Sunday
Apr042010
Sagging breasts? What's to blame?
Sunday, April 4, 2010
If you are like many women, your breasts may not what they used to be. That's life. The media gives the impression that we should remain perky forever. A lot of women, however, find that their breasts start to sag over time. But what is the cause?
A number of studies have been done on this issue. The most recent one, "Breast Ptosis: Causes and Cure" (link goes to abstract) by Brian Rinker, MD, FACS et all was published in the May 2010 edition of the Annals of Plastic Surgery. The study found that among women who had been pregnant at least once, the following factors contributed to breast ptosis (sagging breasts):
On the other hand, factors that did not contribute to breast ptosis included:
This goes against many of the common beliefs held about sagging breasts. I know that I certainly was told my several fitness trainers that I should focus on chest strength if I wanted to ensure that my breasts didn't sag. I certainly have heard people say that they didn't want to breastfeed (or didn't want their wife to breastfeed) because it would cause their breasts to sag.
With regards to breastfeeding in particular, the study says:
The authors of the study also express concern that this myth about breastfeeding contributing to breast sagging may be a significant factor in continued low breastfeeding rates and early weaning. I tend to agree. With all of the true barriers to breastfeeding (ones that we need to work hard to dismantle), we really don't need stupid myths like this piled on top. (and while I'm at it, it is perhaps worth mentioning that not wearing a bra generally does not make your breasts sag more either).
P.S. - I learned about this study on the kellymom.com facebook fan page. If you aren't already a fan, you should be!
A number of studies have been done on this issue. The most recent one, "Breast Ptosis: Causes and Cure" (link goes to abstract) by Brian Rinker, MD, FACS et all was published in the May 2010 edition of the Annals of Plastic Surgery. The study found that among women who had been pregnant at least once, the following factors contributed to breast ptosis (sagging breasts):
- age
- history of significant (>50 lbs) weight loss
- higher body mass index
- larger bra cup size
- number of pregnancies
- smoking history
On the other hand, factors that did not contribute to breast ptosis included:
- breastfeeding
- lack of participation in regular upper body exercise
This goes against many of the common beliefs held about sagging breasts. I know that I certainly was told my several fitness trainers that I should focus on chest strength if I wanted to ensure that my breasts didn't sag. I certainly have heard people say that they didn't want to breastfeed (or didn't want their wife to breastfeed) because it would cause their breasts to sag.
With regards to breastfeeding in particular, the study says:
Pregnancy was seen to be a risk factor for the development of breast ptosis, and the degree of ptosis was seen to worsen with the number of pregnancies. However, a history of breast-feeding was not associated with a higher degree of ptosis. Women consulting a plastic surgeon for postpartum body contouring will often attribute loss of breast shape or volume to breast-feeding, and, in published reports, concerns over changes in breast appearance are consistently ranked among the important reasons why women decide to forgo breast-feeding. These beliefs cross cultural and socioeconomic boundaries. In a survey of high school girls in Italy, 30% of respondents expressed the belief that breast-feeding “makes breasts ugly.”4 In a survey of 220 new mothers in the Dominican Republic, concerns over “loss of breast shape” was given as the second most important reason for early termination of breast-feeding.16 Additional studies are needed to better understand the relationship, if any, between breast-feeding and adverse breast shape, but if the findings in this study hold true, women should be reassured that breast-feeding does not seem to worsen breast ptosis, beyond the effects of pregnancy alone.
The authors of the study also express concern that this myth about breastfeeding contributing to breast sagging may be a significant factor in continued low breastfeeding rates and early weaning. I tend to agree. With all of the true barriers to breastfeeding (ones that we need to work hard to dismantle), we really don't need stupid myths like this piled on top. (and while I'm at it, it is perhaps worth mentioning that not wearing a bra generally does not make your breasts sag more either).
P.S. - I learned about this study on the kellymom.com facebook fan page. If you aren't already a fan, you should be!
Reader Comments (38)
Always wondered about this. I was surprised that race wasn't a factor to check as well.
This reminds me of this page: http://www.bcpinstitute.org/reproductive.htm
It shows how breast tissue grows during pregnancy- and it's pretty clear that it's pregnancy that makes your breasts larger, not breastfeeding. It also looks at the kinds of breast tissue produced and how it's related to breast cancer. Interesting stuff.
The only thing I can see and agree with relating to breastfeeding is what I read (just recently, but I can't remember where now), that when breastfeeding the 'fat' in the breast decreases, making room for Breastmilk. Interesting, but I think there are many different factors, as with anything, that contributes to differences in breast sizes through our life.
What was not listed above, is hormones. Which is something that is very noticeable to me. When it is around the 'time of the month' my breasts change and can be noticed by everyone else. I think hormones is a major contributing factor to our breasts, considering some diminish as we age. Hormones are very important to the female's overall being.
Personally I feel that the breast's have a 'lifespan'. Breasts are supposed to 'sag', there is a reason for it, we just don't know or understand the importance of it yet. That being said, we don't have to be happy about it ;)
One of the most effective anti-smoking campaigns ever run in Australia showed a young woman smoking then aged her with every puff. Forget cancer, young girls don't want to look bad. So this result is something we really need to spread around as much as possible.
I'd be very interested in the effects of weaning time and speed. So does very quick weaning at 3 months have an effect? Because not breastfeeding at all isn't really not breastfeeding - it's very fast, very early weaning. Your body has still made all the hormonal and tissue adjustments to breastfeeding.
From what I've read I understood early on that it was the pregnancy that would effect the shape/perkiness of my breasts and not breastfeeding. But I find it interesting that friends who I've told this to - really struggle to accept it as a scientific fact. I wonder where this comes from? It's one of those prevalent myths - like the one that women with bigger breasts have more of a milk supply.
Interesting. My breasts are definitely saggy now. Too bad, I was hoping they would bounce back when my son weaned.
They didn't study enough people. I know many women whose breasts shriveled up and went smaller, (thus saggy because the skin didn't decrease) after breastfeeding.
For me, pregnancy did next to nothing to my breasts. They did not grow with pregnancy, only with breastfeeding. I've read that sudden weaning can cause the breasts to shrivel and that slower weaning allows you to keep more of your mass, which makes no sense to me as breastfeeding involves the production of milk, not fat. Nevertheless, my breasts are now bigger and frankly, nicer than when I started nursing (and I weaned more slowly than most women I know, although more quickly than women who let the child lead the way) while other women I know who were small-breasted like me have hanging near-empty sacs of skin, and if that's not "saggy", I don't know what is. They are not women who gained much weight or had big breasts or who smoke or who are older. I don't know what pregnancy did to their breasts because I didn't know them then but knowing that pregnancy did very little to MY breasts, it stands to reason that there are others for whom it did very little.
To say that breastfeeding doesn't change breasts for the worse is propaganda with positive intent. They changed mine for the better (by most people's standards-- it is a subjective issue, after all), why can't they change some women's for the worst? Since when does the human body respond the same, look the same, in everyone? Pregnancy is to blame but breastfeeding never is? How convenient. And unlikely.
If the question is whether or not breastfeeding worsens the shape of breasts the longer you do it, well that's just stupid. Once you start breastfeeding, your breast tissue stretches to accommodate all the milk. If you've ever been engorged, that doesn't help either. Then when you wean, the milk goes away and the skin is not changed. It doesn't matter WHEN you wean, you already stretched your skin.
It's very simple, really. Skin stretches and doesn't snap back.
(Or rather, some women's skin doesn't snap back. Mine did, my breasts and my belly after four pregnancies. I only got a couple of stretch marks in the last two weeks of my 4th pregnancy. Everyone is different and yes, sometimes breastfeeding causes a great deal of skin stretch.)
I'm one of the lucky ones. I had great looking breasts before babies, nursed my son till he was 3 and am nursing my 15 month old daughter and they still look fabulous (my rear-end is another story...)
I always thought it was because I wore good bras, but I guess that's a myth too...
I wonder too whether rapid change has a greater effect on the elasticity of the skin than more gradual changes. For example, does a woman who goes from nursing exclusively and frequently being engorged to weaning cold turkey experience more sagging than someone who weaned very gradually over months or even years? Similarly, with pregnancy, I gained almost all of my weight during the second trimester (gained nothing during the first one, gained 27 lbs during the second, gained 8 lbs during the third), and I have pretty bad stretch marks and sagging skin. Would a woman who gained weight more gradually over the course of her whole pregnancy have fewer stretch marks and more elastic skin?
I forgot to add too that even though not all women breastfeed, all of them do produce milk initially. So even someone who is intent on giving formula right from the start is going to fill up with milk and have their breasts stretch with it. So it could be the fact of becoming pregnant, resulting in the birth of a child and milk coming in that causes breasts to sag (rather than the act of choosing to and continuing to breastfeed).
I now have boobs thanks to my pregnancy! Much cheaper than breast augmentation in a financial sense I guess?
My breasts were saggy before pregnancy and are still saggy post pregnancy. The more things change...
I admit, I'm actually even kind of offended by the title of the research--"cures"? As though this is a disease. What is it, a cosmetic disease? It's a maturing process. Why does everything have to be pathologized?
As I understand it (in layperson's terms) the cells "set" (and become less cancer-prone) because of pregnancy. Any pregnancy, as long as it gets to a particular stage of ripeness (which--sorry--I don't know how far along that is).
There are lots and lots and LOTS of different appearance outcomes for breasts after pregnancy, just as there are multitudes of different starting appearances.
Why is it then that immature-appearing breasts are considered the non-"diseased" ones? Immature *everything* is considered "better" which, frankly, sucks.
Ah. But that's what I'm saying: I barely gained any size being pregnant, right up until I gave birth and two days after. I saw barely any change at all. So, change, yes. But not enough to cause sagging breasts.
Liz:
Yeah, I kind of dismissed the "cures" part outright. Considering that the study was done by plastic surgeons, my guess is that the "cure" they would propose is plastic surgery.
Always knew mine were destined to go to seed no matter what I did. My grandmother's stash of saggy-breast jokes is simply astonishing. Don't let the men out of the room, or she'll start sharing the embarrassing hilarity whether you like it or not.
I dunno why race would be a factor, though. I've seen a lot of middle-aged ladies in the gym shower, and it seems to me that we all fare about the same in the sagginess department, correcting of course for size...
oh well. At last I understand why my elders were so freakin obsessed with bra-shopping back in the day. Fake it if you can't quite make it!
Pregnancy definitely did a number on my breasts. It makes sense, since they grew rather rapidly during that time period and in the week or so after, which would would happen whether I breastfed or not. All the same, I'm glad to hear that a study underscores that it had NOTHING to do with breastfeeding. I've heard similar ideas about how breastfeeding ruins breasts, and it's just not true. We need to refute this myth, thanks for doing your part!
Actually, since it was done on women who have gone to a plastic surgeon, they are the ones who have proposed the cure.
Great post! I always cringe when I hear people say they're afraid of breastfeeding because it will ruin their breasts. Seems so vain to me, but not really surprising since our culture seems to value breasts more as sexual objects than for their intended purpose. The sagging breasts was never really a concern for me - mind you, mine weren't particularly perky to begin with (a good bra helps though - though my husband used to tease me about the bra being "false advertising").
I consider myself to be fairly educated, and even I thought initially that breastfeeding caused sagging breasts. It wasn't until I did a lot of research before my first child that I realized this wasn't the case. I imagine it is largely genetic, just like stretch marks are. Having said that, I'm 32 weeks pregnant with my second, and I nonetheless rub lotion on my belly, even though I know that it will not stop the red marks from creeping up my belly. I had terrible stretch marks as a teenager, so I was prepared for it, but it's still depressing.
With the first, I managed to avoid the sagging breasts somehow, but I'm not holding out hope in general. I am very large busted (36F or G - I lost count somewhere), and it just seems that whatever I do gravity will take its toll. I'm not convinced that even women who never get pregnant manage to avoid sagging breasts. Perhaps they stay perkier longer, but I don't imagine there are many elderly women with perky breasts (unless they went under the knife) even if they never had children.
It's definitely the pregnancy because my breasts started sagging at 19 when I was pregnant for four months (obviously I didn't breast feed as I terminated the pregnancy, and it wasn't aging as I was young at the time).
[...] Sagging – What’s to Blame? from PhD in Parenting: To the people that told me that my, um chest would be terribly saggy if I were to nurse my babies and that’s why they were bottle feeding… How sad, because here’s the proof once you have been pregnant that damage is done and you are going downhill long before you ever think about nursing. [...]
[...] more about this study and what a couple other bloggers think about it, go visit PhD in Parenting: Sagging Breasts? What’s To Blame? and Chronicles of a Nursing Mom: Saggy Boobs and [...]
I wonder if anyone has looked at whether sleeping in a bra has any effect. My MIL claims she slept in an underwire bra everynight while bf'ing all 6 of her kids so she would never sag. I am more of a creature of comfort, not to mention probably doomed by my large cup size anyway, so I'm risking it :). Not to mention I've heard underwire bras can contribute to plugged ducts, etc!
[...] Sagging Breasts? What’s to Blame? at PhD in Parenting [...]
I remember my mother harping after me when I was 10 and 11 (a family of early bloomers!) that I needed to wear a bra or my boobs would get saggy. This is the first time I've been told that my lack of a bra at a young age isn't what doomed these things. (The sheer size of both them? Probably the culprit.)
I never worried about the breastfeeding = sagginess issue, because honestly, I wasn't perky to start with.
[...] Sagging Breasts- Breast-feeding’s Not to Blame! Hurray for dispelling that myth! The part that jumped out at me was: In a survey of high school girls in Italy, 30% of respondents expressed the belief that breast-feeding “makes breasts ugly. I think that is really sad! Hopefully that does not directly correlate to how many of those girls will choose to breast-feed! [...]
[...] Devoting a gallery to showing breasts that look good post-breastfeeding implies that breastfeeding impacts the aesthetic of breasts. It does not. (Though as a friend pointed out, pathological engorgement can cause stretch marks, but that’s not the normal, physiological engorgement most moms go through). Research shows that breast aesthetics change during pregnancy (likely due to atrophy of the Cooper’s Ligaments). So, by the time you HAVE the baby, the damage is done. Breastfeeding? Not the culprit. [...]
This was so interesting...as a nurse, I have found no matter what I tell moms about sagging breasts and breastfeeding ...they believe, friends and other women's experiences instead.
There might be another factor...some women have more dense breast tissue than others hence perkier breasts for a longer time...dense breast tissue makes mammography trickier because it is harder to see abnormalities...fat tissue sags more. I believe that this difference in breast tissue is more due to heredity than any exercise etc.
So there might be a relationship between what kind of dominant breast tissue that a woman has and how much her breasts 'sag' after she has been pregnant.
My comments are not based on my scientific readings but from from my work experience...I wish that I had some resources to give you but I guess experience counts for something.
Thanks for this post.
[...] Sagging breasts? What’s to blame? [...]
Hello all,
I just came across this and wanted to say: Regardless of race, skin color etc. your breasts are going to sag as you get older. I have five children, and each I've breastfed. At my age, my breasts look just as perky, (or saggy) as any other woman my age. True, my ladies aren't what they used to be, but who keeps perky teen boobies forever anyways? Ladies: don't let societal pressures to maintain "the perfect breast" effect your decision to breast feed.
I can understand that sagging breasts are the result of pregnancy changes but I still think that my breasts are different due to breastfeeding. I have very small breasts so I have very little sagging (not enought there to sag) but the main difference for me is that my nipples sag!! I think that this would have to be due to breastfeeding for a long time (and breastfeeding a toddler/child)). Can't see that much else would contribute to this!
My "cure" is a good bra. I've had 6 pregnancies, 1 live birth (the remaining 5 were first trimester miscarriages), 12 days post partum, complications set up breastfeeding failure - so basically, I bottle fed. I'd have to argue in agreement with those who comment that it's lacatation (breasts stretch & enlarge due to milk production), not breastfeeding, that causes the problems.
I've believed that for a LONG time, that NOT nursing contributes more to sag than nursing does, and abrupt weaning more than gradual weaning. It's just common sense that skin won't shrink quickly enough to compensate for the reduction in size from engorgement to a closed factory. People who lose weight quickly wind up with extra skin, so why not women who shut down the girls quickly? I only nursed my first for a few weeks, before a BF ignorant doctor told me I had to stop so I could take antibiotics. I was 19, no support, and had no clue about pumping, never crossed my mind that was even an option. The pregnancy/cold turkey weaning did a number on mine. I'm now still nursing my last. He's down to a few times a week (practicing child led weaning) and the girls look sooooo much better than they did before I got pregnant!
[...] I dropped 40lbs and met my life partner Keith. By this time, even with my scary stretch marks, my sagging breasts, my c-section scar, and my fatness, and had fairly normal [...]
Forgot using bad bras when growing up... My breasts are soggy since I was 13, it sucks to know in your whole life you never had nice perky breasts. To make things even better, they are seriously uneven.
Bra shopping is an experience from hell to me, no chance to pick a style I like, but I must stick to ugly bras that would keep the girl in place.
Hate my boobs... period.
My small little breasts sag so much Iam afraid to go look for a bra