Ptosis (breasts)

For other uses, see Ptosis.

Ptosis (breasts)
Classification and external resources
ICD-9	611.81
eMedicine	plastic/128

Ptosis of the breast refers to drooping or sagging of the breast. Breast ptosis is related to the laxity of the superficial fascia, suspensory ligaments and skin.

Stages of ptosis

Ptosis is a natural part of the aging process, though the rate at which a woman develops ptosis depends on many factors. Ptosis can result after pregnancy, or after weight gain and subsequent loss. Breast size is a factor in ptosis, with larger breasts becoming ptotic more quickly. Pseudoptosis is the condition where the nipple is at the level of the inframammary crease, but the breast itself has not dropped. Surgeons offering plastic surgery to address ptosis categorize the condition by the relationship that the nipple has to the inframammary crease.

Overview

Anatomically, the breasts are composed of soft, glandular tissue, with few support structures, such as connective tissue. Breasts are composed of the mammary glands, which remain relatively constant throughout life, as well as the adipose tissue or fat tissue that surrounds the mammary glands. It is the amount and distribution of adipose tissue and, to a lesser extent, glandular tissue that leads to variations in breast size. Sagging is partly determined by genetics, but smoking, a woman's body mass index (BMI), her number of pregnancies, the size of her breasts before pregnancy, and age are all influencing factors.

As the breasts mature, they fold over the lower attachment to the chest wall (infra-mammary fold), and their lower (inferior) surface lies against the chest wall when vertical. In popular culture, this maturation is referred to as "sagging" or "drooping", although plastic surgeons refer to it as ptosis. The surgical procedure to lift the breast is called mastopexy.

Impact of bras

Although the exact mechanisms that determine breast shape and size are largely unknown, it is commonly accepted that it is normal for breasts to sag as women age, because the woman's breast's loses anatomical support over time. Breasts naturally change in shape and size as women age. Many women believe that wearing a brassiere will prevent their breasts from sagging and that breasts cannot anatomically support themselves. Health professionals have, however, found no evidence to suggest that wearing a bra for any amount of time slows ptosis of breasts.

Bras don't prevent sagging

There are conflicting opinions but no known studies to show that bras actually delay the natural process of sagging. Bra manufacturers do not claim that wearing a bra will lessen breasts from sagging as a woman ages, only that the brassiere prevents sagging while it is worn. Deborah Franklin, a senior writer in science and medicine, wrote in Health magazine that, "Still, the myth that daily, lifelong bra wearing is crucial to preserving curves persists, along with other misguided notions about that fetching bit of binding left over from the days when a wasp waist defined the contours of a woman’s power."

Franklin interviewed Dr. Christine Haycock a surgeon at the New Jersey Medical School and an expert in sports medicine. Dr. Haycock said that "Cooper's ligaments have nothing to do with supporting breast tissue... They just serve to divide the breast into compartments." She noted that most women's breasts begin to droop with age and that extremely large-breasted women are generally more affected. However, sagging is not related to ligaments or dependent on breast size.

Pare away the fiction and fears, and the pros and cons of the bra come down to this: If a woman chooses to wear one because it makes her feel good-more supported, more under control or just prettier-more power to her... Haycock suggests that women let pain be their guide when deciding whether to wear a bra during exercise, and when choosing a particular style.

While large-breasted women may be uncomfortable exercising without a bra, Dr. Haycock said that “It’s not doing any lasting damage to chest muscles or breast tissue.” Her research found that “those who wore an A cup were frequently most comfortable with no bra at all."

Bralessness improved comfort

There are some indications that wearing a bra may have an effect opposite to that which was intended. In a Japanese study, 11 women were measured wearing a standardised fitted bra for three months. They found that breasts became larger and lower, with the underbust measurement decreasing and the overbust increasing, while the lowest point of the breast moved downwards and outwards. The effect was more pronounced in larger-breasted women. This may be related to the particular bra chosen for the experiment, as there was some improvement after changing to a different model. These findings were confirmed in a much larger French study of 250 women who exercised regularly and were followed by questionnaires and biometric measurements for a year after agreeing not to wear a bra. While there was some initial discomfort at the first evaluation, this gradually disappeared and by the end of the year nearly all the women had improved comfort compared to before the study. The measurements showed firmer, and more elevated and youthful breasts. One example is given of a woman who had breasts that were uncomfortably large, and who had improvement after two years of being without a bra.

Health ethicists are concerned that plastic surgery and implants have altered our concept of what is "normal" and medicalised women's bodies by making the normal aging process a "disease."

Mastopexy

Main article: Mastopexy

Some women with ptosis choose to undergo plastic surgery to make their breasts less ptotic. Procedures used include mastopexy, placement of breast implants, or both. 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.