“…[having babies] just suck[s] the life out of you!” said my mother’s friend on the topic of breast changes in their late forties. We were at the beach, and both women were lamenting about the arduous task of finding a swim suit that gave their breasts the shape and height that they wanted. My mom’s friend jokingly blamed her situation on breast-feeding, and we all thought it was hilarious. But actually, was that the reason why my mother and her friends were dealing with this issue? As a teenager at the time, I was perfectly satisfied with my perky C-cups, and suddenly saw what I had to look forward to in the next 30 years.
Fast forward 10 years: I am now a doctoral student in a physical therapy program with a bachelor’s degree in exercise and sports science. I have completed 7 courses related to anatomy and physiology and, honestly, have not thought about what really plays into breast-sag. Is it weight loss, aging, breast feeding, obesity, skin conditions, connective tissue wearing, gravity and time, body structure? There are a whole host of factors that could cause and/or exacerbate a decrease in the distance between breasts and belts, and this article is a brief investigation into what is really at play.
One of the greatest benefits of having knowledge is being able to do something about it. Not only will we dive into the structure of the breast and why breasts sag over time, we will get into the realistic solutions for prevention, and potentially reversal(?!). Let’s see what our options are, ladies (and gentlemen)!
The female breast can also be referred to as the mammary gland. Typically, it is located on the front of the chest, with the base spanning between the second and sixth ribs. This gland sits on top of the chest muscles (pectoralis major and minor). There is a layer of loose connective tissue called the retromammary space between the chest muscle and the mammary gland1 (in the image, between the deep fascia and the gland). Due to the looseness of the connective tissue and small amount of fat tissue in this space, the mammary gland is allowed a small degree of movement (you may have experienced this while running). The mammary gland is NOT attached directly to the chest muscle, but to the fascia, and is primarily attached to the deep layers of skin by suspensory ligaments1 (ligaments are like really strong strings). See the black boxes on the image for a visual.
The mammary gland is composed of multiple lobes, which are further broken down into lobules. The lobules are where milk is produced, and are drained by lactiferous ducts, which store the milk in the lactiferous sinus for an infant to then consume via the nipple1. Note: Milk production in the breast is normally stimulated by the hormones associated with pregnancy and post-childbirth—i.e. women typically do not produce milk all the time. Aside from the gland, there is a small network of vessels (veins, arteries, lymph) and fat (adipose tissue) stored in the breast. See the orange boxes on the above image.
Why is any of this important? Partially because I have an uncontrollable desire to help people understand their bodies and how they work, and mostly because knowing what makes up the breast informs us on what tissues are likely changing over time, and what tissues we can have an effective influence on. Thanks for hanging in there—that was a lot of jargon!
Breast Development and Aging
In lieu of dragging you through embryological development, I will share a fun fact: Before puberty, men and women have the same breast structures. You heard me, men have mammary glands! However, male mammary glands are functionless, and therefore do not mature during puberty1. The presence of these glands explains why men can develop breast cancer and are commonly removed in men looking to obtain a particular physique, as they can cause a slight bulge when body fat content is very low.
ANYWAY. Remember when you were in middle school and everyone was awkward, and bras seemed like a torture device? What happened in order for you to familiarize yourself with underwire and push-up padding was a huge hormonal shift (puberty)2. This shift caused maturation of your mammary glands, which kind of made your breasts larger, and caused fat to be stored around that gland, which mostly made your breasts larger. Breasts do swell during lactation; however fat content is the main indicator of breast size and shape. Other important factors are genetics, ethnicity, and diet1.
[In case you were wondering, this is one of the reasons why normal body fat percentage for women is higher than for men. Some of the fat is necessary for healthy breast function, and sometimes women gain weight and their bodies decide to store fat in that particular area. But more on that later.]
Final comment here: for women with multiple pregnancies, breasts tend to increase in size and take on a pendulum shape, and as women progress into old age, breasts typically get smaller due to a decrease in body fat and atrophy (wasting) of the glandular tissue.
Why Breasts Sag ???
Okay, so here we are with all of this lovely information about glands and fat, ligaments, pregnancy, getting old, etc. Let’s look at the controllable and uncontrollable factors that may or may not cause breasts to sag.
Controllable: diet, pregnancies, exercise, weight, bra (type, how often worn), smoking, alcohol consumption, sun exposure, breast feeding, caffeine, medications
Uncontrollable: genetics, ethnicity, congenital conditions, age/time, gravity, body structure, fat storage, (some) medications
I scoped out the research……..AND………the primary cause of breast sagging IS…….
(I know, I was a little disappointed too). But really, the aging process leads to changes in the proportions of fat and glandular tissue3. When glandular tissue atrophies and more fat tissue is stored, the fat tissue is not secured to the fascia over the pectoralis muscle, causing it to become a victim of gravity more so than glandular tissue. Plus, even though the volume of the breast decreases, the amount of skin remains and also succumbs to gravity.
I suppose “time” indicates the predictable relative increase in fat tissue, however uncontrolled or dramatically fluctuating weight changes can also cause the breasts to stretch. This stretch can cause pulling at the connective tissue that holds the gland and some of the fat3. Connective tissue is not very elastic, and if it is stretched for an extended period of time or stretched very far, it is unlikely to return to its initial length if/when the fat tissue decreases.
This fat accumulation is also what is at play after pregnancy. My mom’s friend had it wrong: breastfeeding did not cause her breasts to sag, being pregnant and having swelled breasts did! (In the case of pregnancy, both swelling of the gland AND increased fat storage contribute to increased breast size). Pregnancy and weight gain/loss operate under the same mechanism: the breasts are stretched to a larger size, and when a normal or low weight is met, they become almost ‘deflated.’
Smoking and excessive sun exposure can also have effects on breast sagging. According to the research, both factors have a mechanism for breaking down connective tissue3, meaning that the ligaments mentioned earlier are at risk for becoming weaker and as a result, stretching out without returning to the original length.
These are the major factors…plain and simple. Let’s see what our options are to stave off breast sag for as long as possible!
I am going to go ahead and say that there are some natural and ‘unnatural’ ways to keep the girls up where they belong. Naturally, it is all about lifestyle choices! Not smoking, maintaining a healthy weight, using appropriate sun protection are all things in our control. One choice I did not mention above was our bra choices. I have seen mixed reviews, however there is a slight majority that concludes that wearing a bra, or a particular type of bra, has no effect on the shape, size, or height of breasts upon removing the bra. Bras do not mold your body into what we want it to look like, they just make us look how we want to look while we are wearing them.
On that note, it is always a good idea to wear a supportive sports bra during moderate or vigorous activity. Excessive breast motion can cause early pulling on that sacred connective tissue—it is not worth the risk in my book!
The so-called ‘unnatural’ techniques are actually more like fixes for already sagging breasts: a breast lift, or mastopexy, and bras. A mastopexy is an operation in which the shape of the breasts is altered, which typically includes raising them to be between the second and sixth ribs and raising the nipple/areola to a forward position. With this procedure breast size is not dramatically changed unless performed with a breast augmentation procedure4. Bras can act as a more practical fix by scooping up the breast and providing the desired shape. I always recommend seeing a good bra-fitting specialist, especially when you think your size or shape may have changed. They have a wealth of information and options that I never would have known existed!
Well, ladies (and possibly gentlemen), it looks like we will keep dealing with sagging breasts until someone finds the elixir of life! At least we have some options for dealing with it, and a TON of control in the realm of prevention. I have always encouraged my personal training clients to maintain a healthy weight and body fat percentage, and now this is just one more reason to keep at it! I hope you have learned something new, gotten a few chuckles, and continue to commit to having the healthiest body possible; beauty in turns to beauty out, and you are all beautiful.