As women age, breasts that were once firm and “perky” begin a downward trend. There is no muscle in a breast, so exercising is useless as a breast lift, and skin and the breast gland are not good supporting structures.

So, what is the answer?

In the world of plastic surgery, we have surgical procedures for sagging breasts, and now a non-surgical procedure with no downtime for those with less sagging is available: ThermiBreast.

Sagging can occur from pregnancy and nursing, causing loss breast volume loss, stretching of the skin, and loss of firmness, resulting in women who are self-conscious and unhappy with their breasts.

Some of the loss of elasticity of breast tissue is determined by genetics, but other contributing factors are sun damage, and even cigarette smoking, as well as the mentioned result of pregnancy.

Until recently, the only solution was to surgically reposition the nipples back to their normal location and tailored skin removal to tighten the breasts. A breast lift, called mastopexy, is often combined with either breast implants or fat grafts to replace the fullness of the breast lost due to deflation and sagging.

These procedures are performed under general anesthesia. Incisions are made around the areola, from the areola to the bottom of the breast and horizontally underneath the breast. Recovery time before normal activity is around seven to 10 days.

Occasionally, if the sagging is less than 1 to 1.5 cm, the surgeon might be able to perform a “crescent” mastopexy, which involves a small scar around the upper part of the areola.

Other mastopexy incisions are the “lollipop” incision, shaped like a lollipop with the circle being around the areola and the stem pointing downward or the standard “anchor” incision mastopexy. The surgical scars necessary for a mastopexy are chosen by the plastic surgeon relating to the degree of sagging of each patient.

Many patients elect to not undergo a mastopexy due to visible incisions and recovery time.

Recently a minimally invasive, non-surgical procedure was introduced, offering some patients the option of lifting the breasts 2 to 3 centimeters (about an inch) with no scar and no downtime. The procedure is called ThermiBreast lift.

This procedure utilizes a very high-tech probe that both emits radio-frequency energy and monitors skin temperature under the dermis as well as the skin surface. At certain elevated temperatures, skin tightens and both collagen and elastin are regenerated.

The best candidates for the ThermiBreast are those whose nipples sag about one inch (2.5 centimeters) or less, though it will tighten virtually any breast somewhat. ThermiBreast offers firmer, tighter skin of the entire breast under local anesthesia.

The procedure is painless and takes an hour to perform, with no recovery time. While some immediate tightening is seen, the breasts continue to tighten for the next month or two. Often, because of the tighter skin in the lower part of the breasts, the breasts are firmer and give the appearance of a breast augmentation.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand