Mastopexy and the B.A.G.S. system: what determines the upper pole

Mastopexy is the surgery that repositions the breast when the areola-nipple complex has descended and the skin no longer supports the existing volume. It is not a breast augmentation, a breast reduction, or a method for changing body weight. The outcome depends on the patient’s starting anatomy, the quality of the skin, and whether additional volume is needed. At Mallorca Medical Group, this decision is made during consultation, never based on a photograph.

In Spain, breast lift surgery ranks among the most requested procedures across several age groups, according to the SECPRE study on the reality of aesthetic surgery in Spain (2022 data). This figure describes demand; it does not indicate that every patient with ptosis is a candidate for surgery.

What anatomical problem it addresses

Breast ptosis has been described for decades based on the position of the nipple relative to the inframammary fold. The Regnault classification (Clin Plast Surg, 1976) remains a useful reference for grading the degree of descent, not a scale that dictates a particular technique. During consultation, skin thickness, the clavicle-to-nipple distance, the breast base, and whether the lower pole is deflated or, conversely, laden with tissue are also assessed.

The American Society of Plastic Surgeons notes that a breast lift repositions the breast and removes excess skin, and that an implant is only used when the patient wants more volume than her own tissue can provide. This distinction prevents two common mistakes: operating only on the skin when volume is lacking, or placing an implant when the actual issue is positioning.

What the B.A.G.S. system offers and what it does not resolve

The B.A.G.S. system (Breast Anchoring Glandular Suspension) is a lift technique described by Dr. José Ignacio García Ceballos, MD, FCCP, MRCS I England, to address the position and shape of the upper pole in mastopexy, with or without an implant, and also in certain revision procedures. The suspension is planned from inside the gland, accessed through the inframammary fold, to anchor the tissue and redistribute the patient’s own volume upward.

It does not eliminate the scar. The inframammary incision is concealed by underwear in most cases, but it is a genuine scar, and its final appearance varies depending on the skin, tension, and aftercare. Nor does it create tissue if the patient’s own volume is insufficient: if the goal is a fuller cleavage than the anatomy allows, an implant should be considered, or a more modest result accepted. The Mallorca Medical Group breast lift clinical page summarizes these options without presenting them as equivalent.

With or without an implant

Without an implant, mastopexy rearranges the existing tissue. This makes sense when there is sufficient volume and the patient accepts a higher, sometimes slightly smaller, breast, since some skin is removed. With an implant, projection is added. The implant does not replace anchoring: if the gland is not suspended, the added weight may cause the lower pole to descend again.

The previously published article on when the patient’s own tissue is sufficient covers that overlap. This article focuses on the upper pole: how it is determined whether internal suspension can improve it, and in which patients it is not worth attempting.

Who is not a candidate, or not yet

Mastopexy is not indicated if the patient’s weight is not stable, if pregnancy is planned in the short term, if the expectation is a scar-free breast or one identical to someone else’s image, or if the examination shows minimal descent with discomfort limited to bra size. Smoking, a history of abnormal scarring, or an unstudied breast condition require postponing or ruling out surgery. Each case is individual.

Dr. García Ceballos, licence number 070707779, with 25 years of practice in plastic, aesthetic, and reconstructive surgery, explains during consultation what can be improved and what cannot. The initial assessment is not a formality: it is the point at which surgery may be ruled out.

Recovery, without a miracle timeline

The surgery is performed under general anesthesia. Discharge and return to activity depend on the procedure performed, whether an implant is used, and each patient’s individual response. A supportive bra, rest for the upper body, and monitoring of the inframammary wound are part of the plan, not an optional detail. The final shape of the upper pole cannot be judged in the first week: swelling continues to change the contour for months.

If you are looking for personalized guidance, request your appointment at Mallorca Medical Group. The consultation serves to inform and to decide, including when the right decision is not to operate.