Woman's breasts play a fundamental role in the self esteem, perception of feminity, psychological confidence, sexual sphere, gender assignment and acceptance of body morphology.
Inherited breast droopiness or acquired mammary ptosis sagginess may be due to genetical, hormonal, reproductive, surgical and weight oscillations reasons. Mammary ptosis can be classified as slight when the nipple nipple and areola complex is located shortly below its canonically ideal and natural born location, mild when it is near the level of the submammary fold crease, moderate when below, severe when the nipple and areola complex sits quite below the submammary fold crease and extreme if it is far into the abdomen; the suitability of breast sagginess surgery (considering the involved and always unsightly scars) and the indication of the right surgical technique depends on the grade of breast ptosis. As a rule of thumb it can be said slight grades of mammary droopiness need and justify no treatment, being candidates to just breast implants augmentation to enhance the breasts and fill them up to a full cleavage; mild cases should follow the same breast implants only course of action, and only extremely motivated, well aware of the scars and informed patients should get treatment of the breast ptosis; moderate grades of droopiness begin to be a genuine indication of ptosis treatment, with or without breast implants, but also may go for augmentation only should the patient be reluctant to scars and accept the subsequent low breasts; severely low breasts pretty much require breast lift, anyhow some selected patients may prefer very low and unsightly breasts but of satisfactory size as a price to avoid the scars of mammary ptosis correction; finally extreme grades of breast droopiness require, as a mandatory indication, the scars and treatment to rebuild the mammary mounds, with or without associated breast implants augmentation.
As an associated surgical gesture the patient may opt for the treatment with mammary prostheses of an objectively or subjectively, totally or partially empty breast with a certain amount of spare skin and disproportion between the cutaneous shell and the inner content has to be customized to achieve the desired increase in size and preferred shape of the breasts, expand the breast skin, fill the upper pole, achieve a full cleavage, reshape the breasts and balance all the anatomical mammary structures affected.
Best state of the art treatment for the droopy and saggy breast is the mastopexy breast lift of lollipop vertical or inverted T anchor pattern scars and eventually, should the breast be hollow and the patient desire upper pole and cleavage fullness or simply size augmentation, with augmentation mammoplasty with cohesive silicone gel filled breast implants, either round or anatomical shaped, recommendable with textured shell surface placed in the subfascial plane simultaneously with the mastopexy execution.