As aging occurs, the tissues in the body change. These changes occur as a natural part of the aging process, and some parts of the body are affected more than others. Breast sagging is caused by two general mechanisms. The first is the natural aging process. This process is generally not controllable and occurs in everyone to variable degrees. One of the natural changes that occurs with aging is tissue sagging. The second mechanism is external factors. These factors are controllable. Proper nutrition, weight control, exercise, and avoidance of harmful lifestyle choices (tobacco use, excessive alcohol intake, excessive ultraviolet light exposure, etc.) are examples of avoidable causes of tissue aging. Although there are some treatments available that can “reverse” the effects of tissue aging (e.g. Retin-A), the normal aging process of tissues is not avoidable.

Breast sagging generally means a change in the shape and position of the breasts. The breasts become more elongated and lower as breast sagging progresses. During aging, the microarchitecture of the tissues changes and loses integrity. Two primary structures that are affected are collagen and elastin fibers. As aging occurs, these two anatomic structures “deteriorate,” meaning they are less able to maintain youthful breast shape. The changes in these structures are actually visible when viewed under a microscope. As these structures lose strength and elasticity, they are less able to oppose the effects of gravity, which results in tissue sagging. These changes occur in many anatomic areas of the body, including the breasts. Studies have been performed that follow the adolescent breast through adulthood to old age, and the changes are somewhat predictable throughout life.

The primary support system of the breasts includes the breast ligaments, the breast gland, and the skin envelope. As aging progresses, the breast ligaments become lax, which allows sagging of the breasts. The breast gland also becomes more lax, which also allows breast sagging. As with the breast ligaments and breast gland, the skin can also stretch or become inelastic, which will result in breast sagging. In the case of the skin envelope, there is a mismatch between the volume of the skin envelope and the volume of the breast contents. If the skin envelope volume exceeds the breast content volume, this can contribute to sagging.

The change in breast morphology is more complicated than simply a lowering and flattening of the breast on the chest wall. At the bottom of the breast, there is a well-defined and well-described anatomic entity known as the infra-mammary fold. It is observed externally as the crease at the bottom of the breast. The infra-mammary fold generally maintains its position on the chest wall during aging, so the breast descent is partially halted at this level. As the breast descends, the bottom is blocked by the infra-mammary fold, so the breast folds over the infra-mammary fold, distorting the more youthful shape.

Another important factor that affects breast sagging is breast size. Breast size accounts for some of the variability in sagging from patient to patient. As one would expect, the larger the breasts, the earlier in life sagging will occur, and the more sagging will occur. Patients with small breasts in the “A cup” range may never experience any significant sagging. Lastly, the effect of child bearing can greatly affect breast sagging. During pregnancy, the breasts become larger, thereby stretching the skin and internal tissues of the breast. After pregnancy, the breast and internal tissues shrink. The combination of tissue stretching and decrease of tissue integrity as a result of stretching leads to breast sagging.

Is There a Solution to Breast Sagging?

Fortunately, there is a treatment for breast sagging: breast lift surgery (mastopexy). This is a frequently requested plastic surgery procedure that changes the position and the shape of the breasts to a more youthful state with various surgical techniques. For details about this treatment, please visit the page of our website dedicated to breast lift surgery and/or schedule an in-person consultation by contacting Herring Plastic Surgery online or by telephone at 910.486.9093 today.