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Behnaz Fayazi, MD
Treatment Of the Aging Breast
Behnaz Fayazi, MD

Treatment Of the Aging Breast

Breast development occurs in distinct stages throughout a womans life. The first notable changes occur before birth, and again at puberty and during the childbearing years. Significant changes also occur during menstruation, pregnancy, weight changes, and when a woman reaches menopause. In fact, the first signs of aging may be noticeable around the age of 35, where the breast tissue begins to shrink in size.
The breast mass is made up of breast glandular tissue (parenchyma), fat, and ligamentious structures that support the breast parenchyma. Another supporting structure that is of significance is the skin envelope that surrounds the breast. Changes in the skin elasticity as well as the stretching of the ligamentous supportive structures lead to breast ptosis. Ptosis of the breast refers to drooping or sagging of the breast.
Ptosis is a natural part of the aging process, though the rate at which a person develops ptosis depends on many factors. Ptosis develops relatively early in some women. They tend to have somewhat larger breasts and thinner skin. Ptosis can also be a result of weight gain followed by weight loss as well as after a pregnancy. Loss of breast tissue and stretching of the skin envelope lead to the displacement of the nipple-areola complex in relation to the inframammary crease (the crease located beneath each breast.) The location of the nipple in relation to the center of the breast mound, is another criteria used to assess the degree and type of ptosis.
The displacement of the nipple, the amount of excess skin, and the degree of volume loss are important criteria used in determing the best approach to correcting the ptosis. A breast lift, also known as a mastopexy, is a procedure used to raise and reshape sagging breasts. This procedure is designed to elevate the breasts and give them a more youthful appearance. Some women may need a very limited breast lift for correction, while others may need a full mastopexy. The more limited procedures produce less scarring than others, but they are generally best when only a minimal lift is needed. A breast lift may also be completed in conjunction with breast augmentation surgery, especially if significant breast volume loss is present. This approach is frequently recommended in women with significant weight loss after gastric bypass, or after gastric banding procedures. The altered breast shape that has lost much of its upper breast fullness is usually the real source of a womans discontent. Therefore, insertion of breast implants is generally recommended to improve the shape of the sagging breast; to give a more youthful upper breast fullness.
Minor ptosis can almost always be corrected with implants alone. This is especially true for women with small breasts. With moderate ptosis, satisfactory results are achieved with implants alone in some women, but others require skin and possibly tissue resection. The correction of major ptosis always require excision of the skin and tissue.
Certainly not all women fall into the general categories of mild, moderate, and major when it comes to breast ptosis. Given the fact that every womans breast size, skin quality, and degree of ptosis are different, only a plastic surgeon can determine the best approach in each individual patient. As with any other procedure, patient education is key to a successful outcome.

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