Sag Story

Post Pregnancy Concern

Q: I am an attractive, well-built 24-year-old female who has recently had a baby. My question concerns a problem many of my peers and I now have: sagging breasts. I'm very active and lift weights. I also wear good support bras, so what else can I do? Is there anything I can do?

F.F.
Colorado Springs, Colorado

A: Before answering your question, it is important to explain what happens to the breasts during pregnancy.

Breasts are composed of hormone-sensitive glandular tissue, fat, and connective tissue (fascia) covered by skin. They lack true supporting structures like ligaments, cartilage, or muscle; the pectoralis major and minor muscles lie underneath the breast tissue.

Under the hormonal influence of pregnancy and lactation, the glandular tissue (and sometimes the fat content as well) increases, stretching the skin. When the hormonal stimulation is gone, the breasts return to their pre-pregnancy size, but the skin is stretched and the breasts appear to sag.

This same process occurs with sizable weight fluctuations. When the fat content of the breasts increases, the skin is stretched; the breasts then sag upon weight loss.

There is no scientific evidence that exercise causes your breasts to sag. However, wearing a bra with adequate support even when you're not exercising can help minimize breast discomfort caused by bouncing.

Contrary to what some popular advertisements say, no cream, drug, cold-water treatment, or exercise program will reduce sagging. Remember, the pectoral muscles are under the breasts and toning them will not affect the breast.

The only effective answer to your problem is to consider plastic surgery, either with implants or a breast lift - a mastopexy. The latter procedure removes excess skin from the lower section of the breast and moves the nipple and underlying breast tissue to a new, higher location.

Implants or mastopexy can cost $1,000 to $5,000 and may not be covered by insurance. Postoperative complications include infection, scarring, blood clots, bleeding, hardening or slippage of the implants, and difficulty with breast feeding.

Consult with a qualified plastic surgeon to discuss your own particular concerns, expectations, risks, and benefits.

About the authors: Carol L. Otis, M.D., is Chief Medical Advisor to the Sanex WTA and a UCLA student health physician. Roger Goldingay is a former professional soccer player. They are married and the co-authors of The Athletic Woman's Survival Guide.

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