Can grade 4 breast ptosis be corrected without breast implants? It can, in certain cases where the breast glandular tissue has not undergone atrophy and a relatively large amount of tissue remains. Instead of adding volume with breast implants, the surgeon can preserve, redistribute, and reshape the patient’s own breast glandular tissue to improve the position and shape of the breasts and the nipple-areola complex.

Ms. SN, born in 1987, 1.60 m tall and weighing 53 kg, was assessed by the surgeon as having grade 4 breast ptosis, with abundant glandular tissue and both the glandular tissue and nipple-areola complex concentrated in the lower pole. In addition, she had a pectus carinatum chest structure, an oblique breast base plane, glandular tissue with a tendency to fall laterally, and thin breast skin.

With the existing amount of glandular tissue, the planned approach was Mastopexy without breast implants, prioritizing the preservation of autologous breast glandular tissue and using a new-generation Ultrasonic Surgical Scalpel.

Ms. SN’s Breast Condition Before Surgery

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Through direct examination, the surgeon noted:

• Grade 4 breast ptosis, with the glandular tissue and nipple-areola complex positioned low.
• Abundant breast glandular tissue, concentrated mainly in the lower pole.
• Pectus carinatum.
• An oblique chest wall plane, causing the breast glandular tissue to tend to fall laterally.
• Thin breast skin, with the tissue-supporting capacity requiring careful consideration in the surgical plan.

Therefore, Ms. SN’s condition was not simply a matter of the skin and breast glandular tissue sagging downward. The thoracic skeletal structure, the distribution of glandular tissue, and skin quality all influenced the surgical approach.

What Is Grade 4 Breast Ptosis?

Breast ptosis is a condition in which the breast tissue and nipple-areola complex descend below their normal position relative to the inframammary fold.

In severe cases of breast ptosis such as Ms. SN’s, the glandular tissue is concentrated mainly in the lower pole, the nipple-areola complex is positioned low, and the skin is stretched. This causes loss of fullness in the upper part of the breast, while the lower part becomes heavier and extends downward below the inframammary fold.

Is breast implant placement mandatory for Grade 4 breast ptosis?

No. Severe breast ptosis does not mean that breast implants are necessarily required. Breast implants serve to add volume. Meanwhile, some patients with breast ptosis still have a relatively large amount of their own breast glandular tissue.

In Ms. SN’s case, the main issue is not a lack of volume, but that the glandular tissue is concentrated and has descended into the lower pole.

Therefore, the surgeon can assess whether the existing glandular tissue can be used for reshaping instead of adding volume with breast implants. This allows the patient to undergo Mastopexy while preserving autologous breast glandular tissue, save the cost of additional breast implant placement, and reduce the risk of recurrent breast ptosis after implant placement.

How Is Mastopexy Without Breast Implants Performed?

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The principle of this approach is to use the patient’s own breast glandular tissue to reconstruct the breast shape.

Depending on each patient’s anatomy, the surgical plan may include:

• Removing excess skin according to an appropriate surgical design.

• Preserving the necessary amount of glandular tissue.

• Redistributing the glandular tissue concentrated in the lower pole.

• Recreating the breast shape and projection using autologous tissue.

• Adjusting the position of the nipple-areola complex.

• Controlling the tendency of the glandular tissue to fall laterally within anatomical limits.

The goal is to recreate the breast shape using the patient’s own tissue without using breast implants to add volume.

Why Is Preserving Breast Glandular Tissue Important in This Case?

Ms. SN has a large amount of glandular tissue. This is a source of autologous tissue that the surgeon can assess for use during the reshaping process.

Instead of removing a large amount of tissue and then using breast implants to restore the volume, the approach in this case is to preserve an appropriate amount of glandular tissue and redistribute the tissue concentrated in the lower pole.

Put simply:

The glandular tissue is not lacking → the glandular tissue is not in the appropriate position → reshape and redistribute the tissue instead of adding breast implants.

However, the amount of tissue that can be preserved depends on the anatomy, tissue quality, and the need to ensure safe blood supply in each individual case.

How Does Pectus Carinatum Affect Breast Reshaping?

The breasts lie on the bony chest wall. Therefore, the skeletal structure can directly affect the direction and shape of the glandular tissue.

In Ms. SN’s case, pectus carinatum combined with an oblique breast base plane causes the glandular tissue to tend to fall laterally.

Therefore, Mastopexy is not simply about “lifting the breasts higher.” The surgeon also needs to evaluate the orientation of the bony chest wall and the distribution of glandular tissue over the breast base.

The existing skeletal structure cannot be changed by breast reshaping surgery alone. Therefore, the surgical goal needs to be determined based on the actual anatomical limits.

How Does Thin Breast Skin Affect the Outcome of Breast Reshaping?

The skin and supporting tissue system play an important role in maintaining breast shape.

In individuals with abundant glandular tissue but thin skin, the weight of the tissue can place pressure on the outer soft-tissue envelope. This is a factor that the surgeon needs to take into account when designing and securing the tissue during breast reshaping.

Therefore, long-term results depend not only on the amount of glandular tissue but also on skin quality, the characteristics of the supporting tissues, chest structure, age, and changes in the body over time.

Can an Asymmetrical Areola Be Corrected at the Same Time as Mastopexy?

Depending on the specific condition, the shape and position of the nipple-areola complex can be assessed and adjusted as part of the Mastopexy plan.

In Ms. SN’s case, the areola was asymmetrical and positioned low, together with the glandular tissue concentrated in the lower pole. Therefore, the nipple-areola complex is an important part of the surgical plan and cannot be separated from the redistribution of glandular tissue.

The goal is to reposition the nipple-areola complex to a position that is more appropriate for the newly reshaped breast while also improving overall symmetry.

Who May Be Suitable for Mastopexy Without Breast Implants?

An approach without breast implants may be considered for individuals who:

• Have breast ptosis but still have an adequate amount of glandular tissue.

• Do not desire a significant increase in breast volume.

• Prefer the use of their own tissue.

• Desire improvement in breast position and shape rather than an increase in size.

• Are assessed by the surgeon as suitable based on their tissue, skin, and anatomical structure.

Not all cases of breast ptosis are suitable for the same technique. Whether breast implants are needed should be decided after a direct examination.

Summary of Ms. SN’s Breast Reshaping Case

Patient: Ms. SN, born in 1987
Height: 1.60 m
Weight: 53 kg
Condition: Grade 4 breast ptosis with abundant glandular tissue
Characteristics: Glandular tissue and areolae concentrated in the lower pole, pectus carinatum, an oblique breast base, glandular tissue tending to fall laterally, distorted areolae, and thin skin
Surgical approach: Mastopexy without breast implants, prioritizing the preservation of autologous breast glandular tissue
Goal: Redistribute the glandular tissue, improve the position of the nipple-areola complex, and recreate a breast shape that is proportionate to the body.

Conclusion

Grade 4 breast ptosis does not mean that breast implants are necessarily required. If the patient still has an adequate amount of glandular tissue, the surgeon can assess the option of preserving and redistributing the patient’s own tissue to recreate the breast shape.

In Ms. SN’s case, there was abundant glandular tissue concentrated in the lower pole, together with pectus carinatum, an oblique breast base, glandular tissue tending to fall laterally, distorted areolae, and thin skin. Therefore, the Mastopexy plan needs to address both the breast ptosis and the patient’s individual anatomical characteristics.

The goal is not to add an additional breast implant, but to appropriately utilize the existing glandular tissue to recreate a natural and balanced breast mound on the patient’s own breast base.