The goal of mastopexy surgery is to elevate breast tissue, orient the nipple areolar complex properly, and improve symmetry of the breasts in order to maximize the aesthetics of the breasts. Various procedures and modifi-cations have been suggested to improve the appearance of sagging or ptotic breasts. Breast ptosis is seen as Cooper's ligaments and the dermis become lax and gravity causes descent of breast tissue and the nipple areolar complex. A variety of factors can contribute to these phenomena. Patients with heavy breasts are more prone to ptosis because of excessive breast weight. Postpartum changes leave the suspensory ligaments and skin stretched following lactational engorgement and subsequent parenchymal atrophy. Postmenopausal patients demonstrate atrophy of breast tissue, dermal thinning, and loss of skin elasticity. Patients who have undergone massive weight-loss of en lose breast volume and are lef with redundant, loose breast tissue and skin resulting in breast ptosis. The removal of breast implants can similarly leave the breast envelope empty and lax. © 2009 Springer-Verlag Berlin Heidelberg.