape of breasts while they are being worn. [18] [20]

There is some evidence that bra use reduces the development of Cooper's ligaments, connective tissue that supports breast shape. That atrophy from bra-wearing may therefore lead to more breast sag in the long run, much as the connective tissue in a limb weakens while it is in a cast and must be re-strengthened afterward. [21] Studies have actually documented that, after an initial period of adjustment, women experienced a significant increase in comfort and breast firmness from going without bras. [22] [23]

Surgery

Some women with ptosis choose to undergo plastic surgery to make their breasts less ptotic. Plastic surgeons offer several procedures for lifting sagging breasts. Surgery to correct the size, contour, and elevation of sagging breasts is called mastopexy. [24] [25] Women can also choose breast implants, or may undergo both procedures. The breast-lift procedure surgically elevates the parenchymal tissue (breast mass), cuts and re-sizes the skin envelope, and transposes the nipple-areola complex higher upon the breast hemisphere. If sagging is present and the woman opts not to undergo mastopexy, implants are typically placed above the muscle, to fill out the breast skin and tissue. Submuscular placement can result in deformity. In these cases, the implant appears to be high on the chest, while the natural breast tissue hangs down over the implant.

See also

Related Research Articles

<span class="mw-page-title-main">Breast</span> Region of the torso of a primate that in females serves as a mammary gland

The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues.

<span class="mw-page-title-main">Nipple</span> Part of the breast

The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to breastfeed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along with the ductal system. Male mammals also have nipples but without the same level of function, and often surrounded by body hair.

<span class="mw-page-title-main">Areola</span> Pigmented area on the breast around the nipple

The human areola is the pigmented area on the breast around the nipple. Areola, more generally, is a small circular area on the body with a different histology from the surrounding tissue, or other small circular areas such as an inflamed region of skin.

<span class="mw-page-title-main">Mammaplasty</span> Surgically modifying the appearance of the breast

Mammaplasty refers to a group of surgical procedures, the goal of which is to reshape or otherwise modify the appearance of the breast. There are two main types of mammoplasty:

  1. Augmentation mammaplasty is commonly performed to increase the size, change the shape, and/or alter the texture of the breasts. This usually involves the surgical implantation of breast implant devices.
  2. Reduction mammaplasty is commonly performed to reduce the size, change the shape, and/or alter the texture of the breasts. This involves the removal of breast tissue.
<span class="mw-page-title-main">Mammary gland</span> Exocrine gland in humans and other mammals

A mammary gland is an exocrine gland in humans and other mammals that produces milk to feed young offspring. Mammals get their name from the Latin word mamma, "breast". The mammary glands are arranged in organs such as the breasts in primates, the udder in ruminants, and the dugs of other animals. Lactorrhea, the occasional production of milk by the glands, can occur in any mammal, but in most mammals, lactation, the production of enough milk for nursing, occurs only in phenotypic females who have gestated in recent months or years. It is directed by hormonal guidance from sex steroids. In a few mammalian species, male lactation can occur. With humans, male lactation can occur only under specific circumstances.

<span class="mw-page-title-main">Cooper's ligaments</span> Connective tissue in the breast that help maintain structural integrity

Cooper's ligaments are connective tissue in the breast that help maintain structural integrity. They are named for Astley Cooper, who first described them in 1840. Their anatomy can be revealed using Transmission diffraction tomography.

<span class="mw-page-title-main">Breast reduction</span> Plastic surgery procedure

Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the patient's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the patient's self-image, and of the patient's mental health.

<span class="mw-page-title-main">Nursing bra</span> Specialized brassiere

A nursing bra is a specialized brassiere that provides additional support to women who are lactating and permits comfortable breastfeeding without the need to remove the bra. This is accomplished by specially designed bra cups that include flaps which can be opened with one hand to expose the nipple. The flap is usually held closed with a simple clasp or hook.

<span class="mw-page-title-main">Breast engorgement</span> Medical condition

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Intermammary cleft</span> Breast cleavage

The intermammary cleft, intermammary sulcus, or sulcus intermammarius is a surface feature of males and females that marks the division of the two breasts with the sternum (breastbone) in the middle. The International Federation of Associations of Anatomists (IFAA) uses the terms "sulcus intermammarius" or "intermammary cleft" when referring to the area between the breasts.

<span class="mw-page-title-main">Breast hypertrophy</span> Human disease

Breast hypertrophy is a rare medical condition of the breast connective tissues in which the breasts become excessively large. The condition is often divided based on the severity into two types, macromastia and gigantomastia. Hypertrophy of the breast tissues may be caused by increased histologic sensitivity to certain hormones such as female sex hormones, prolactin, and growth factors. Breast hypertrophy is a benign progressive enlargement, which can occur in both breasts (bilateral) or only in one breast (unilateral). It was first scientifically described in 1648.

Mastopexy is the plastic surgery mammoplasty procedure for raising sagging breasts upon the chest of the woman, by changing and modifying the size, contour, and elevation of the breasts. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nipple-areola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding.

Amastia refers to a rare clinical anomaly in which both internal breast tissue and the visible nipple are absent on one or both sides. It affects both men and women. Amastia can be either isolated or comorbid with other syndromes, such as ectodermal dysplasia, Syndactyly and lipoatrophic diabetes. This abnormality can be classified into various types, and each could result from different pathologies. Amastia differs from amazia and athelia. Amazia is the absence of one or both mammary glands but the nipples remain present, and athelia is the absence of one or both nipples, but the mammary gland remains.

<span class="mw-page-title-main">Inframammary fold</span> Natural lower boundary of the breast

In human anatomy, the inframammary fold (IMF), inframammary crease or inframammary line is the natural lower boundary of the breast, the place where the breast and the chest meet. The choice of the term depends on the prominence of the feature. It is also sometimes called the inframammary ligament. From the cosmetological point of view, it is an important aesthetic component of the breast which should be taken into consideration during various kinds of breast surgery.

<span class="mw-page-title-main">Lactation</span> Release of milk from the mammary glands

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.

Breast development, also known as mammogenesis, is a complex biological process in primates that takes place throughout a female's life.

SPAIR is a short-scar breast surgery technique developed by Dennis C. Hammond, assistant professor of surgery at Michigan State University. The technique was designed to allow a better-shaped breast, a limited amount of scarring, and a more accelerated healing process, by eliminating the lateral scar beneath the breast found in conventional breast reduction surgery. The technique is considered to be a good alternative to vertical mammoplasty.

<span class="mw-page-title-main">Maternal physiological changes in pregnancy</span>

Maternal physiological changes in pregnancy are the adaptations that take place during pregnancy that enable the accommodation of the developing embryo and fetus. These are normal physiological adaptations that cause changes in behavior, the functioning of the heart, blood vessels, and blood, metabolism including increases in blood sugar levels, kidney function, posture, and breathing. During pregnancy numerous hormones and proteins are secreted that also have a broad range of effects.

The pencil test is an informal test of breast development and the need to wear a bra. It was published in a 1971 advice column by Ann Landers mostly containing reader responses, pro and anti-bra, to her recent column "berating the braless female who shamelessly bounced and flopped and went shopping ... [which for Landers] created a deluge of mail". One Chicago correspondent chimed in:

The question "to bra or not to bra” can be easily answered if the undecided woman will apply this test to herself. Take an ordinary woodcase pencil. Put it under one breast. If the pencil stays there you should wear a bra. If it falls, you can go braless.

References

  1. ↑ "The Nation: Cooper's Droop" . Time Magazine. 14 February 1972. Archived from the original on 22 December 2019. Retrieved 22 December 2019.
  2. 1 2 3 4 5 6 7 Rinker, B; Veneracion, M; Walsh, C (2008). "The Effect of Breastfeeding on Breast Aesthetics". Aesthetic Surgery Journal. 28 (5): 534–537. doi: 10.1016/j.asj.2008.07.004 . PMID   19083576.
  3. 1 2 Rinker, Brian; Veneracion, Melissa; Walsh, Catherine P. (May 2010). "Breast ptosis: causes and cure". Annals of Plastic Surgery. 64 (5): 579–584. doi:10.1097/SAP.0b013e3181c39377. ISSN   1536-3708. PMID   20354434. S2CID   8953778.
  4. ↑ Stuart, Julia (November 2, 2000). "Don't burn your bra just yet". The Independent. Archived from the original on 17 July 2018. Retrieved 4 February 2012.
  5. 1 2 Toffelmire, Amy. "Why do breasts sag?". MedBroadcast.com. Archived from the original on 16 September 2013. Retrieved 3 February 2012.
  6. ↑ De la Torre, J. I. (2009). "Breast Mastopexy". Archived from the original on December 7, 2019. Retrieved February 2, 2012.{{cite journal}}: Cite journal requires |journal= (help)
  7. ↑ Younai, S. Sean. "Breast Sagging - Ptosis". Archived from the original on 28 December 2011. Retrieved 4 February 2012.
  8. 1 2 "Anatomy of Breast Ptosis – How Breasts Sag". Archived from the original on 24 August 2013. Retrieved 4 February 2012.
  9. ↑ Lauersen, Niels H.; Stukane, Eileen (1998). The Complete Book of Breast Care . New York: Fawcett Columbine/Ballantine. ISBN   978-0-449-91241-6. ...there is no medical reason to wear a bra, so the decision is yours, based on your own personal comfort and aesthetics. Whether you have always worn a bra or always gone braless, age and breastfeeding will naturally cause your breasts to sag.
  10. ↑ "Dr. Ram Chandra – Vampire Breast". Archived from the original on 10 April 2021. Retrieved 16 June 2016.
  11. 1 2 Rinker, Brian; Veneracion, Melissa; Walsh, Catherine P. (March 2010). "Breast Ptosis". Annals of Plastic Surgery. 64 (5): 579–584. doi:10.1097/SAP.0b013e3181c39377. PMID   20354434. S2CID   8953778.
  12. ↑ "Sagging Breasts". Channel 4. 2009. Archived from the original on 2 May 2008. Retrieved 3 February 2012.
  13. 1 2 "Healthy Breast: Why You Should Wear Sports Bras on Every Workout?". Archived from the original on 23 August 2012. Retrieved 4 February 2012.
  14. ↑ Scurr, Joanna C.; White, Jennifer L.; Hedger, Wendy (2010). "The effect of breast support on the kinematics of the breast during the running gait cycle". Journal of Sports Sciences. 28 (10): 1103–1109. doi:10.1080/02640414.2010.497542. PMID   20686995. S2CID   24387606.
  15. ↑ Page, KA; Steele, JR (April 1999). "Breast motion and sports brassiere design: Implications for future research". Sports Medicine. 27 (4): 205–211. doi:10.2165/00007256-199927040-00001. PMID   10367331. S2CID   32512448. Archived from the original on 2012-07-11.
  16. ↑ "The Cooper's Ligaments". Boobuddy. Archived from the original on 2019-05-18. Retrieved 2018-02-21.
  17. ↑ "For the Last Time, "Tribal African Women" Are Not Proof That Bras Prevent Breast Sagging I The Lingerie Addict". The Lingerie Addict - Expert Lingerie Advice, News, Trends & Reviews. 19 November 2013. Archived from the original on 23 August 2019. Retrieved 12 March 2019.
  18. 1 2 "Female Intelligence Agency: Why do women wear bras?". 007b Breast. Archived from the original on 31 August 2011. Retrieved 10 May 2011.
  19. ↑ "Female Intelligence Agency: What causes sagging of breasts?". 007b Breast. Archived from the original on 2019-05-18. Retrieved 2011-07-07.
  20. ↑ Cawthorn, Simon (November 2000). "Bras, the Bare Facts". Channel 4. Archived from the original on 2012-07-13. Retrieved 2012-01-31.
  21. ↑ Smith, Ken L. (February 2017). "Bras Actually CAUSE Breast Sagging". Breastnotes. Archived from the original on 2020-10-20. Retrieved 2020-11-05. These women's breasts were not being suspended by the Cooper's Ligaments when they wore a bra, so removing their bra placed some stress upon those ligaments, which ligaments require in order to develop. They will not develop without a need... without some stress or pressure placed upon them. The ligaments in a casted leg are 'on vacation'... no stress... no weight... because the doctor said "I don't want you to put any pressure on that leg for six weeks!" But when the cast came off, the ligaments had to go back to work, just like the breast ligaments had to go back to work when the bra came off, after lolling around in that bra for decades.
  22. ↑ "Breast Support: When Do Bras Help or Harm?". Dr Pepi. 3 November 2010. Archived from the original on 9 May 2021. Retrieved 5 November 2020.
  23. ↑ Glynn, Sarah (13 April 2013). "Bras Make Breasts Sag, 15-Year Study Concludes". Medical News Today. Archived from the original on 4 November 2020. Retrieved 5 November 2020.
  24. ↑ Mastopexy at eMedicine
  25. ↑ Smith, Dr. R. Scott. "Fuller Breasts: A Woman's Guide to Breast Augmentation". Breastbook.com. Archived from the original on 10 February 2008. Retrieved 2011-07-07.

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