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Dr Tim Neavin
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Dr Tim Neavin

Smoking May Lead to Breast Sag

Gravity alone isn’t the only enemy to perky breasts. Newton’s law of universal gravitation states that “every point mass in the universe attracts every other point mass with a force that is directly proportional to the product of their masses.” This may be a weak argument to describe men’s physical attraction to large, heavy breasts, but it does help explain one of the reasons that breasts fall over time and why women will turn to breast lift surgery to fix sagging.

Right behind Newton’s law of gravity to explain falling breasts follows aging and smoking. Women who smoke will droop more and faster. University of Kentucky plastic surgeon Brian Rinke investigated risk factors for ptosis, or breast droopiness. He found four key factors that promote breast sagging.


Cigarette smoking breaks down elastin, a protein in the skin that keeps skin tight. Elastin is the component that gives youthful skin its elastic appearance and helps support the breast.


Pregnancy was also strongly correlated to ptosis (breast droopiness), with the effects increasing with each pregnancy. This makes sense because pregnancy induces lactation, and hence enlargement of the breasts. The tissues of the breast stretch but don’t always return to their tighter state.


Naturally, as women age, breasts yield to gravity and tend to sag and fold over the inframammary crease (the lower breast fold attachment point to the chest wall). This is especially true for larger-breasted women. Thus, bigger breasts tend to drop faster. Of course, breasts can be reduced.

Weight Changes

The fourth reason was weight gain and loss. Weight gain and loss, similar to lactation, enlarge and stretch breast tissues. Stretched tissues may not return to their former, tighter state, especially in smokers who have damaged their elastin. Fortunately, there are ways to correct breast droopiness. Breast augmentation can fill out a deflated, saggy breast. Sometimes a breast augmentation alone can restore the youthful, perky breast appearance.

Sometimes, a breast lift is needed to raise the nipple and breast mound. Mastopexy can also be combined with breast augmentation. As a rule, the droopier the breast, the more incisions are needed to correct the ptosis.