Breast Lift

Sagging Breast Surgery

The misconception that placing an Implant in a Sagging breast will solve the problem

Many people choose augmentation surgery expecting that “adding volume will correct sagging.” However, when the actual anatomical structure and direction of physical load are considered, an Implant is not a means of resolving sagging, but rather a factor that can worsen it.

Why does placing an Implant in a Sagging breast fail?

Anatomical Structure and Direction of Load

Breast shape is determined by the following two axes.

ㆍ Vertical axis: The centerline connecting the Nipple and the center of the breast

ㆍ Base footprint: The “base area” of the Breast fixed over the ribs

The occurrence of sagging has two implications.

1. The Nipple position has descended below the base footprint.

2. Weight is concentrated in the lower breast (pole), resulting in structural stretching.

In other words, sagging is caused not by a lack of volume, but by structural collapse. However, problems arise when augmentation surgery is performed under the misconception that “adding volume will solve it.”

An Implant must be aligned with the “Nipple center,” but in a Sagging breast, the Nipple has descended. If the Implant is placed according to the Nipple position, the entire Breast becomes positioned excessively low, resulting in a deformity. Therefore, many hospitals compromise by leaving the Nipple low and inserting only the Implant in the upper portion (upper pole) as if it were placed on top.

The result is as follows.

The Anatomical Cause of “Snoopy Nose Deformity”

ㆍ The upper breast appears rounded.

ㆍ However, an inverted appearance occurs in which only the Nipple appears to sag further downward.

ㆍ The Nipple points downward, while the Implant is pushed upward.

This is structurally inevitable and worsens over time, because gravity pulls both the Implant and the original tissue downward.

The Second Repeated Failure in Attempts to Lift After Augmentation

The Pitfall of the Periareolar Lift

When the outcome of the first surgery is unsatisfactory, hospitals commonly suggest the following solution.

“The Areolar can be cut into a circle and the upper portion can be lifted.”

This is the so-called donut lift (Periareolar Lift). However, it inherently causes excessive widening of the Areolar diameter.

Why Do Wrinkles Form Around the Areolar?

The skin around the Areolar is highly elastic, while the outer skin is firmer.

When a larger area of skin is fitted around a small Areolar circumference, the surrounding skin does not gather; instead, the Areolar widens and absorbs the wrinkles. Over time, rather than the wrinkles flattening, the tissue adapts by increasing the Areolar diameter abnormally.

When this process is repeated, the following complex deformities occur.

Widened Areolar

Lower-pole volume that still remains below

Abnormal Nipple and breast axis

Sagging worsened by the weight of the Implant

In other words, only sutures that make it appear lifted are performed without an actual lift, so the underlying cause is not addressed at all.

Then how should it be resolved?

The answer is to eliminate the cause.

There are two causes of sagging.

1. Excessive weight concentrated in the lower breast

2. Vertical collapse of stretched skin and tissue

Removal of Excess Lower Tissue + 3D Repositioning

Breast shape is determined not by “excision,” but by “repositioning (reshaping).”

Remove a portion of the heavy lower tissue,

reposition tissue that can be moved upward to the upper portion, and

set the Nipple–Areolar Complex (NAC)–cone axis in its normal position.