Drooping Breasts, Causes, Symptoms, diagnosis, Treatment

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Breasts 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, gravity, higher body mass index, larger bra cup size, and significant weight change.[rx][rx] Post-menopausal women or people with collagen deficiencies (such as Ehlers-Danlos) may experience increased ptosis due to a loss of skin elasticity. Many women and medical professionals mistakenly believe that breastfeeding increases sagging.

Anatomy

The breast is a subcutaneous structure that originates at the fourth interspace. The breast is held in place by the skin-fascial attachments at the inframammary fold and over the sternum but is not attached to the pectoralis fascia. Skin adherence to the deep fascia at the inferior and medial borders make this area less mobile compared to the lateral and superior breast borders. The most important aspect of breast reduction anatomy is an understanding of the blood supply and nerve supply to the nipple areolar complex. There are three main sources of blood supply to the breast, and sensory innervation is divided into sections of the breast and the nipple areolar complex.

The internal mammary artery supplies approximately 60% of the breast parenchyma, mainly the medial portion of the breast through medial perforators. The medial breast skin is supplied by the anterior cutaneous divisions of the second through seventh intercostal nerves. The lateral thoracic artery supplies an additional 30% of breast parenchyma, primarily the superior, outer, and lateral portions. The superior portion of the breast sensation is supplied by the supraclavicular nerves formed from the third and fourth branches of the cervical plexus. The anterior and lateral branches of the third, fourth, and fifth posterior intercostal arteries supply the remaining lower outer breast quadrant. Lastly, the nipple is supplied by the overlap between these vascular networks, while sensation is supplied by the lateral cutaneous branch of the fourth intercostal nerve. 

Causes of Breasts Ptosis

  • 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.[rx] 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.[rx]
  • 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 increase with each pregnancy.[rx] 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)).[rx] Other significant factors were higher body mass index and larger bra cup size.[rx]
  • 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,[rx] and as a result, some are reluctant to nurse their infants. Research shows that breastfeeding is not the factor that many thought it was.[rx] Rinker concluded that "Expectant mothers should be reassured that breastfeeding does not appear to have an adverse effect upon breast appearance."[rx] Also discounted as causes affecting ptosis are weight gain during pregnancy and lack of participation in regular upper body exercise.[rx]
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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.[rx] 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.[rx]
  • 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.[rx]
  • 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.[rx]

Diagnosis of Breasts Ptosis

Ptosis scale

Stages of ptosis

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

  • Grade I: Mild ptosis - The nipple is at the level of the infra-mammary fold and above most of the lower breast tissue.
  • Grade II: Moderate ptosis -The nipple is located below the infra-mammary fold but higher than most of the breast tissue hangs.
  • Grade III: Advanced ptosis - The nipple is below the inframammary fold and at the level of maximum breast projection.
  • Pseudoptosis - The nipple is located either at or above the infra-mammary fold, while the lower half of the breast sags below the fold. This is most often seen when a woman stops nursing, as her milk glands atrophy, causing her breast tissue to sag.
  • Parenchymal Maldistribution - The lower breast tissue is lacking fullness, the inframammary fold is very high, and the nipple and areola are relatively close to the fold. This is usually a developmental deformity.[rx]
  • Breast Measurement - BREAST-V - is a validated breast volume formula reported by Longo et al.[]. We modified BREAST-V because one of the variable FFp, could not be precisely measured in our study population since the proportion of Chinese women with breast ptosis is far less than that in American or European countries. In that case, we used BP to replace FFp in the BREAST-V formula to estimate breast volume in our cohort as follows: breast volume = −231.66 + 0.5747 × (SN-N)2 + 18.5478 × (BP) + 14.5087 × (N-IMF).
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Treatment of Breasts Ptosis

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.[rx]
  • 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.[rx] Bra manufacturers are careful to claim that bras only affect the shape of breasts while they are being worn.[rx][rx]

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.[rx][rx]
  • 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.

Exercise

Since breasts don’t have muscle, you can’t firm up breast tissue with exercise. However, beneath the breasts are fibrous connective tissue and muscles that can be exercised to improve the overall appearance of your chest. Various chest exercises are recommended to improve not only muscle strength but posture as well. Some common exercises to try are:

  • pushups
  • swimming
  • bench press
  • arm curls
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Diet and Nutrition

Try to eat a balanced, healthy diet to feed and nourish your skin so it stays healthy, strong, and resilient for many years to come.

  • It’s also important to maintain an optimal weight for your body type. Being overweight puts pressure on your skin tissue, and the extra weight may add additional weight to your breasts, which could result in sagging.
  • In addition to a healthy diet, healthy lifestyle decisions are imperative. Smoking tobacco is harmful to your skin as well as your overall health. It may play a contributing factor to sagging breasts.
  • Importantly, make sure you drink enough water throughout the day and stay hydrated. Water powers everything in your body, and drinking enough will keep your skin strong and improve the overall firmness and strength of the breast tissue.

Posture

  • Bad posture, such as having a hunched or bent back, can cause the breasts to hang by their own weight, putting more pressure and tension on the breast tissue and aggravating sagging.
  • Good posture, on the other hand, involves teaching your body to assume positions during movement where the least amount of strain is placed on supporting ligaments and muscles.

References

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