We have all heard of the popular “pencil test”: if you place a pencil under the fold of your breasts, and the pencil stays in place, your breasts sag and need to be lifted, either by a bra or surgically.¹ But whether a breast lift is right for you goes beyond a simple test. Here are some ways to look at your breasts - and yourself- to determine what’s right for you.
Breasts Naturally Have Some “Droop”
With the exception of very young women and those with very small breasts, breasts naturally have some sag to them. Simply having some natural droop to the breast is not a reason to sprint to your local plastic surgeon’s office.
Plastic Surgeons define breast “ptosis,” or droop, by the relationship of the nipple areola complex to the inframammary fold, or the crease at the bottom of the breast. As the nipple descends lower on the breast mound, the breast appears more ptotic. In the most severe form of ptosis, the nipple is at the lowest point on the breast, and points downward.²
Women with significant ptosis – where the nipple is below the level of the inframammary crease, may benefit from a breast lift. A mastopexy, or breast lift, corrects breast ptosis. The surgery lifts the nipple to higher position, and tightens the breast into a more youthful shape, raising it higher on the chest wall. If your breast droops, and if the droop bothers you, a consultation with a Board Certified Plastic Surgeon to discuss mastopexy surgery is the next step.
Scars Are A Tradeoff for a Better Shape
If you decide that your droopy breasts bother you significantly, and surgery is in your future, be sure to understand that all surgery, even aesthetic procedures, leaves scars. The typical scars for a breast lift are around the areola and straight down the center of the lower breast in a “lollipop” pattern. In severe cases of droop, where the breast has an excess of skin in all vectors, the scar will extend into the crease of the breast in an “anchor” pattern.
Over time, scars fade and most mastopexy scars are well-accepted by patients. There are also topical silicone scar treatments available to optimize scars as they mature.³ But be sure to understand and accept the tradeoff between the scars and the improved breast shape.
You Recognize the Difference Between Deflation and Droop
For women whose breasts appear empty or deflated, but whose nipples are centered on the breast, a breast implant may be all that is necessary. A well-placed breast implant may add enough lift and volume to make a lift unnecessary. While breast implants do not change the position of the breasts on the chest, adding some volume may be enough to improve the breasts’ appearance without the scars of a lift.⁴
So before you put too much faith in your trusty pencil, take a look at your breasts and decide if they droop. Then decide if the droop bothers you...
- If the answer is no, invest in a flattering bra to support your breasts and look great in your clothes.
- If the breast droop does bother you, ask yourself whether an improvement in shape and position is worth a scar.
- Finally, take a note of whether your breasts droop, or rather, appear empty.
- If you’re not sure, your local Board Certified Plastic Surgeon is trained to evaluate this distinction.
- Armed with this information, you are on your way down the path best for you!
¹ West, Richard (June 1975). "Texas Monthly Reporter: Low Talk". Texas Monthly. Emmis Communications: 12
² Kirwan, L. (2002). "A classification and algorithm for treatment of breast ptosis". Aesthetic Surgery Journal. 22 (4): 355–363
³Longaker, MT et al. A Randomized Controlled Trial of the embrace® Device to Reduce Incisional Scar Formation. Plast Reconstr Surg. 2014 Sep;134(3):536-46. Lim AF, et al. The embrace® Device Significantly Decreases Scarring Following Scar Revision Surgery in a Randomized Controlled Trial. Plast Reconstr Surg. 2014;133:398-405.
⁴ Smith, Dr. R. Scott. "Fuller Breasts: A Woman's Guide to Breast Augmentation". Breastbook.com
By Dr. Jennifer Weintraub of Duet Plastic Surgery - Expert Plastic Surgeons