Many women are plagued by the problem of drooping breasts. The condition is most commonly found after pregnancy or because of obesity. Pregnancy stretches the breast skin and can also cause a reduction of the amount of breast tissue due to hormonal action after the delivery. Stretch marks may also be present, which are essentially tears in the skin. Major weight loss is another cause of sagging, as is laxity of the skin because of aging; but it sometimes affects young women for no apparent reason.

Other problems can involve the shape of the breasts or various imperfections in the nipples. For example, the pigmented area called the areola might be excessively large and unappealing or it might be too pale. Even the nipples themselves can be abnormal. They may be inverted or too small. While none of these problems seem overly serious, they can bring displeasure to the woman who has them.

As with small breasts, any of the conditions listed above can be emotionally shattering. The affected woman may begin to doubt her femininity and even her sexuality. She may become a tentative lover, and in extreme cases, she might give up lovemaking (and relationships with men) completely. But there is an alternative.

Most of these problems can be corrected through cosmetic surgery. While any particular operation may not cure emotional trauma, it should certainly help to erase it. A woman with beautiful breasts acts beautiful. She is sure of her appeal. She carries herself better and relates to other people with more confidence.

There are three basic approaches to lifting the breasts: doing an actual skin tightening procedure, placing breast implants and lifting just the nipple. It is important to realize, however, that whichever operation is elected, some type of compromise is involved. Yet, with each of them the nipple remains attached to the underlying breast substance so there should be little if any change in sensitivity, nipple erection or the ability to nurse a child.

The true uplift is the most effective answer to sagging breasts. It involves removing the excess skin from below the breast thus pushing the breast up without disturbing the actual breast tissue. The nipple is transposed superiorly into a normal position. The operation basically creates a new brassiere out of the skin, and that holds the breast up permanently. The severe consequence, however, is scarring.

There are several variations of the skin tightening procedure. The most common is similar to the one to be described under breast reduction, except that no breast tissue is removed.

With the patient sitting, the new position of the nipple-areolar complex is marked, usually slightly above the level of the existing breast fold. Other markings are made as well. The operation is then performed with local or general anesthesia with the patient lying down. A superficial incision is made around the areola without separating it from the breast. Then the skin is gently parted from the underlying tissue and the breast is elevated. Finally, the excess skin is taken up from below creating the "brassiere" and the incision is closed.

A week later the sutures are removed. There is little if any pain after the operation; a person could return to work in a day or two with the bandages still in place. Strenuous activity should be avoided for three or four weeks, after which any activity is permissible.

Stretch marks that are present in the skin will not be removed; but the tightening of the skin pulls on the stretch marks, making them less apparent.

While this procedure can create a very nicely shaped breast, there are several scars that result. One will form around the nipple, but it may be hard to see because it is located at the junction between the darker pigmentation and lighter skin. Another scar will extend from the nipple down to the breast fold, and a third will form across the breast fold itself. (One variation of this operation minimizes this latter scar.) The final shape of the scar resembles an anchor or an inverted "T." These scars might be thin and acceptable, but sometimes they thicken or spread and become very apparent. One must strongly consider this possibility before having the operation.

In any event, permanent, visible scars will result. They will be trading the scars for the uplift. Complications like infection, skin or nipple loss, and postoperative bleeding occur only occasionally, and should not be a deterrent. The only other risk apart from the quality of the scars is the possibility that the cosmetic appearance will be out of balance. The nipples may be slightly off center, or the breasts may be improperly lifted and noticeably unequal. But if the surgeon is careful, this will hardly ever happen. If it does, it can generally be corrected through another operation.

Unhappily, the results of this correction are not always permanent; this usually has nothing to do with the surgeon's skill, nor is it a complication. If the skin tone was poor to begin with, the sagging might reappear to some extent. On the other hand, the breasts could stay uplifted for years. And even if they were to drop a bit, the patient should still be better off than before.

NOTE: Another means of lifting involves removing the excess skin by only excising a circular portion of skin around the nipple and areola, avoiding any other scars. This works if only a minimal amount of lift is necessary. If a major lift is attempted in this fashion, a severe unsightly puckering of the skin around the areola will result.

THE NIPPLE LIFT: One very nice compromise is to just lift the nipple. Although the breast is not lifted to the extent possible with the conventional lift, this is often a very satisfactory compromise, as it leaves a scar only around the upper half of the areola. No other scars will result.

With the patient in a sitting position, the new location of the nipple is marked. A semi-circular line is drawn around the upper half of the areola and another is made that curves from one end of the line around the areola upward to the mark for the new nipple position and then curves downward again to the other end of the areolar line. The patient then lies down and under local anesthesia the skin within the lines above the nipple is shaved off. (Shaving instead of excising preserves all the sensation in the area.) The nipple-areolar complex is then pulled upward to its new position and sutured in place. Of course the breast itself is pulled up too. The only drawbacks are that the areola itself becomes somewhat elongated and the scar above the areola might spread a bit.