Estrogen is also essential to maintaining a fibrous protein called collagen, which makes up much of the breasts connective tissue. Ptosis scale
Plastic surgeons describe the degree of breast sagging using a ptosis scale like the modified Regnault ptosis scale below:
Grade I: Mild ptosis—The nipple is at the level of the infra-mammary fold and above most of the lower breast tissue. Grade II: Moderate ptosis—The nipple is located below the infra-mammary fold but higher than most of the breast tissue hangs. Grade III: Advanced ptosis—The nipple is below the inframammary fold and at the level of maximum breast projection. Pseudoptosis—The nipple is located either at or above the infra-mammary fold, while the lower half of the breast sags below the fold. This is most often seen when a woman stops nursing, as her milk glands atrophy, causing her breast tissue to sag. Parenchymal Maldistribution—The lower breast tissue is lacking fullness, the inframammary fold is very high, and the nipple and areola are relatively close to the fold. This is usually a developmental deformity. Causes
University of Kentucky plastic surgeon Brian Rinker encountered many women in his practice who attributed their sagging breasts to breastfeeding, which was also the usual belief among medical practitioners. He decided to find out if this was true, and between 1998 and 2006 he and other researchers interviewed 132 women who were seeking breast augmentation or breast lifts. They studied the womens medical history, body mass index (BMI), their number of pregnancies, their breast cup size before pregnancy, and smoking status.
Women who experience multiple pregnancies repeatedly stretch the skin envelope during engorgement while lactating. As a womans breasts change in size during repeated pregnancies, the size of her breasts change as her mammary glands are engorged with milk and as she gains and loses weight with each pregnancy. In addition, when milk production stops (usually as a child is weaned), the voluminous mammary glands diminish in volume, but they still add bulk and firmness to the breast. A 2010 review found that weight gain during pregnancy and breastfeeding were not significant risk factors for ptosis. Middle-aged women
In middle-aged women, breast ptosis is caused by a combination of factors. If a woman has been pregnant, postpartum hormonal changes will cause her depleted milk glands to atrophy. Breast tissue and suspensory ligaments may also be stretched if the woman is overweight or loses and gains weight. When these factors are at play, the breast prolapses, or falls forward. When a woman with sagging breasts stands, the underside or inferior skin of the breast folds over the infra-mammary fold and lies against the chest wall. The nipple-areola complex tends to move lower on the breast relative to the inframammary crease. The nipple of the breast may also tend to point downward. Post-menopausal women
In post-menopausal women, breast atrophy is aggravated by the inelasticity of over-stretched, aged skin. This is due in part to the reduction in estrogen, which affects all body tissues, including breast tissue. The loss of estrogen reduces breast size and fullness.