The Different Levels of Ptosis

There are certainly varying degrees of ptosis, or sagging breasts. Some need smaller lifts for correction, while other cases require a full mastopexy. We are going to cover the most commonly described ptotic grades to help you better determine what you may need in terms of a breast lift. 

This overview is solely for informational purposes. Only a qualified medical professional can help determine what your needs are after a physical examination. Also, please remember that although you may qualify for a less scarring breast lift technique, not all surgeons offer every method. This is why it is important to consult with several surgeons and cover all your options so you get exactly what you want.

Determining Your Degree of Ptosis

The first step is to locate your mammary crease, which lies directly underneath the breasts. The easiest way is with a ruler, placing the highest edge directly against the junction of the breast and ribcage.

If the central point of your nipple (not your areola) is slightly above or directly in front of the top of the ruler (the mammary crease), you may have Grade 1 Ptosis. This very mild to mild ptosis usually needs only a crescent, or partial, lift to correct the position of the areolae up to approximately 4 cm. Stretching of the scar, creating an egg-shaped areola, is possible if the patient does not wear a bra regularly during the scar maturation phase – which can take up to a year – and even after if there is much weight to the breast.

If the central point of your nipple is 1 - 3 cm below the top of the ruler, you may have Grade 2 Ptosis. Mild to moderate ptosis can often be corrected with minimal scarring. The Benelli, or periareolar, lift involves removing a doughnut-shaped piece of skin from around the areola (including some of the areola itself in areola reduction cases) to draw the breast together as if it were a drawstring pouch. The edges are then sutured and may exhibit some puckering, but this should flatten out over the next year. I have seen cases of severe ptosis corrected with a Benelli and augmentation with proper flattening of the suture line. The periareolar lift is also called a Doughnut or circumareolar lift.

If the central point of your nipple is more than 3 cm below the top of the ruler, you may have Grade 3 ptosis and will usually require a vertical (keyhole) mastopexy or anchor lift. Many times patients who need an anchor incision also need an areola reduction. This will result in a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola, and a scar around the areola itself.

Psuedoptosis occurs when your nipple is still slightly or well above your inframammary crease but the breast still appears droopy due to the presence of a significant, but somewhat flattened, breast lobe. Usually women with pseudoptosis have smaller areola complexes that did not stretch during pregnancy or weight gain. Many times these women will need a vertical or anchor scar lift to reduce the amount of the lobe.

Even if you pass the ptosis "tests" above, you may still feel as though your breasts lie too low on your chest wall or that your areolae have stretched out. Some women's breasts (like mine) naturally sit lower on the chest wall. They have no ptosis, good volume and a proper inframammary crease, but the entire breast complex is rather low on the torso.

Typical Patient Needing Breast Reduction With a Lift

Note the nipple and areola complex position and the low position of the breasts on the torso. This breast type would more than likely need a full anchor mastopexy incision. Many times women who need an anchor incision also need an areola reduction. This will result in a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola, and a scar around the areola itself.

Very Severe Ptosis Needing Significant Tissue Removal and Reconstruction

This breast type would need a full anchor mastopexy incision and an areola reduction. This will result in a scar at the inframammary crease, a vertical scar from the crease to the bottom of the areola, and a scar around the areola itself.