Breast Surgery After Children

Having children is one of the great joys of life. They do however exact a toll on the body of the mother. The two main areas affected by childbirth and breastfeeding are the breasts and abdomen. This article will address the breasts and a separate article will address the abdomen.

As a Plastic Surgeon of over 25 years experience, I know all my patients are individuals in their physical characteristics and in their personal desires and their goals.

Women come in all different shapes and sizes. They deposit fat in different areas and have skin with different characteristics. Genetics is a powerful force. As is gravity, childbirth and breastfeeding.

For many women, the weight gain of pregnancy and subsequent weight loss, enlargement of the breasts with breastfeeding, and the natural loss of glandular tissue after completion of breastfeeding, leaves them with breasts that have lost volume, are saggy and drooping.

Other causes of empty sagging breasts are the effects of gravity, the inevitable change in hormones as menopause approaches, and also the effects following a weight loss.

For any patient, the first thing to decide in the is whether they are happy with their current breast volume. Obviously if they are too big, they could have a simple breast reduction to reduce the volume and lift the breasts. There are Medicare item numbers for breast reduction surgery.

If the patient is happy with the current volume of the breasts, then a breast lift (mastopexy), can be used to maintain the current volume and by removing excess loose skin and concentrating the available volume higher on the chest. This surgery involves scars on the breast, but the underlying muscle is not touched. This surgery can be performed as a day procedure.

There are also Medicare items numbers for breast lift surgery if specific criteria are met.  The current criteria is that at least two‑thirds of the breast tissue, including the nipple, lies inferior to the inframammary fold (fold under the breast) where the nipple is located at the most dependent, inferior part of the breast contour. Pre-operative photographs as evidence of this are required.

If the breasts have lost volume and the patient desires to be bigger, then volume will need to be added in the way of a breast prosthesis. If the breasts are not too droopy, i.e. the nipple sits relatively high above the fold under the breast, then a breast augmentation can add volume and fullness to the breasts. The size of prosthesis is a decision for the patient; however, the prosthesis selected must have enough volume to fill the empty breast envelope.

There is a point, however, when the size of prosthesis needed to fill the specific loose breast envelope is either technically inappropriate, or unsatisfactory to the patient. Under this circumstance, the breast envelope must be reduced (by the same technique as a breast lift). This allows an appropriate sized prosthesis to be used to achieve the desired effect and appearance. This is called an “augmentation mastopexy” where the breast is both lifted and filled to the desired size.

If the breast lacks volume, and the nipples are hanging low below the inframammary fold, then the breast would need to be lifted as well as a prosthesis placed (augmentation mastopexy). If the breast is not lifted to raise the nipples, the breast tissue will tend to hang off the breast prosthesis and look unsatisfactory outside of a bra. The downside of course of lifting the breast is that scars will be required to remove the excess loose skin.

A key factor for any surgery is timing. Ideally this surgery should be done after it is decided the family is complete. This is not a hard rule but does mean the possible effects of further pregnancies can be avoided.

Timing after breastfeeding is also a key factor. Basically, it is ideal if the breast goes through all of its “shrinkage” changes, and the patient is back to her realistic body weight. This way there are no moving variables. Also milk production must have ceased, otherwise there is a risk of milk cysts and leakage, as well as an increased risk of infection. Roughly 6 months as a minimum after ceasing breastfeeding is a good guideline.

As you can see, there many issues and options to consider thinking about surgery for empty sagging breasts. Some of these are technical and are dictated by the specific characteristics of the patient. Some are personal and dictated by the preferences of the patient.

There are a lot of variables to be considered, and these and other relevant issues would be discussed in detail during a comprehensive consultation.

Important Note:

The content on our page in general in nature and does constitute medical advice. Any surgery or invasive surgery carries risks and has a recovery time. Please refer to the procedure page for detailed information.