Breasts come in many shapes and sizes. They can be round and full, teardrop- or bell-shaped, or asymmetrical, and they tend to change with age. While breasts may start out shapely or perky early in life, as you get older, the connective tissue and ligaments that support them gradually lose strength and elasticity, leading to sagging. The medical term for this age-related drooping is ptosis (pronounced “toe-sis”).
Other factors play a role in breast sagging over a lifetime, including weight fluctuations, changes in breast tissue composition, pregnancy, and genetics. Carcinogens in cigarette smoke and ultraviolet (UV) rays from the sun also contribute to the loss of elasticity by damaging the collagen and elastin fibers that keep skin firm.
About 80 percent of women ages 45 to 65 report a significant difference in their breasts with aging, and sagging is the number-one change they notice, according to a study in the European Journal of Ageing.
While ptosis doesn’t have harmful health consequences, it can affect your emotional well-being if you are unhappy with how your breasts look. Lifestyle changes like improving your posture and wearing a supportive bra may reduce the appearance of ptosis. For more severe cases, a breast lift may be an option.
How low do you go?
The amount of breast sagging varies from mild to severe. Doctors assign ptosis a grade from one to three, based on the relationship between the position of the nipple and the inframammary fold (IMF)—where the breast meets the chest wall.
- Grade 1: Mild ptosis. The breasts are only slightly droopy, with the nipples positioned at the same level as the IMF.
- Grade 2: Moderate ptosis. The breasts are moderately sagging, with the nipples slightly below the IMF.
- Grade 3: Severe ptosis. There is significant sagging, with the nipples well below the IMF.
Sometimes the breasts sag, but the nipples remain higher than the IMF. Doctors call this “pseudoptosis,” or “false ptosis.” The extent of sagging will determine the most effective method of correcting it.
For a “natural” lift
For mild to moderate ptosis, you can try these lifestyle approaches to improve the shape and position of your breasts:
- Exercise. Because breasts contain fat and breast tissue but not muscle, exercise won’t strengthen them. However, aerobic and strengthening workouts do contribute to weight loss, which can reduce sagging that’s related to excess weight.
- A healthy diet. Proper nutrition isn’t a cure for breast sagging, but eating lots of healthy protein from foods like lentils, eggs, fatty fish, vegetables, and nuts/seeds will help keep your breast skin healthy and prevent weight gain. Staying hydrated by drinking plenty of water keeps the skin of your breasts supple and prevents the wrinkling and dryness that contribute to sagging.
- Good posture. Aging weakens bones, reduces muscle strength, and causes the discs between vertebrae to lose height, all of which can increase spinal curvature and contribute to stooped posture. When the spine is curved, the breasts hang forward, increasing the effect of gravity on them. Strengthening and stretching your muscles and maintaining proper alignment while sitting, standing, and lying down are important for improving posture and helping prevent your breasts from sagging forward. For instance, while sitting, keep your feet flat on the floor, tuck your chin, and draw your shoulder blades slightly back and together. When standing, have your feet hip-width apart, keep your pelvis in neutral alignment, and gently move your head and shoulders back.
- Sunscreen use. Applying an SPF 30 or higher sunscreen to sun-exposed areas of your chest not only reduces the risk of skin cancer, but also protects against sun damage that can contribute to stretching and sagging. By blocking harmful UV rays, sunscreen helps preserve the skin’s collagen and elastin, keeping the breasts firmer and slowing sagging over time.
Whether regularly wearing a bra will reduce the development of sagging over time is a matter of some debate; however, especially for women with larger breasts, a supportive bra can at least provide a lift and improve comfort (you can find supportive bras today that don’t have an underwire). Wearing a good sports bra prevents the breasts from bouncing and causing discomfort during high-impact activities like running, tennis playing, and aerobic dancing, but if you’re large-breasted, they are a good choice even for walking and other lower-impact activities.
Because many women wear bras that fit them poorly, it’s important to buy a size and style appropriate to your shape and needs. You can find a good match on a website like Thirdlove.com, herroom.com, and Evelyn & Bobbie, or go to a department store or specialty shop for a fitting.
The bra you choose should fit properly but not be so tight that it pinches you. You should be able to run a finger under the bottom of the bra, as well as between the strap and your shoulder. Shortening the straps will give you a slight lift and keep the skin from stretching. Your breasts should fill the entire cups but not overflow them.
A surgical pick-me-up
If lifestyle changes don’t give you enough of a pleasing result, a breast lift could be considered to improve the shape and position of the breasts. To make sure you’re a good candidate, a board-certified plastic surgeon will examine you, discuss your health history, and determine your goals before performing the procedure. Be warned that Medicare won’t cover the cost when it’s considered cosmetic surgery (as opposed to breast reconstruction after mastectomy, for example).
Mastopexy is the medical term for breast lift surgery. It can give the breasts a more youthful appearance by removing excess skin, tightening the tissue, and raising the nipple. This procedure is sometimes combined with a breast implant or reduction to give the breasts more (or less) volume as they are lifted.
There are several versions of the breast lift that use incisions of various sizes and shapes. Which version is best for you largely depends on the extent of sagging. Recovery after a breast lift can take several months, with time needed to regain sensation in the breasts as nerves heal.
But a breast lift isn’t appropriate for everyone. It can’t be done in women with breast cancer, and it may pose risks for anyone who has uncontrolled diabetes or cardiovascular disease, an active infection, an immune system disorder, blood clotting issues, or a history of poor wound healing, or who smokes. It’s important to discuss these and other possible risks with a surgeon before deciding to have this procedure.
BOTTOM LINE: Breast sagging is a normal part of aging. It’s nothing to worry about from a health perspective, but if the appearance bothers you, try lifestyle changes like exercise and wearing a more supportive bra. You might also consult with a plastic surgeon about a breast lift procedure.
