Pinch under the breast to check sagging.
One of the biggest mistakes in aesthetic surgery is patients thinking that implants can fix any issue with the shape of their breasts. It is very common for patients to come to consultations and say things like, “I want my breasts to be perky again, so I need large implants.” But the reality is that the breast structure is limited in what it can do. If your breasts are sagging, simply adding a large, heavy implant without removing the excess skin is like putting a heavy rock inside an old, stretched-out sock – it will not make the sock stand up; instead, it will only get more stretched and sag even more.
So, if you want to find out whether you are a good candidate for a simple Breast Augmentation (Implants) or if you need a Mastopexy (Lift), then you should check the condition of your skin (“the envelope”) and the nipple position. These two things can be evaluated at home with two easy, trustworthy self-evaluations: The Pinch Test (to check volume) and the Pencil Test (to check the effect of gravity).
The Pinch Test: Identifying “Empty” Skin
This test can come in handy when you want to know if it is sagging (ptosis) or if it is just simple deflation (involution). A lot of women confuse volume loss with sagging after breastfeeding or losing weight.
The method: Look at yourself in the mirror standing without your bra on. Take the skin at the upper part of your breast (the “upper pole”) between your fingers just below your collarbone and pinch it.
- The finding: If you can grab more than 2 to 3 centimeters of loose, thin skin, and your breast tissue feels like it has been “forced” to the bottom of the pocket, then you most likely have Pseudoptosis (false sagging).
- Interpretation: Your skin envelope is slightly loose, but the internal structure is mostly intact. This is typical after breastfeeding. In such instances, a lift might not be necessary. Usually, an implant can serve as a filler and re-inflate the empty skin envelope to a perky, full look without the need for additional incisions.
The Pencil Test: Measuring Gravity
This is a time-honored, classic test to verify true Ptosis (medical sagging). It mainly focuses on the stress put on your Inframammary Fold (the crease under your breast) due to your breast’s weight.
The method: Grab a pencil (or a piece of paper) and lay it horizontally under your breast exactly where your breast is touching the ribcage. Let your breast naturally hang over the pencil.
- No problem: If the pencil drops straight away to the floor, then you pass the test. Your breast is considered self-supporting and it is also sitting high on your chest wall.
- Problem: If the pencil remains caught in place, held there by the breast’s weight hanging over it, then you have a sagging problem. The skin has stretched enough to fold over itself.
- Interpretation: Being able to pass the pencil test means that you cannot depend on an implant solely. When an implant is placed in a breast that can trap a pencil, the implant is going to be sitting high on the muscle, while the natural breast tissue will be sliding off it and hanging below, thus creating the infamous “Waterfall Deformity” or “Double Bubble.” The skin hammock needs to be tightened by a lift.
The “Nipple Rule”: How Much Have You Dropped?
A strict grading system based on the nipple position relative to the breast crease (Inframammary Fold) is what surgeons use. You can do a quick check in the mirror by lifting your hand a bit.
- Normal: The nipple is above the breast crease.
- Grade 1 (Mild Ptosis): The nipple coincides with the fold. (This is the “gray area”—sometimes an implant alone is enough, sometimes a small lift is necessary).
- Grade 2 (Moderate Ptosis): The nipple is below the fold, but it is still pointing forward or slightly up. (You will definitely need a lift).
- Grade 3 (Severe Ptosis): The nipple is at the lowest point of the breast curve and is clearly pointing downwards. (A full Anchor Lift will be necessary to reposition the nipple and remove the extra skin).
What Role Does the Skin Elasticity Play?
The last aspect of your self-check is the “Snap Back” ability. Suppose your breast skin is somewhat similar to a rubber band.
- Great Elasticity: If you stretch your skin and it immediately goes back to the initial position lying against the tissue, your collagen is pretty strong.
- Bad Elasticity: When the skin gradually makes its way back, or if there are stretch marks (striae) on it, then the collagen has been compromised.
At Lin Europe Clinic, we always say that the skin largely dictates what the surgery will be like. Eventually, thin, damaged skin will not be able to support the weight of a large implant. You should know that if you have an issue with sagging and lack of elasticity, then the only way to survive is not by trying to hide your skin’s shortcomings under a big implant. Gravity will dominate, and you will be faced with the necessity of revision surgery in just a couple of years.
Breast Surgery in Turkey
Lin Europe Clinic is the right choice if you want breast surgery in Turkey because you want to be informed about the “Lift vs. Implant” dilemma. Most clinics may try to persuade you by selling a simple augmentation because that operation is quicker and the scars are smaller. However, we focus on your shape staying beautiful for a long time rather than a quick fix.
Our surgeons in Istanbul have experience with the Augmentation-Mastopexy (The Combo). This consists of cutting away the overly stretched skin, moving the nipple back to the center and the youthful position, and then placing a small implant to give the upper pole volume again. Although this leaves more scars compared to a simple augmentation, it is an only means to have an uplifted, tight, youthful silhouette that will not let gravity dominate for many years.
Frequently Asked Questions About Sagging
Simply no, since breasts consist of fat and glands, not muscles, hence exercise cannot tighten the skin or repair stretched ligaments. Chest exercises can only develop the muscles under the breast but lifting the breast tissue itself is not physically possible through exercises.
Removing the excess skin and squeezing the tissue during the operation, almost all women lose about one cup size. So, if you want to keep your current volume or be bigger, you will have to insert an implant while doing the lift.
While implants can only add volume behind the breast and cannot physically change the position of the nipple, i.e., lift the nipple on the chest wall. Actually, an implant placed behind a sagging nipple basically directs it downward even more and this is how “Snoopy nose” deformity is created.
This problem happens when a breast implant is placed in a breast that is sagging without the aid of a lift, thus the implant stays up while the natural breast tissue slides off and droops below it. This results in an unnatural present of a “double bubble” where the implant and the breast look like two separated mounds.
To tell the truth, pregnancy and not breastfeeding accounts for most of the damage to the structures, it is the rapid stretching and deflation of the skin. Breastfeeding may lead to the volume (deflation) loss but the ligament stretching usually happens before the baby is born.
egnault, P. (1976). Breast ptosis. Definition and treatment. Clinics in Plastic Surgery.
Kirwan, L. (2002). A classification of breast ptosis. Aesthetic Surgery Journal.
Rubin, J. P., et al. (2010). Optimizing outcomes in breast augmentation. Aesthetic Surgery Journal.
