Q. I am in my 40s and self-conscious about my breasts sagging; even with supportive bras, I am not happy with my appearance. What are my options to correct this?

A. As a board-certified breast surgeon, I am frequently asked about changes to the breasts over a woman’s lifetime. Changes in the shape and texture of a women’s breasts are a natural part of aging. Over time, estrogen levels drop, which leads to a loss of gland tissue in the breast. Along with changes in skin elasticity, this may cause the breasts to appear smaller and lower down than before. The nipples may also change in appearance.

Breast tissue shifts in composition and shape as we age. A premenopausal adult woman’s breasts consist of fat, tissue, and mammary glands. As menopause approaches, levels of the hormone estrogen drop, and the mammary glands start to shrink. Shrinking mammary glands tend to be replaced by fat, generally resulting in softer, less full breasts. As the breasts begin to deflate, stretch marks and wrinkles can appear on the breast skin. For many, their breasts become elongated, stretched, or flattened, often with extra space appearing between the breasts. The nipples can also change in appearance and position.

In addition, the connective tissue within the breast breaks down, and this loss of internal structure can result in sagging breasts. Other factors like the number of pregnancies, breastfeeding, smoking, weight gain, and genetics can all play a role in the degree of breasts sag.

There is no way to avoid the changes in breast elasticity, volume, fullness, contour, shape, and position as we age and our bodies change. Fortunately, there are various treatment options to correct these changes and restore the breast to a more youthful appearance and feel. I use options such as breast lift, augmentation, reduction, and fat grafting to help women regain their confidence with corrective surgery. Please visit my photo gallery for a sampling of before and after photos showing various options for breast rejuvenation.

If you would like to have an individual consultation with me to discuss your options for corrective breast surgery, please call Beth, my Patient Care Coordinator, or use our online consultation request form. I look forward to helping you on your path to a more positive body image.

– Cindy Wu, MD, FACS