How Do You Fix Saggy Breasts? – A Breast Lift, Breast Implants or Both?

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How to tell if you need a Breast Lift or a Breast Augmentation or both

Need to know how to fix saggy breasts? Are your nipples pointing south? Read about the best surgical procedures to treat your droopy Breasts.

Overly saggy breasts or droopy breasts are known as ptotic breasts or breasts with ptosis (pronounced ‘tosis’ – the p is silent!). Ptosis is the result of losing the inevitable battle between skin elasticity and age.

Considering Breast Lift Surgery for Saggy or Droopy Breasts?

Get the guide Mastopexy Surgery Guide

Breast Lift Guide Download

Do you have Saggy or Drooping Breasts?

Drooping of the breasts (breast ptosis) is a natural inevitable process.

A Breast Lift or Mastopexy procedure is one of the common requests from women with drooping breasts.

Why do breasts sag and droop over time?

  • The most noticeable sagging occurs due to the process called “breast involution.”
  • Breast involution is a process where the milk-making system inside the breast shrinks because it is no longer required.
  • This happens either after weaning or not long after pregnancy if the woman did not breastfeed. It also occurs during menopause.
  • When the tissues inside your breast start to shrink, your breast can look “empty” and saggy

Breast Ptosis: What causes Saggy Breasts?

There are many causes of Breast Ptosis including:

  • Effects of gravity
  • Bouncing on unsupported breasts (not wearing a good bra)
  • Smoking (causes thinning of the skin or dermis)
  • Significant weight loss or pregnancy – ‘over-stretching’ of skin that doesn’t bounce back
  • Number of pregnancies – ‘stretched too many times’ – weakens collagen
  • Larger breast cup size even before pregnancy
  • Ageing of the breast glandular tissues ‘breast laxity’

The amount of ptosis or degree of sagging is partly determined by your inherited characteristics like skin elasticity and breast density.

Some patients’ breasts are denser than others. Your breasts are made from both heavy breast tissue (like mammary glands) and lighter fat.

  • Metaphorically, one could be said to be similar to calamari, and the other to a more custard-like substance
  • The ratio of these two components influences your breast density and your breast density can influence the degree of Ptosis
  • Denser breasts may sag faster and further over time but other factors may also play a factor

How to classify Ptosis of saggy breasts

  • Grade 1 Ptosis – MILD – Shape Malformation
  • Grade 2 Ptosis MODERATE – No Bra Support/running is a problem
  • Grade 3 Ptosis SIGNIFICANT – Size change (Stretched post-pregnancy or after significant weight gain/loss)
  • Grade 4 – Allotrophic Skin – Poor collagen strength

Most patients seeking a breast lift are at the moderate or more severe stages of drooping. Others feel they’ve been left with ’empty bags’ for breasts after breastfeeding.

Others with milder to moderate drooping may decide to combat droopiness for a period of time with a suitably sized Breast Implant or Lift with Implant (Masto-Aug).

Ptosis - Breast Ptosis degrees of droopiness

There are several surgical solutions for the Ptotic Breast:

  1. Breast Lift without implants (Mastopexy)
  2. Breast Augmentation (BA) – inserting an implant without re-positioning
  3. Breast Lift with implants (Masto-Augmentation, Masto-Aug or MA)
  4. Staged and Variations of above surgeries (multiple surgeries)

Surgeon Experience and Scar Minimisation, the keys to any great.

Our Surgeons are also highly skilled at no drains procedures.

All invasive surgery leaves a scar, our experienced surgeons use advanced surgical procedures and are specially trained to minimise the extent of any breast surgery scars.

We can also use special post-surgical scar minimization techniques including post-op treatment with Fraxel Laser, Healite II LED and our Rapid Recovery Pack.

Our Rapid Recovery package contains scientifically proven products to facilitate healing, along with some ‘feel good’ gifts to help you make the most of your recovery time.

If you feel better, you heal better!

Scars also usually fade away over time and may settle even further over 12 to 18 months to fully settle.


Solution 1 –  Breast Lift without Implants (Mastopexy)

A breast lift repositions the breasts back into a higher position. It’s similar to being in a Bra without being in a Bra.

The Downsides of a Mastopexy

  • Breast Scars (Skin is soft and scars will fade over time).
  • A breast lift will NOT increase fullness or firmness
  • A breast lift will NOT increase breast size (would need a breast implant or additional fat transfer to the breast)

The Upsides of a Mastopexy

  • Your breasts are back where they should be – up higher
  • You’ll look better and feel better in your clothes


Solution 2 – Breast Augmentation Surgery

If your breasts have too much skin and NOT enough internal ‘filling’ tissue, then you CAN correct sagging or drooping with just a Breast Implant under certain guidelines.

There are three specific guidelines for choosing this Surgical Option.

For this option to be best for you, you should ideally pass these criteria tests (and discuss ALL best breast lift surgery options with your Plastic Surgeon):

  1. The Finger or Pencil test – A Breast Augmentation (BA) alone is NOT suitable if you can fit 2 fingers behind your Breast at the crease or inframammary fold (IMF).
    Or if you place a pencil along the breast crease and behind the breast, and it falls, then you PASS the test – but if it stays in place by the weight of the sagging breast, the ‘pencil’ test is failed and there is sagging that will likely require a Breast Lift not solely a Breast Augmentation.
  2. The ‘Hands-on Head’ Test – A Breast Augmentation is NOT suitable if your breasts are still droopy when your hands are on your head. If Breasts still droop when you have your hands over your head, then you’ll likely need a Breast Lift or a Breast Lift with Augmentation.
  3. The IMC Test –  A breast augmentation alone is usually NOT suitable if your nipple falls (droops) below your IMC – inframammary breast crease.

If the implant required is bigger than, for example, a small container of ice cream (e.g., a 400ml+ implant) – then that is TOO big for a BA — and a Breast Lift should be considered.


Get the Breast Augmentation Surgery guide!

Breast Augmentation Guide Download

The Downsides of a Breast Augmentation for Ptotic Breasts

  • You can get a less-desirable aesthetic result –  re nipple positions & breast shape.
  • There are small incision scars – usually under the crease of the breast.

The Upside of a Breast Augmentation for Ptotic Breasts

  • Your breasts are bigger in size or you gain more shapely cleavage
  • It’s a simpler, less expensive surgical solution that suits some patients

Note: We see many Revision Cases where under-experienced surgeons performed a breast augmentation in situations where a breast lift or more complex breast lift with implants was required.OPTION 3 Breast Lift with Implant (Mastopexy-Augmentation)

Masto-Aug surgery, as it’s known, is a challenging surgical procedure for Ptotic Breasts. Your Surgeon is aiming for two different surgical directions – sometimes at cross-purposes to get the best result.

  • Breast Lift (MA) Outcomes – Higher, Smaller & Tighter
  • Breast Augmentation (BA) Outcomes – Lower, Bigger & Wider

This is a complex operation requiring a very experienced Plastic Surgeon but the advantage is a better result aesthetically.

The Downsides of a Breast Lift with Implant (Breast Augmentation Mastopexy or ‘BAM’)

  • Breast Augmentation Mastopexy is a challenging surgery that is not easy to get perfect
  • Surgical Scars are similar to those of a Breast Lift, yet will fade over time

The Upside of a Breast Lift with Implant

When done by a highly experienced Plastic Surgeon, the Aesthetic result can be very pleasing

Nipple & Breast positioning can be altered to suit individual tastes or breast beautification


Solution 4 – Multiple Breast Procedures or Staged Surgeries

Sometimes it is better to do TWO separate surgeries to get the best result for ptotic breasts – especially if breasts are uneven or asymmetric.

When surgeries are sequenced, you have one Surgery first, and heal fully; then have the second or follow-on Surgery.

The Downsides of Staged Surgery

  • 2 surgeries, 2 costs and 2 recoveries

The Upsides of Staged Surgery

  • Can lead to a better Aesthetic result for some patients
  • If you are borderline on whether or not you need a lift and augment or just augmentation, you can do an augmentation and later decide whether or not you wish to pursue a lift

Our Plastic Surgeons are dedicated to getting you the best results from a Breast enhancement, Lift or Augmentation surgery.

Our Surgeons want to make sure you know your options, and what results to expect from different procedures. They believe that ‘The foundation should be constructed before completing the penthouse’ — and that sometimes TWO separate surgeries can be the ideal solution to get the best Breast Augmentation or Breast Lift results for some patients.

It is important, however, to have realistic expectations about what Breast Surgery can and cannot accomplish for your body or breasts. Sometimes 3D Vectra imaging can help you to imagine what you may look like after Breast Augmentation Surgery or Mastopexy.

Breast Augmentation and Breast Implant Sizes: Don’t choose an implant that’s too BIG

If you have a breast implant, large heavier breasts or just dense breast tissue, it’s like having a bowling ball inside a thin shopping bag. And no matter what you do, our Surgeons believe you’ll need to wear a good bra ALL the time (except for sleeping) or further sagging and re-drooping of your breasts is likely.

Gravity will always win.

Further Reading about Breast Augmentation or Boob Job

Last updated: 02/05/2022
Author profile image
Dr Craig Rubinstein - MBBS, FRACS (Plast)
Dr Craig Rubinstein MBBS, FRACS (Plast), a Specialist Plastic Surgeon, is one of Australia's most respected Melbourne Surgeons for Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction surgery and Abdominoplasty procedures. Using advanced surgical techniques to gain better body contouring and natural-looking surgical results, Dr Rubinstein is highly regarded by peers and patients for best-practice Clinic Patient-care and patient education strategies. He published a chapter on corrective surgery for Breast Asymmetry. Qualifications/Training Fellow of the Royal Australasian College of Surgeons (FRACS) The Australasian Society of Aesthetic Plastic Surgery (ASAPS) The Australian Society of Plastic Surgeons (ASPS) The Australian Medical Association (AMA) American Society of Plastic Surgeons (ASPS) The International Society of Aesthetic Plastic Surgeons (ISAPS) Founder: Coco Ruby Plastic Surgery previously Cosmetic Surgery for Women and Men Bio Page:

Coco Ruby’s Specialist Plastic and ENT Surgeons

With a wealth of experience and training, our Specialist Plastic Surgeons are dedicated to best practice patient care and education, customising Breast Enlargement Surgery for each and every patient to best meet their needs and desired surgical outcomes.

coco ruby specialist plastic surgeons 

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday to Friday.

Phone 1300 264 811, Email us: or Book a FREE 15-minute Phone Chat with our Patient Liaison Manager or a Virtual Consultation with a Surgeon.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.