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

Do you have Saggy or Droopy Breasts that need Surgery?

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 saggy droopy breasts who seek out Mr Mark Gittos Specialist Plastic Surgeon in London UK

saggy droopy breasts

Why do breasts get saggy and droopy 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.

Drooping Breasts At An Early Age? It’s Not Uncommon.

Besides breast involution, breasts can start to droop at any age as they do NOT have muscles in them. They have ligaments and connective tissue.

  • When gravity pulls the breasts down, ligaments and breast skin can stretch, which makes breasts droop or sag.
  • This can depend on the elasticity of your skin & ligaments as determined by your genes, your nutritional intake & your environment, as well as normal aging processes.
  • Large breasts often have a greater tendency to sag than smaller breasts, as there is more weight on larger breasts for gravity to pull down.
  • But eventually smaller breasts will sag or start to droop, and if the breasts are fairly empty of tissue (some say they feel these look like a ‘droopy sock’), the nipples can begin to point downward and fall below the inframammary fold.

Does Frequent Exercise Cause Breasts to Sag, Resulting in Drooping Breasts?

Activities during sports such as tennis or running can, over time, cause your breast ligaments to stretch or even to tear. It’s always important to consider to support your breasts during sports and to wear protection if involved in impact sports that might impact your breasts or damage your breast tissue.

I lost weight and my breasts are drooping – Help!

  • Another common cause of sagging breasts is weight loss.
  • Breasts have a high volume of fat tissue to muscle tissue.
  • Tissues can atrophy with age and weight change.
  • When you lose weight, some of the fat will disappear from your breasts.
  • Typically the skin and ligaments inside the breasts do not retract accordingly.
  • This results in an ’empty’ looking breast that then sags or droops.

Do I really need to wear a Bra to stop my breasts from drooping with age?

London Breast Surgeon and Plastic Surgeon, Mr Mark Gittos, says:

  • ‘Wearing a supportive sports bra almost every day is essential to prevent breast sagging’.

Does taking Vitamins help my breasts?

Besides wearing a good sports bra, some vitamins can help your skin

  • ‘You can strengthen the elasticity of your skin and ligaments via nutrition. Vitamin C is very important for collagen synthesis within the skin and this may help reduce the drooping’.

Need to know how to fix sagging breasts? Are your nipples pointing south? Here are 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 over time
  • 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 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

Saggy and Droopy Breast Chart London Plastic Surgery

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 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 several surgical solutions for the Ptotic Breast:

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


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

The Downsides of a Mastopexy

  • Having Breast Scars (Skin is soft and scars can 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

Download Mr Mark Gittos’ Guide to Breast Lift Surgery – Mastopexy for Sagging Breasts

Guide Breast Lift


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 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.
  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.


  • 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.


  • 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 should have been performed.

Download Mr Mark Gittos’ Guide to Cosmetic Breast Surgery

Guide Ultimate Breast Surgery


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.

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


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


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.


  • 2 surgeries, 2 costs and 2 recoveries


  • 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

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.

Scars also usually fade away over time and may settle even further over 12 to 18 months to fully settle. Mr Mark Gittos is dedicated to getting you the best results from a Breast enhancement, lift or augmentation surgery.


Breast Augmentation & Breast Implant Sizes: Don’t Choose An Implant That’s Too Big. Gravity Will Always Win.

So wear a good sports bra, avoid smoking and have plenty of vitamin C. If all of this fails, then give us a call to see if we can help you.

Read Mr Mark Gittos’ Blog about Solutions for Firmer Breasts

Finding a Breast Lift Surgeon in London

For many women in United Kingdom, having breast lift surgery is a life-changing experience. There are many qualified plastic surgeons, but it is always best to find one who is experienced in breast lifting procedures. Always Look for an experienced surgeon that you feel comfortable with and get a second opinion.

Why Choose Mr Mark Gittos – London Plastic Surgeon?

With a wealth of experience and training, Mr Gittos is 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. Mr Gittos has significant breast surgery experience and a current FRACS membership.

About Mr Mark Gittos FRACS (Plast) – London Plastic Surgeons 

Practice locations in London & Essex, UK and Auckland, New Zealand.

Mr Mark Gittos offers high quality, natural-looking cosmetic surgery results and is highly experienced in BreastBody and Face Surgery having performed over 4000 Surgeries in the last 26 years. 

With world-wide expertise Mr Gittos is an expert in breast, face and body surgery for men & women. 

Mr Mark Gittos is a leading Specialist Plastic Surgeon and operates a practice in London UK and Auckland New Zealand. His practice focuses on both surgical and non-surgical procedures, each designed to help restore, improve or change a physical characteristic or problem. The first step in every case is to talk through your personal requirements and explore all the options, before deciding on the most effective solution.

Naturally, before any treatment is begun, we will explain clearly the advantages and risk factors; so that you have the information you need to make an informed decision that is best for you. Visit the practice to find out more.


Do your Research

  • Read the Website and Blogs relevant to your procedure
  • Browse our Frequently Asked Questions including how to choose a Surgeon for your procedure
  • Download the Guides to Surgery

What to Bring to your Plastic Surgeon Consultation

  • Bring a friend or relative to help discuss the information and your choices
  • Take lots of notes and read the documents provided thoroughly
  • Want more information before scheduling your consultation?

Book your Initial Surgery Consultation

  • A Referral from your GP or specialist is helpful but NOT essential – you can have a consultation without a GP Referral
  • Email us or Call in London on 07557 858156  to arrange your surgeon consultation appointment.
  • Secure your consultation with Mr Gittos by paying the Consultation Fee in advance
  • A consultation with Dr Gittos is £195.

Please contact us to arrange to book a consultation or to speak with our Patient Care Advisor.

Send an enquiry form today or UK phone 07557 858156 during Clinic Hours