I often see patients in consultation who are seeking to have their breasts "lifted." When a woman's breasts droop we plastic surgeons say that the breasts are ptotic. There are two types of ptosis, and they can exist independently or together. Ptosis is most often thought of as then the position of the nipple. In a youthful breast the nipple height, or level of the nipple, is above the inframammary crease (the line where the bottom of the breast meets the chest wall). If the nipple level is at or below the inframammary crease, the breast is ptotic. The second type of breast ptosis is when the breast tissue has fallen but the nipple height remains in a normal position. Women often describe this as a "deflated" breast; plastic surgeons refer to this as pseudoptosis.
When breasts are ptotic (either type of ptosis), the underlying problem is that there is too much skin for the amount of underlying breast tissue. Therefore there are two ways to correct ptosis: increase the volume of the breast (breast augmentation) or reduce the amount of skin of the breast (breast lift also called mastopexy). Of course these can be done together – an augmentation mastopexy.
The proper operation to correct ptosis depends on the severity of the ptosis, the quality and elasticity of the skin, and the ultimate volume (cup size) that the patient desires. If a patient wants larger breasts, then the implant will "fill-up" or partially "fill-up" the skin envelope and less (or no) skin will need to be removed. The larger implant the patient chooses the less skin will need to be removed. If a patient has little ptosis and wishes an augmentation, then the implant alone may correct the ptosis. Mild to moderate degrees of ptosis can be corrected by removing skin from around the areola (called a crescent mastopexy or donut mastopexy) with or without the placement of an implant. More severe ptosis requires tightening the skin around the areola as well as the skin in the lower part of the breast (a vertical mastopexy or Wise pattern mastopexy) with or without an implant.
Many techniques to correct breast ptosis exist. You should discuss ptosis correction with your plastic surgeon in the context of your desired breast volume or cup size. Please make sure that your surgeon is certified by the American Board of Plastic Surgery and is a member of the American Society of Plastic Surgeons.