PHYSIOLOGY  

Breast “sag” or “hang” because the “skin bra” is larger than the breast tissue.
Over time the weight of breast tissue can continue to stretch the skin and acts like a “rock in a sock”.
Some women develop breasts that sag but more often the cycle of expansion and contraction of breast tissue (during pregnancy and/or after weight loss) results in a permanent stretching of the skin. Technically the “viscoelastic elastic” properties of the skin have been irreversibly altered.  An analogy is like a pair of panty hose that have lost their elasticity. Unfortunately there are no known reliable non surgical techniques to significantly shrink the skin.

BREAST LIFT
Mastopexy (breast lift) involves shaping the breast, repositioning the nipple areolar complex (NAC) and when needed reducing the size of the NAC, and by removing excess skin that causes the sag of the breast. The nipple is left connected to the breast tissue.
Each of the below techniques involves a progressive removal of excess skin and builds on each other to lift and contour the skin “bra” to the shape of the breast desired.

Depending on how much excess skin and desired shape the three main types:
1)Peri areolar = doughnut shaped scar around NAC. Primary result is elevation of the NAC.
2)Vertical = lollipop shaped scar. Elevation of the NAC and shaping the breast in a horizontal plane.
3)Inverted “t” = anchor shaped scar. Elevation of the NAC, shaping the breast in both a vertical and horizontal and plane.

Depending on your desires, shape and look of the breasts your chosen Plastic Surgeon
will decide what type of Mastopexy is required. I request that patients bring in photos of “ideal” or “model” photos to better help me understand what the patients needs, wants and desires are.

YOUR SIZE
Breast size will not significantly change because skin is only resected.

SENSATION
The nerve to the nipple areolar complex (NAC) is directly under the NAC and is rare  to be disturbed by removing the excess breast skin during a mastopexy. The surrounding breast skin may have some short term numbness but usually returns.

UPPER UPPER POLE FULLNESS
Current mastopexy techniques will not often maintain over the long term the “upper pole” fullness patients desire. A small breast breast implant is placed to  can be to create the upper pole contour and will not increase size substantially.

SCARS
Scaring is always a concern. However there are various postoperative “anti scar”
programs to optimize, reduce and treat scars.
In my experience if the desired goals of shape and positioning of the NAC is obtained …. The patients rarely complain about the scars.

I suggest you you collect several “model” or “goal” photos and then make a appt. with Plastic Surgeon, who has experienced and who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).