Recurrent breast ptosis: signs, challenges, and treatment

Recurrent breast ptosis refers to the condition in which the breasts begin to sag again after undergoing cosmetic mastopexy (breast lift surgery). According to Dr. Ho Cao Vu, Master of Science (MSc), the most common cause is inaccurate surgical planning during the initial procedure.

In such cases, patients frequently experience skin deficiency, fibrosis, significant loss of glandular volume, misalignment of the nipple-areola complex, and poorly placed scars from previous surgeries, all of which complicate future reconstruction efforts.

During a breast implant removal surgery. Photo courtesy of Dr. Cao Vu

Tissue and skin deficiency for implant-based reconstruction

Dr. Vu notes that managing recurrent breast ptosis presents several challenges. One major issue is tissue and skin deficiency. During the original breast lift, excess skin, and sometimes breast tissue, is removed, and implants may be inserted depending on the surgeon's recommendation. If too much tissue is removed, there may not be enough remaining to support future corrections, making implant-based reconstruction difficult or unfeasible.

Scarring

Another complication is scarring. Some patients develop hypertrophic (raised) scars or contractures, tightened areas of skin that can extend across the breast. These issues may be exacerbated by poor blood circulation, post-operative bleeding, fluid accumulation, infection, improper implant selection, excessive compression from bandaging, or heat damage from surgical instruments.

Before any revision surgery, a thorough evaluation of the scar's size, location, age, pigmentation, and tissue quality is essential. If the scar tissue is dense and inelastic, the risk of poor circulation, skin damage, and tissue necrosis during surgery increases.

Difficulty in redistributing breast tissue

Redistributing breast tissue is another challenge. The nature of breast tissue varies by age, childbirth history, and natural anatomy. If the original surgery removed tissue unevenly or failed to reposition it properly, revision becomes highly complex.

Because breast tissue contains numerous small blood vessels, maintaining blood flow is critical to healing. In revision procedures, surgeons must delicately move tissue while preserving vascular integrity, especially when existing scars or hardened tissue are present.

Each level of ptosis severity requires a different treatment plan. Photo courtesy of Dr. Cao Vu

Treatment recommendations based on ptosis severity

For grade 1–2 breast ptosis, patients can self-assess by standing upright with arms relaxed and no bra. If the nipple lies 1–2 cm below the inframammary fold, it indicates mild sagging. In these cases, Dr. Vu recommends breast augmentation using implants with the Dual Plane II technique, which enhances both shape and volume.

For grade 3–4 ptosis, patients should evaluate glandular volume, skin elasticity, and the presence of stretch marks. If there is marked glandular imbalance, loose skin, and stretch marks caused by ruptured collagen fibers (often post-childbirth), mastopexy without implants is advised. This method preserves natural glandular tissue, offers comprehensive correction, and reduces the risk of recurrence.

For patients with limited glandular tissue but good skin elasticity and vertically oriented grade 3 ptosis, a two-stage procedure, breast augmentation followed by areola reduction, is recommended. This approach minimizes incision tension and reduces the risk of visible scarring.

Patients may choose which stage to undergo first, depending on personal needs and expectations.