Breast sagging is a common problem women face with aging, breast deflation after breast feeding and/or after the placement of large breast implants. The cause is a disproportion between the size of the breast tissue and the amount of skin enveloping it combined with stretched out and weakened ligaments that connect the breast tissue to the chest wall. This flattens out the top half of the breasts so that most of the remaining breast tissue is in the bottom half of the breasts. Because the problem is related to the skin and breast tissue (fat, breast gland and suspensory ligaments) rather than muscle this problem is unaffected by exercise. Historically the treatment was surgical removal of excess skin sometimes with some manipulation of the breast tissue and/or a breast implant resulting in a firmer breast with more fullness in the upper half of the breast. Removal of skin alone does not always restore the more youthful appearing upper half fullness.
The pattern of skin removal (circle around the nipple, lollipop, inverted-T incision) used depends on the degree of drooping or amount of skin that needs to be removed. For larger skin removals the anchor pattern or inverted-T has been the mainstay. The problem with this is some patients develop large symptomatic scars.
This patient had a traditional skin removal breast lift mastopexy using the inverted-T or anchor pattern skin removal.
The latest option on the horizon, as of today it has mostly been performed on pigs, is the “Internal Bra Breast Lift” also called the “Cup & Up”. It was developed in Israel and trial on human patients has just begun in Europe.
The blue dots represent where the small less than half inch incisions are made under the breasts to insert the silicone sheet and higher on the chest to allow the straps to be attached to the ribs.
As I see it the pros are that this will give the breast the desired upper half fullness with minimal surgery or skin incisions. The cons are that
1-this will not work if there is still significant breast tissue breast skin disproportion in which case it would look odd if you did just this internal bra procedure.
2-the upper chest scars can be visible with a low cut dress and in patients prone to bad scarring this is the last place you want a problematic scar
3-the procedure is advertised as a minimal procedure performed under local anesthetic but the upper ends of the straps are screwed into the rib bones and surgery on bones under local anesthetic is painful as anyone who has broken a bone can tell you
4-if the skin is very loose and thin from being stretched out there may not be thick enough tissue to adequately cover or camouflage the silicone sling at the bottom of the breast
In short it is too early to tell if this procedure will amount to anything or if it will be good for specific types of patients. What we can say for sure at this point is that it will not be good for all patients with drooping breasts.
This sling idea is not exactly new. Some surgeons routinely remove the surface of the excess skin and then move the deeper layers of this excess skin into position as a deep sling that is sutured over the ribs at the bottom of the breasts. Some surgeons in Brazil place a nonabsorbable mesh under the breast at the time of surgery. The material used in Brazil incites a reaction and scar tissue formation which the surgeons say keeps the breast in position. The problem there is controlling the degree of tissue reaction and scar formation.