How to Determine Which Type of Breast Lifts Is Needed After Massive Weight Loss

By: Dr. J. Timothy Katzen


What Is A Breast Lift?

A breast lift is a plastic surgery procedure performed to reshape and reposition the breasts. The medical term for a breast lift is "mastopexy," which comes from the Greek word "masto-" referring to "woman's breast" and the Greek word "-pexy," which means to "fix in place or fastening."

A mastopexy is performed to restore a more youthful and lifted appearance to the breasts. This procedure is typically chosen by individuals who are experiencing breast sagging, also known as breast ptosis. Usually, patients undergoing a mastopexy wish to improve the position of their breasts as well as a desire to improve the firmness and contour of their breasts.

Why Have A Breast Lift?

There are many reasons why someone might choose to undergo a breast lift (mastopexy) procedure. Here are some common motivations:

1. Breast Sagging: One of the primary reasons for getting a breast lift is to address breast sagging. Over time, factors like aging, pregnancy, breastfeeding, weight fluctuations, and genetics can cause the breasts to lose their youthful shape and firmness. A breast lift can help lift and reshape the breasts, restoring a youthful and perky appearance.

2. Post-Weight Loss: Significant weight loss can result in severe losses of fat through the breasts. Breast fat and tissue loss can result in excess, loose breast skin. A breast lift can help remove excess skin and reshape the breasts, allowing individuals to enjoy the results of their weight loss efforts fully.

3. Enhanced Confidence: Many women choose to have a breast lift to boost their self-esteem and body confidence. Feeling more comfortable with the appearance of their breasts can lead to increased self-assurance in clothing choices and everyday life.

4. Reversing the Effects of Pregnancy and Breastfeeding: Pregnancy and breastfeeding can have a significant impact on the breasts. A breast lift can help restore the breasts to their pre-pregnancy shape and position, addressing issues like stretched skin and sagging caused by these life events.

5. Clothing Fit: Some individuals find that their breasts have lost their youthful shape and are not well-suited for certain types of clothing. A breast lift can improve clothing fit and allow for more wardrobe options.

6. Physical Discomfort: In some cases, breast sagging can lead to physical discomfort, including back, neck, and shoulder pain. A breast lift can alleviate these symptoms by reducing the weight and strain on the upper body. For patients with large breasts, the breast lift is combined with a breast reduction.

7. Improved Breast Symmetry: Some individuals have naturally uneven or asymmetrical breasts, which can lead to self-consciousness or discomfort. A breast lift can help create a more balanced and symmetrical breast appearance. Sometimes, a breast is performed on one breast to achieve symmetry.

8. Aesthetic Goals: Some people desire a more youthful or aesthetically pleasing breast appearance. They may opt for a breast lift for their overall beauty enhancement goals.

How Do I Determine What Grade Breast Ptosis I Have?

To determine what grade breast ptosis you have, you will need a pencil, a camera/phone with a camera, and a mirror where you can see the side of your breasts. This exercise is called the pencil test.

To figure out how badly your breasts sag, you will need to do three things:

It would be best to place a pencil under your breast in the infra-mammary fold.

  1. The inframammary fold is under the breasts between the breast and the upper abdominal wall.
  2. You will need to take a picture of the side of your breast. Keep the pencil in the middle of the frame.
  3. Finally, it would be best to determine whether the nipple-areolar complex is above, level, or below the pencil. The position of the nipple-areolar complex in relation to the pencil (inframammary fold) determines your breast ptosis classification.

How Is Breast Sag or Breast Ptosis Classified?

As mentioned, breast ptosis classification is characterized by the position of the nipple-areolar complex in relationship to the rest of the breast and the infra-mammary fold. Sometimes, the nipple-areolar complex is at the top of the breast and sometimes, the nipple-areolar complex is at the bottom of the breast. The position of the nipple-areolar complex depends on many factors including natural weight gain and loss cycles (yoyo diets), massive weight loss, gastric bypass, significant running without a sports bra, aging, pregnancy, breastfeeding, genetics, and sun damage.

Let's look at the breast ptosis classification system more closely.

Aesthet Surg J, Volume 38, Issue 4, April 2018, Pages 374–384,

  1. Grade I: Mild Breast Ptosis: This grade represents a minor degree of sagging. The nipple-areolar complex aligns with the pencil test or inframammary fold in mild breast ptosis. This grade is more common in younger patients who have not had children and have not lost significant weight.
  2. Grade II: Moderate Breast Ptosis: In this case, the nipple is located below the inframammary fold (pencil) but not at the lowest portion of the breast. This grade indicates a more noticeable degree of sagging than in mild ptosis. Grade II is more common in older patients who have had several children and have lost a modest amount of weight.
  3. Grade III: Severe Breast Ptosis: The nipple-areolar complex is significantly below the inframammary fold and points downwards. Often, the nipple-areolar complex is at the bottom of the breast. This grade is a more severe level of breast sagging or ptosis. This grade is the most common form or grade of breast ptosis for weight loss patients.

Each type of breast ptosis requires a different approach if surgical correction is sought, and the choice of procedure (like breast lift, augmentation, or a combination) depends on the degree of ptosis and the patient's aesthetic goals. It's important for individuals considering treatment for breast ptosis to consult with a qualified plastic surgeon to understand the best options for their specific condition.

What Are The Different Types Of Breast Lifts?

There are four basic types of breast lifts or mastopexies. We will discuss them in detail, going from the least invasive to the most involved breast lifts needed.

1) Crescent Breast Lift: A crescent mastopexy is the most minimal breast lift. This procedure is called a crescent breast lift because the breast tissue that is removed is in the shape of a crescent. This breast lift is started by making an incision along the top portion of the areola between the pigmented areolar skin and the surrounding breast skin. Typically, the crescent breast lift incision extends from approximately nine to 12 o'clock to three o'clock. The amount of breast lift is determined and marked. A counter-curved incision is made in the breast skin. This counter incision joins the incision made in the areolar-breast skin junction from nine to three o'clock. The intervening breast skin is removed and the incision is closed with dissolvable sutures. The width of the skin removed during a crescent breast lift is about 1-2 cm. A crescent breast can raise the nipple-areolar complex to 6 cm, depending on the size of the areola.

This is a female patient who weighs 118 lbs. She was unhappy with her small breasts and wanted larger natural-looking breasts. So she underwent breast augmentation with 500 cc medical-grade silicone implants. She previously wore a size A bra and now wears a size D.

2) 360 Periareolar, Doughnut, Or Benelli Breast Lift: This breast lift has several names. This type of breast entails an incision that extends 360 degrees around the nipple-areolar complex. This mastopexy is also called a doughnut mastopexy because the specimen removed is shaped like a doughnut. Additionally, this procedure is named a Benelli breast after Dr. Benelli, a famous plastic surgeon from Italy. During this procedure, a circular incision is made 360 degrees around the areola. A counter incision is made 360 degrees. This counter incision can be made in a circle, oval, or egg shape. The skin between these two incisions is removed. With the skin around the areola removed, the breast is reshaped, and the skin is tightened. The breast mound is brought up like a volcano around the areola; thus, the breast is lifted. To maintain the shape, permanent sutures are placed within the breast and around the areola. The areolar nipple complex is not removed. Often, the size of the areolar can be reduced or resized. The advantages of this procedure are that a significant lift can be achieved with a minimal hidden incision around the areola. The disadvantages are that there may be some wrinkling or radial spoking, like the wheels on a bicycle around the incision for many months. Another difficulty with this type of mastopexy is that there is a permanent suture involved. Sometimes, this permanent suture can become exposed or break. If the suture becomes exposed, it may need to be removed. If the suture breaks, the areola can enlarge, resulting in a large asymmetric areola and misshapen breast.

This is a 5'7 female who weighs 154 pounds. She achieved her goal of losing 80 pounds with diet and exercise. Upon losing the weight she was left with excess skin and deflated breasts. She underwent a breast augmentation with medical-grade silicone implants.

3) The Lollipop Or Vertical Mastopexy: During this procedure, the 360-donut mastopexy incision is used, but an incision is extended from six o'clock on the nipple-areolar complex to the inframammary fold. Extension of this incision involves the excision of a triangular or elliptical breast skin area. The lollipop or vertical mastopexy lift is for patients who require more breast lift than the traditional 360-periareolar lift. This incision may need to extend even onto the chest for larger breast lifts to allow sufficient lift.

This is a 34 year old female who weighed 260 pounds and lost 90 pounds. She was not happy with the size of her breast and how droopy it was. She underwent breast augmentation with lift.

4) The Anchor Or Inverted T Mastopexy: The anchor or inverted T Mastopexy is the most definitive breast lift. An incision is made 360 around the areola, down the front of the breast, and underneath the breast from the sternum towards the axilla. The resulting incision and scar pattern looks like an anchor or an upside-down letter T. Basically, it's an extension of the 360 donut mastopexy, vertical mastopexy, and a continuation of the incision underneath the breast in the inframammary fold. There are a variety of patterns of blood supply to the nipple-areolar complex. The blood supply can be from below or above or sometimes both. If the breast is very pendulous and the nipple to sternum distance is very long, the nipple-areolar complex sometimes is removed and pasted back like a postage stamp. This surgery is called a free nipple graft.

This is a 48-year-old white female patient with a starting weight of 412 pounds underwent a life-changing gastric bypass surgery. Following the procedure, she successfully shed an impressive 187 pounds. However, she still felt dissatisfied with the appearance of her breasts after the significant weight loss. To address her concerns, the patient sought the expertise of Dr. J. Timothy Katzen in Beverly Hills, CA. Under his care, she underwent a breast reduction and breast lift procedure. The surgery aimed to improve the shape and contour of her breasts, restoring her confidence and aligning her physical appearance with her weight loss achievements. The results of the procedure were highly successful, and the patient expressed great satisfaction with the outcome. She is now able to fully embrace and enjoy the transformative effects of her weight loss journey. It is important to note that individual results may vary when it comes to cosmetic procedures, and the happiness and satisfaction experienced by this patient may not reflect the experiences of others.

All these breast lift procedures can be combined with breast augmentation with breast implants. Breast lifts take approximately two to three hours to perform, depending on the complexity of the cases. Breast can be performed under local or general anesthesia with a board-certified anesthesiologist. It would be best if you planned to return to work at approximately one to two weeks. You should be able to resume chest exercises in approximately one month.

What Type Of Breast Lift Do I Need?

If you have Grade I ptosis, you will probably need a crescent breast lift.

If you have Grade II ptosis, you will probably need a doughnut or vertical mastopexy breast lift. If you have Grade III ptosis, you will probably need an anchor breast lift.


These are generalities. A careful and thorough physical examination with an experienced breast lift plastic surgeon is important before any plastic surgery is to be scheduled.

If you are considering a breast lift after massive weight loss or after natural aging, please call Dr. J. Timothy Katzen at (310) 859-7770 to schedule an appointment. For your convenience, Dr. Katzen has offices in Beverly, CA, Las Vegas, NV, and Dubai, UAE.

Additionally, Dr. Katzen can consult on virtual platforms like Skype, WhatsApp, Facetime, and Zoom. CALL TODAY and get your breasts back to where they belong….UP!


Qureshi AA, Myckatyn TM, Tenenbaum MM. Mastopexy and Mastopexy-Augmentation. Aesthet Surg J. 2018 Mar 14;38(4):374-384. [PubMed]

Benelli, L. A new periareolar mammaplasty: the "round block" technique. Aesthetic Plast Surg. 1990 Spring;14(2):93-100.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.