Classification and assessment techniques of breast ptosis: A systematic review

BACKGROUND: Breast ptosis is characterized by the inferolateral descent of the glandular area and nipple-areola complex. A high degree of ptosis may negatively impact a woman's attractiveness and self-confidence. There are various classifications and measurement techniques for breast ptosis used as references in the medical and garment industry. A practical and comprehensive classification will provide accurate standardized definitions of the degrees of ptosis to facilitate the development of corrective surgeries and well-fitting undergarments for women in need.

METHODS: A systematic review on the classification and assessment techniques to measure breast ptosis was carried out based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.

RESULTS: Of 2550 articles identified in the literature search, 16 observational and 2 randomized studies describing the classification and assessment techniques of breast ptosis were included in the review. A total of 2033 subjects were involved. Half of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, all randomized trials recorded a low overall bias.

CONCLUSION: A total of 7 classifications and 4 measurement techniques for breast ptosis were identified. However, most studies did not demonstrate a clear derivation of sample size beside lacking robust statistical analysis. Hence, further studies that apply the latest technology to combine the strength of previous assessment techniques are needed to develop better classification system that is applicable to all affected women.