by Anne Eglash MD, IBCLC, FABM
Does breastfeeding cause sagging breasts? There is evidence that some women decide against breastfeeding because they are concerned about their breasts becoming saggy. Even though this has been a belief held by various populations of women, the research has not been clear cut. Studies have shown a variety of reasons for saggy breasts, such that the contribution of breastfeeding is controversial.
What is meant by sagginess, or medical speaking, ptosis? Breast surgeons use various criteria that describe nipple droopiness.
The authors of the study reviewed for today’s Clinical Question of the Week used the Regnault P criteria, which defines 3 grades of severity. Grade 1 ptosis- the nipple lies at the level of the inframammary fold (where the lower breast margin meets the chest wall). Grade 2 ptosis- the nipple is below the inframammary fold, but it is not the lowest point of the breast. Grade 3 ptosis- the nipple is below the inframammary fold and points down, so is at the lowest point of the breast.
The authors of a 2017 study reviewed breast measurements of 605 Chinese women, and evaluated risk factors for degrees of ptosis. Among these women, only 5.5% never had children, and 85% of the women had breastfed.
According to the author’s findings, what was the relationship between breastfeeding and breast sagginess (ptosis)? Choose 1 or more?
- Risk of breast sagginess increases the longer that a woman breastfeeds.
- Women who nurse for 1-6 months do not have a significantly increased risk of sagginess.
- A BMI over 24.7 is more likely to be associated with saggy breasts than breastfeeding for over 13 months.
- All of the above
See the Answer
A and B
A Prospective Study of Breast Anthropomorphic Measurements, Volume and Ptosis in 605 Asian Patients with Breast Cancer or Benign Breast Disease
Nai-si Huang , Chen-lian Quan , Miao Mo, Jia-jian Chen, Ben-long Yang, Xiao-yan Huang, Jiong Wu
The current study aims to summarize breast anthropomorphic measurement features in Chinese patients with breast diseases and to investigate their potential correlations with demographic factors.
Materials and Methods
Fifteen breast anthropomorphic parameters of 605 Chinese female patients were collected prospectively. Breast ptosis status was scaled by two methods and breast volume was calculated according to a modified formula of BREAST-V.
Results
Among 1210 breasts, the average breast volume was 340.0±109.1 ml (91.8–919.2 ml). The distance from the nipple to the inframammary fold was 7.5±1.6 cm in the standing position. The width of the breast base was 14.3±1.4 cm (8.5–23.5 cm). The incidence of breast ptosis was 22.8% (274/1204), of which 37 (23.5%) and 79 (31.7%) women had severe ptosis assessed by different criteria. Increased height (OR[odds ratio] = 1.500, P<0.001), post-menopausal status (OR = 1.463, P = 0.02), increased BMI, breastfeeding for 7–12 months (OR = 1.882, P = 0.008) and more than one year (OR = 2.367, P = 0.001) were risk factors for an increased breast volume. Post-menopausal status (OR = 2.390, P<0.001 and OR = 2.621, P<0.001 for different scales), BMI≥24.7 kg/m2 (OR = 3.149, P<0.001 and OR = 2.495, P = 0.002), breastfeeding for 7–12 months (OR = 4.136, P = 0.004 and OR = 4.010, P = 0.002), and breastfeeding for more than one year (OR = 6.934, P<0.001 and OR = 6.707, P<0.001) were independent risk factors for breast ptosis.
Conclusions
The current study provides anthropomorphic measurements data of Chinese women with breast diseases, which are useful for cosmetic and reconstructive breast surgery decisions. Post-menopausal status, increased BMI, and breastfeeding for more than six months were independent risk factors for both increased breast volume and breast ptosis.
IABLE Comment By Anne Eglash MD, IBCLC, FABM
I was not thrilled to learn that in this population, breastfeeding over 6 months was associated with breast sagginess, and that this risk increased the longer women reported breastfeeding. However, the authors point out that approximately 70% of women in this population breastfed for over 6 months, but only 22-26% of these women had any degree of ptosis. The authors found that the higher the BMI, the greater the ptosis, and post-menopausal status was also associated with ptosis.
Some other studies have found that the number of pregnancies is more strongly associated with breast ptosis than breastfeeding. In this study, only 29% of the mothers had 2 or more deliveries, so this variable was not measured. We know that breast architecture changes during both pregnancy and lactation, so just becoming pregnant can contribute to breast sagginess.
For women who are contemplating not breastfeeding because of a fear of breast sagginess, the good news is that we can counsel that there is good evidence showing no significant increase in sagginess if she nurses for 6 months or less. And, nursing past 6 months is a risk factor but not a ‘death sentence’ for breast shapeliness. Let’s remind women that pregnancy is a package deal with breastfeeding, and just becoming pregnant increases her risk of breast sagginess. There is no guarantee that not breastfeeding, or stopping breastfeeding at 6 months is going to prevent sagginess.
One more little thing- from my experience as a family doc, it is a rare postmenopausal woman who is not saggy. This means that not breastfeeding is not a long term investment in breast perkiness. Age + gravity take our girls down regardless!