The forms of breast ptosis vary, and it cannot be judged solely by the degree of ptosis; the proportional relationship with the chest must also be considered. Small and drooping breasts may have no clinical manifestations but can directly or indirectly affect the beauty of body curves. Medium-sized breasts with ptosis may cause a certain degree of discomfort, insufficient breast elevation, and visible asymmetry in appearance, which is hard to conceal even when dressed. Large and drooping breasts, due to the gravitational force, may exhibit some symptoms of macromastia, such as chest, neck, shoulder, and back pain, easy fatigue, and a feeling of heaviness. Moreover, they create significant difficulties for women in choosing attire, affecting normal psychological development and causing various psychological and physiological problems. To correct this deformity, both breast reduction and breast suspension are required, making the treatment more complex. To a certain extent, correcting this type of breast ptosis is similar to breast reduction plastic surgery.
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1. Classification and grading of breast ptosis
(1) Classification of breast ptosis: This classification can be based on the cause of ptosis and the degree of breast ptosis.
According to the cause of breast ptosis, it can be divided into the following three categories:
1) Breast ptosis after weight loss: Mainly caused by the relaxation of fat tissue and skin in the breast after weight loss. Common in middle-aged and young women.
2) Senile breast ptosis: With the decline of various functions in the elderly, endocrine function also decreases. The sagging of elderly breasts is caused by the obvious degeneration and atrophy of skin, supporting tissues, fat, and glands, so the breasts appear hollow and drooping.
3) Breast ptosis after breastfeeding: After breastfeeding stops, due to the decrease in hormone levels, the mammary ducts, glands, and fat tissue all undergo atrophy, while the skin and supporting tissues remain relatively more abundant, leading to breast ptosis.
(2) Classification of breast ptosis: Based on the relationship between the lower breast fold and the lower pole of the breast, it can be divided into five types:
1) Normal breasts: The lower breast fold and the lower pole of the breast are on the same plane.
2) Mild ptosis: The lower pole of the breast exceeds the lower fold by 1-2 cm.
3) Moderate ptosis: The lower pole of the breast exceeds the lower fold by 2-3 cm.
4) Severe ptosis: The lower pole of the breast exceeds the lower fold by 4-10 cm.
5) Extremely severe ptosis: The lower pole of the breast exceeds the lower fold by more than 10 cm.
Breast ptosis classification can also be divided into four types according to breast volume:
1) Normal volume breast ptosis: Volume 250-350ml.
2) Small breast ptosis: Volume less than 200ml.
3) Moderately large breast ptosis: Volume 600-800ml.
4) Macromastia: Volume greater than 1500ml.
2. Indications for breast lift
The purpose of treating breast ptosis is to suspend the drooping breast. In this regard, any type or degree of breast ptosis, as long as the patient requests a breast lift surgery without obvious contraindications, can be performed. However, plastic surgeons should fully understand the patient's motivation and psychological activities before surgery and not act blindly, otherwise, it may cause unnecessary trouble. In principle, mild breast ptosis does not significantly change the appearance even when wearing thin and transparent clothes. If patients feel that mild breast ptosis affects their self-expression and strongly request surgery, trauma-free surgeries like periareolar breast suspension can be adopted after excluding psychological barriers. Therefore, the following indications for breast lift are proposed:
1) Various types of breast ptosis affecting aesthetic appearance requiring surgery.
2) Breast ptosis causing physical symptoms, such as shoulder, back, and chest pain, or breast crease erosion.
3) Breast ptosis affecting special professional performance requiring surgery, such as fashion models and athletes.
3. Preoperative preparation for breast lift
Patients who choose surgery should start from their first visit to ask the doctor relevant questions. Of course, the most important thing is to clearly understand one's surgical motivation. According to experience, general motivations include several aspects.
1) Subjective intention: Believing that breast ptosis affects body shape beauty and requesting surgery.
2) Physical symptoms: Physiological effects caused by drooping and enlarged breasts.
3) Psychological factors: Fear of others' comments and ridicule.
4) Family and social factors: Boyfriends or husbands dislike drooping breasts, colleagues think drooping breasts affect body shape beauty, etc.
In addition, patients should understand matters related to the surgery, such as whether it is a simple breast lift or if they want to increase or decrease breast size. They should specify what kind of breast shape they desire post-surgery, its size, and confirm there is no need for postoperative breastfeeding. Before surgery, there should be a unified understanding with the patient. Complications that may occur post-surgery should also be explained clearly to the patient, such as hematoma, infection, although not too serious, they can affect aesthetics. Other complications may include abnormal sensation of the breast and areola, erectile dysfunction of the nipple, incomplete symmetry on both sides, secondary ptosis, incision scars, etc. However, the conversation should be tactful. Our goal is to correct the patient's breast deformity while ensuring the patient doesn't lose confidence in the surgery and refuse it. [Continue reading: Aesthetic surgery for breast ptosis]
Whether inpatient or outpatient surgery, detailed preoperative examinations should be conducted. These include: menstrual history, pregnancy history, childbirth history, breastfeeding history, family history, blood, urine, and stool routine tests, coagulation time, liver and kidney function, electrocardiogram, and chest X-ray.