How to Fix Saggy Breasts – Breast Lift, Implants or Both?

Best Surgical Treatment for Saggy or Droopy Breasts

Breasts sagging, called breast ptosis, is a natural inevitable process especially with ageing or after childbirth and breastfeeding. A Breast Lift or Mastopexy procedure is one of the most in demand procedures for women with saggy, droopy breasts.

Dr Mark Gittos is a breast surgery expert and Plastic Surgeon in New Zealand who has helped hundreds of patients achieve their aesthetic goals.

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

Guide Breast Lift

What Causes Breast Sagginess

  • The most noticeable sagging occurs due to the process called breast involution
  • Breast involution is a process where the milk production 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 Can Happen.

Besides breast involution, breasts can start to sag at any age, especially if they are on the larger side. The breasts 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 ageing process
  • Large breasts often have a tendency to sag sooner in life 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 Exercise Cause Breasts Sagginess?

Sports activities such as tennis or running can, over time, cause your breast ligaments to stretch or even tear. It’s always important to consider proper support for your breasts during sports and to wear protection if involved in impact sports that might 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
  • Tissues can atrophy with age and weight fluctuations
  • When you lose weight, some of the fat will disappear from your breasts
  • Typically the skin and ligaments inside the breasts do not retract after weight loss
  • This can result in ’empty’ looking breasts

Is the Bra Efficient in Preventing Breast Sagginess?

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Auckland Breast Surgeon and Plastic Surgeon, Dr Mark Gittos, says:

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

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.

Breast Lift or a Breast Augmentation or Both to Treat Breast Sagginess

Overly saggy breasts or droopy breasts are known as ptotic breasts or breasts with ptosis.  Breast sagginess can only be corrected with the help of plastic surgery. However, most women don’t know what the suitable procedure might be.

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

Classification of Breast Ptosis:

  • 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
hanging tits - perky nipples New Zealand - CHART for Saggy Tits, Sagging Breasts, Torpedo Tits, Droopy Tits and Droopy Breast Chart - Dr Mark Gittos Best Breast Surgeon New Zealand Auckland

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.

Women with mild to moderate drooping can get 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 larger 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)

OPTION 1 – Breast Lift without Implants

A breast lift repositions the breasts into a higher position.

The Downsides of a Mastopexy

  • Having Breast Scars
  • 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 2 – Breast Augmentation

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 Dr Gittos):

  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

The downsides of breast augmentation

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

The upsides of breast augmentation

  • Your breasts are bigger in size and your cleavage more interesting
  • Your breasts have the shape you’ve always wanted

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 Dr Mark Gittos’ Guide to Cosmetic Breast Surgery

Guide Ultimate Breast Surgery

OPTION 3 – Breast Lift with Implants

Masto-Aug surgery, as it’s known, is a challenging surgical procedure for Ptotic Breasts. Dr Gittos 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 breast augmentation with implants

  • 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 upsides of breast augmentation with implants

OPTION 4 – Multiple breast procedures

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 stages surgeries

  • 2 surgeries, 2 costs and 2 recoveries

The upsides of stages surgeries

  • 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.

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

Finding a Breast Lift Surgeon in Auckland

For many women in New Zealand, 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 Dr Mark Gittos – Auckland Plastic Surgeon?

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

Further Reading about Breast Augmentation

Medical References

About Dr Mark Gittos FRACS (Plast) – New Zealand Plastic Surgeon 

Practice locations in Herne Bay Auckland, Northland and Bay of Plenty – Kerikeri, Whangarei, New Plymouth & Tauranga

Dr Mark Gittos is a leading Specialist Plastic Surgeon and operates a practice in Herne Bay, Auckland and in the UK. The 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.

Dr 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 worldwide expertise Dr Gittos is an expert in breast, face and body surgery for men & women. 

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.


Please NOTE: Dr Gittos only performs surgery on non-smoker patients with a BMI less than 30. To check your BMI please visit the NZ Heart Foundation website. For help giving up smoking before surgery visit the Smoke Free website

Do your Research

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
  • Dress in simple clothes as you may need to undress for examination
  • Bring your medical referral and any relevant medical documents or test results

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 on 09 529 5352 to arrange your surgeon consultation appointment.
  • Book a consultation with Dr Gittos by paying the Consultation Fee – $350 incl GST

Traveling for Surgery? – Consider post-surgery luxury recovery in a Hotel with LuxeCare

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

Send an enquiry form today or phone  09 529 5352  during Clinic Hours