How do I fix Saggy Breasts? Breast Lift, Breast Implants or Both

Needing to know how to fix sagging breasts? Are your nipples pointing south? Read about the best surgery procedures to treat your saggy, droopy Breasts.

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

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.

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’

Breast Lift Guide Download

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

Some patient’s 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 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 or droopy 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

Ptosis - Breast Ptosis degrees of droopiness

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 more mild 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).

There are a 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 & Variations of above surgeries (multiple surgery)

Surgeon Experience and Scar Minimisation are the keys to any great breast surgery result

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.

Our Surgeons are also highly skilled at NO DRAINS procedures.

OPTION 1 –  Breast Lift without Implants (Mastopexy)

A breast lift re-positions 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

OPTION 2Breast Augmentation (a BA or Breast Implant 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 inframmary 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.
  1. The ‘Hands on Head’ Test – A BA 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, they you’ll likely need a Breast Lift or a Breast Lift with Augmentation.
  2. 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.

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 (Masto-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

OPTION 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 for the best results, 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.

Want to go smaller? Read about Breast Reduction Surgery.

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

The Battle of the Bowling Ball

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.


If you are considering the many surgical solutions for saggy or droopy breasts – always consult an experienced specialist plastic surgeon and always get a second opinion.

For very complex cases and difficult breast revision patients we can offer a group consultation with the combined expertise of several of our experienced plastic surgeons on a Friday morning.

Please call us or fill in the confidential contact form to enquiry about your suitability for any of these surgical solutions for saggy breasts.

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Last updated: 18/05/2018
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Dr Geoff Barnett
Dr Geoffrey Barnett, FRACS (Plas) is a Melbourne based Specialist Plastic Surgeon who has over 35 years of expertise in Plastic and Reconstructive Surgeon for Cosmetic Surgery, Plastic Surgery and Body Contouring Surgery after Bariatric Surgery. Qualifications and Memberships: Specialist Plastic Surgeon (FRACS) Member - Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery [FRACS (Plast). The Royal Australasian College of Surgeons (RACS) is the only professional body recognised by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) to train Surgeons in Australia and New Zealand. Author BIO page: