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Breast ptosis is characterized by an inferior descent of the nipple relative to the breast fold and lower pole skin redundancy. Initial patient evaluation focuses on determining their expectations, identifying risk factors for surgical correction, and assessing breast anatomy. Various surgical approaches can be used to correct breast ptosis, with specific indications and nuances accompanying each technique. Assessing breast ptosis severity and selecting appropriate mastopexy techniques are essential to achieving excellent surgical results and high patient satisfaction. This activity reviews the evaluation and treatment of breast ptosis and highlights the role of the interprofessional team during the initial assessment, treatment, and postoperative recovery of patients. Objectives: Differentiate between various degrees of breast ptosis and understand the anatomical factors contributing to each stage. Implement appropriate treatment plans based on the degree of breast ptosis and patient preferences. Identify potential complications and risks associated with breast ptosis surgeries. Coordinate preoperative assessments, surgical management, and postoperative follow-up care with the interprofessional team to optimize care for patients undergoing breast ptosis surgery. Access free multiple choice questions on this topic.

Although breast ptosis can present in patients of all ages and breast sizes, it is commonly associated with aging, macromastia, weight loss, pregnancy, and hormonal changes. This condition affects physical appearance and can significantly impact patients' emotional well-being. The natural history of breast ptosis begins with skin envelope stretch and laxity developing in the ductal structures and supporting ligaments. Subsequently, the breast parenchymal volume increases, rendering the supporting structures ineffective and causing skin redundancy. Ptosis can also occur when parenchymal volume decreases (eg, after significant weight loss) and relative skin redundancy ensues. The ptosis classification system is based on the degree of inferior breast displacement, for which various corrective techniques can be used (depending on the type of ptosis). Addressing breast ptosis involves clinical assessment, surgical expertise, and patient-centered communication, all of which contribute to achieving desired aesthetic outcomes and enhancing the overall quality of life for individuals seeking intervention.[1]

The incidence of major complications is 1.15% after mastopexy, 1.40% after augmentation, and 1.86% after augmentation/mastopexy, with hematomas and infection being the most frequent (1% and 0.25%, respectively). Small hematomas can be observed, but large and tight (or expanding) hematomas require urgent evacuation, hemostasis, and reclosure. A body mass index greater than 30 is an independent risk factor for postoperative infection and hematoma formation, among other complications. Patient age older than 60 years is also an independent risk factor for hematoma formation.[19] The most common nonmajor complications after mastopexy alone are suture spitting, bottoming out, and excess scarring. Bottoming out is a complication of breast implant surgery that consists of the descent of the IMF with inferior displacement of the implant, causing breast asymmetry. Suture spitting is more common in the SPAIR technique, bottoming out in inferior pedicle-based and inverted-T mastopexies, and excess scarring in periareolar mastopexies. Other tissue-related complications are nipple necrosis, malposition, deformity, and ptosis recurrence. Implant-related complications after augmentation/mastopexy are implant malposition and asymmetry, capsular contracture, and skin rippling. Reoperations are typically delayed until the breast tissue has fully settled and the final shape and projection have been acquired, which can take 6 to 12 months. A survey completed by 487 board-certified plastic surgeons in 2002 elucidated the following findings: the most popular approach was the inverted-T mastopexy, but the modified vertical mastopexies (Hall-Findlay and SPAIR techniques) were becoming more popular and had the highest satisfaction rates. Periareolar mastopexy had the lowest satisfaction rate among surgeons and had the highest revision rate (50%) compared with inverted-T and vertical mastopexy (21% and 29.9%, respectively). Most revisions were secondary to recurrent ptosis, bottoming out, excess scarring, and malposition.[20]

Breast ptosis treatment requires close cooperation between all interprofessional healthcare team members to achieve optimal outcomes. This begins with the primary care physician and nurse practitioner identifying patients with breast ptosis and assessing their pertinent medical history, including breast cancer risk factors and the need for further breast cancer screening.[3] Given the surgery is elective, all the medical problems and risk factors should be identified and minimized, including encouraging the patient to stop smoking. The specialist surgeon will navigate the various surgical options with the patient and subsequently perform the most suitable procedure. In the postoperative period, the patient will require vigilant monitoring from the entire interprofessional team, with nursing playing a significant role in patient monitoring and coordination with the pharmacy for postoperative pain control. A physical therapist may guide the patient in a slow and progressive return to more intense physical activity in 4 to 6 weeks postoperatively.[2] At the same time, the surgeon and nurse supervise the recovery of the patient. Open communication among the entire interprofessional team is essential for the patient to obtain the best possible outcome.