As time passes, pregnancy, breastfeeding, major weight loss, hereditary factors or simply the aging process can cause changes to the appearance and contour of your breasts. These changes include sagging of the breast envelope, breast deflation with loss of volume and nipples that point downward. These changes can be very frustrating to many women, and you are not alone if you feel the same.

The breast is made of three types of tissue: skin, breast gland and fat. Your breasts are approximately 50-percent glandular breast tissue and 50-percent fat. Weight loss that occurs following pregnancy, lifestyle modifications or weight loss surgery can cause the fat component within your breasts to decrease, leading to a deflated and sagging appearance to your breasts, with nipples that now point toward the floor. In recently pregnant women, breastfeeding can further contribute to this loss of volume, leaving your breasts smaller and flatter than they were before you had children.

As time passes, our body gradually stops producing elastin and collagen, two proteins that are integral to healthy, elastic skin. Without sufficient amounts of these proteins, the skin loses its elasticity, and the breasts start to sag.

Thankfully, Maryland plastic surgeon Joseph Michaels, MD, FACS, can perform a mastopexy, or breast lift surgery, to address these aesthetic concerns. With breast lift surgery, Dr. Michaels will tighten the breast skin, elevating the breasts to a higher, more youthful-looking position on the chest wall. This improves the appearance of drooping breasts. He will also move the nipples to a more centered location on the breast to correct the look of southward-pointing nipples. Finally, Dr. Michaels can reduce the size of overly enlarged areolas (the darker-pigmented skin encircling the nipple), so they are in better proportion with your newly lifted breasts.


There are several breast lift approaches to rejuvenate the look of the breasts, each of which Dr. Michaels reviews with patients during consultation. He recommends a treatment protocol that is appropriate to your unique body type and satisfies your distinct desires. (Note: Depending on your age and / or your personal and family history of breast disease, a recent mammogram will be required prior to undergoing breast surgery.)

In general, breast lift surgery is performed on an outpatient basis, under general anesthesia.

To start the procedure, Dr. Michaels creates an incision on the breast. He eliminates any excess skin from the breast region. The breast surgeon tightens the underlying tissue structures and may re-shape the existing breast tissue mound. This skin tightening and reshaping of the breast tissue will elevate the newly molded breast mound to a more rejuvenated position on the chest wall. If the areola is too large, Dr. Michaels will also excise some of the skin around the outer perimeter of the areola to reduce its overall size. He will also move the nipple to a higher, more centered position on the breast during the procedure. The nipple remains attached to the tissue underneath to help preserve nipple sensation. Lastly, Dr. Michaels closes the incision with dissolvable stitches and dresses the treated area with bandages and an overlying surgical bra.

Before & After Photos

Incision Approaches

There are three principal incision approaches available for breast lift surgery: periareolar, vertical and inframammary. Dr. Michaels will review these options with you during your consultation and will recommend which approach is best suited to your individual needs. He may suggest a combination of incision patterns.

Pariareolar Incision

The periareolar approach involves the removal of a “donut-shaped” area of skin adjacent to the areola. The incision is well hidden within the outer border of the darker-pigmented areola skin. This approach allows only a modest amount of skin to be removed and allows for a small degree of nipple elevation. For these reasons, it may not be a suitable option for patients with significant excess skin and nipple ptosis (drooping).

Vertical Incision

With the vertical incision approach, Dr. Michaels uses a periareolar incision in addition to an incision that runs vertically down the front of the breast, starting at the bottom edge of the areola and extending to just above the breast’s natural crease. This allows Dr. Michaels to remove more excess skin, tighten the underlying breast tissue and elevate the nipple to a greater degree.

Inframammary Incision

For patients that have a significant amount of excess skin, especially in the lower pole of the breast, an inframammary incision that involves making a horizontal incision under the natural breast fold is added to the periareolar and vertical incisions mentioned above. This allows Dr. Michaels to remove the appropriate amount of skin to tighten the breast envelope and to optimize the final shape.

Regardless of which incision approach is used, the incisions do leave a scar on the breast. Over time, scars that have been properly cared for should fade until they match or closely match the color of the surrounding skin, so they are nearly unnoticeable. Proper care of these incision sites is essential to minimize the appearance of scars. This includes protecting the incision from sun exposure for at least one year, as even 20 minutes of sun exposure can cause scars to become red and raised from the skin’s surface. Once this happens, it is difficult or impossible to improve the look of the scars.

Related Procedures

For patients who are unhappy with both the sagginess of their breasts, as well as the loss of breast volume that often occurs as a result of breastfeeding or major weight loss, Dr. Michaels can include breast augmentation with breast lift to increase the fullness of the breasts.

During your consultation, Dr. Michaels will evaluate your anatomy and carefully listen to your aesthetic concerns before identifying which procedure is most appropriate for your specific needs.

In addition, certain patients who desire an increase in breast volume without the use of saline or silicone breast implants might be suitable candidates for combination breast lift with autologous augmentation surgery. With autologous augmentation, the breast augmentation surgeon increases the volume of the breast either by recruiting tissue adjacent to the existing breast tissue or by performing liposuction to obtain fat that can then be transferred to the existing breast to increase overall volume of breasts. However, not everyone is an appropriate candidate for autologous augmentation.

Quick Facts


2-4 hours





Side effects

Temporary swelling, muscle tightness, bruising and some pain


Pain, bleeding, infection, asymmetry, damage to nerves (in rare cases), need for revision


4-7 days: back at work. 1 week: light exercise only. 2-3 weeks: more strenuous activity allowed. 8-12 weeks: swelling resolves and patient can resume normal activity.

Duration of results

Variable, as further sagging occurs with age

If you would like to learn more about the breast lift procedure, click here or call (301) 468-5991 in Bethesda, Maryland or (703) 957-8610 in Fairfax, Virginia to schedule a consultation.