Breast Thread Lifting: Techniques, Innovations, and Clinical Applications

Aesthetic breast surgery continues to evolve, offering patients solutions ranging from augmentation and reduction to mastopexy and oncoplastic reconstruction. One common concern is breast ptosis, defined as the descent of the breast gland over the thoracic wall. Ptosis arises from intrinsic and extrinsic factors such as aging, gravity, pregnancy, weight fluctuations, smoking, higher BMI, and larger breast size. These factors weaken structural supports like Cooper’s ligaments and the fascial system, resulting in tissue descent and loss of upper pole fullness (Bogdan et al., 2025).

This article reviews the anatomical, technical, and clinical aspects of breast thread lifting, emphasizing recent advancements, procedural nuances, and imaging integration for precision and safety, as highlighted in the contemporary review by Bogdan and colleagues (2025).

Evolving Approaches to Breast Ptosis: Thread Lifting as a Minimally Invasive Option Traditional mastopexy effectively corrects ptosis but involves extensive tissue manipulation, longer recovery, and visible scarring. In contrast, breast thread lifting has emerged as a minimally invasive alternative for mild to moderate ptosis, offering subtle lift with minimal downtime. While well-established in facial rejuvenation, its application in breast aesthetics is still developing. Pioneering work by Dr. Roger Khouri, combining thread-based techniques with external expansion and fat grafting, laid the foundation for modern, less invasive breast reshaping. How Breast Thread Lifting Works: Anatomy and Technique

Breast thread lifting uses barbed sutures, either absorbable or non-absorbable, inserted into the subcutaneous layer to provide mechanical lift and stimulate neocollagenesis. Strategically placed threads restore breast contour, improve symmetry, and reposition the nipple–areolar complex without large incisions. Understanding the breast’s fascial anatomy—including superficial and deep fascial layers, retromammary space, and Cooper’s ligaments—guides optimal thread placement and vector orientation.

Anatomical Considerations

The breast’s structural integrity is largely supported by the superficial fascial system, which comprises a superficial layer near the dermis and a deeper layer posteriorly. The retromammary space allows natural mobility. The pectoral fascia overlays muscles such as pectoralis major, upper rectus abdominis, and serratus anterior, while Cooper’s ligaments anchor the breast to the dermis.

Glandular tissue, organized into lobules and ducts, is enveloped by subcutaneous fat, whose distribution changes with age, hormonal status, and body composition. Factors such as weight fluctuations, pregnancy, and aging weaken these attachments, leading to ptosis. Patients with rapid weight loss often present challenges for mastopexy due to increased breast mobility, making preoperative planning and precise surgical marking essential.

Classification of Breast Ptosis

Breast ptosis is commonly graded using Regnault’s system, which classifies nipple–areola descent relative to the inframammary fold (IMF). Grades I–II typically indicate mild to moderate ptosis, which are ideal candidates for thread lifting. Understanding the ptosis grade informs procedural planning and expected outcomes.

Challenges in Surgical Correction

Upper pole dissection is technically challenging due to the dense fascial network, including the pectoralis fascia and superficial layers. Although minimally invasive, thread lifting still involves subcutaneous manipulation and foreign material implantation, with potential complications such as asymmetry, dimpling, thread migration, granulomas, and infection.

A key limitation is the lack of standardized technique. Variations in insertion patterns, vector orientation, and operator skill can result in inconsistent outcomes. While threads temporarily reposition superficial tissue, they do not halt underlying degenerative processes, and ptosis can recur over time.

High-resolution ultrasound has become a valuable tool for preoperative planning and postoperative assessment, allowing detailed visualization of tissue layers and improving procedural accuracy. Breast Thread Lift VS Traditional Mastopexy

Indications for Breast Thread Lifting

Thread lifting is primarily indicated for:

• Mild to moderate ptosis (Grades I–II)

• Small to moderately sized breasts

• Minimal to moderate skin excess

• Early parenchymal involution

It can be used as a primary intervention, a secondary treatment for recurrent ptosis, or to enhance postoperative contouring. Combining thread lifts with skin retraction, excision, or autologous fat grafting can improve upper pole fullness, projection, and symmetry, providing a comprehensive minimally invasive approach. Compared to traditional mastopexy, thread lifting offers reduced invasiveness, shorter recovery, and lower procedural morbidity, though results may be less dramatic in severe ptosis.

Thread Materials and Mechanism

Thread selection is critical for outcomes. Factors include:

• Material: PDO (polydioxanone) or PLLA (poly-L-lactide)

• Design: Barbs or cogs for anchoring

• Tensile strength and diameter

• Absorbable vs. non-absorbable

  
  

Absorbable threads gradually resorb and stimulate neocollagenesis, while non-absorbable threads provide longer mechanical support but may carry higher risks of chronic inflammation. Multi-strand configurations enhance collagen deposition and tissue scaffolding, promoting longer-lasting lift and improved tissue quality.

Surgical Technique Overview

Preoperative Assessment

A thorough clinical breast examination is essential to identify preexisting pathology, structural anomalies, or suspicious lesions. Presence of malignancies or benign tumors contraindicates the procedure. The procedural field is prepared aseptically, and local anesthesia is administered to optimize patient comfort. Preoperative counseling should emphasize the temporary nature of results, which generally last 6–12 months, and include psychosocial considerations.

Thread Insertion Techniques

Key strategies include:

• Crosshatch threading: Reinforces tissue beneath the nipple–areola complex and upper pole.

• Circular insertion: Creates a scaffold-like network in the upper pole for firmness and shape.

• Linear vectors: Angled threads mechanically oppose gravity for prolonged lift.

  
  

Following insertion, patients typically wear a supportive bra or brace for two weeks to stabilize tissues. Minor bruising and swelling are expected.

Minimally Invasive Approach

Thread lifting is performed via small incisions with fine needles or cannulas, minimizing trauma and scarring. It is generally conducted under local anesthesia, sometimes with mild sedation. While results are less dramatic than open surgery, the procedure is ideal for subtle ptosis correction and asymmetry management.

Postoperative Care

Follow-up is recommended at 12–15 months to assess thread integrity, tissue response, and potential maintenance procedures. Minor complications may include dimpling, asymmetry, hematoma, or localized infection.

Innovative Thread-Based Breast Lifting Techniques

Thread Stabilization Technique

Performed under general anesthesia, this method uses two micro-incisions along the midclavicular axis. Threads are advanced subdermally, looped around the clavicle, and anchored to provide durable suspension, with layered closure promoting optimal healing.

Hypodermic Bodice Technique

Incorporates a reticulated mesh implant beneath a cellulocutaneous flap. Suspension threads are tunneled to the clavicle and tied to pre-established sutures, enhancing upper pole projection and long-term lift.

Multi-Level Subdermal Breast Elevation with Clavicular Thread Anchoring

Employs a multi-point subdermal suspension system with concentric looped threads and clavicular fixation. This technique provides graduated lift and stability without skin excision, maintaining natural contour.

Limitations and Considerations

Thread lifting provides primarily short-term aesthetic improvement and is best suited for mild to moderate ptosis. Significant skin redundancy reduces efficacy. Patients must be counseled regarding:

• Temporary results and potential recurrence

• Need for maintenance procedures

• Limitations in mechanical lift for severe ptosis

  
  

Histological studies indicate that multi-strand threads stimulate greater collagen deposition but may increase foreign body response. Thread type, diameter, architecture, and insertion technique influence both mechanical lift and regenerative response. Long-term effects of repeated sessions remain uncertain, with potential fibrosis or altered tissue quality affecting future surgical outcomes.

Indications, Contraindications, and Patient Selection

Ideal Candidates

• Adequate skin elasticity and minimal redundancy

• Desire for subtle lift and improved upper pole fullness

• Preference for minimally invasive procedure with faster recovery

• Minor asymmetry or nipple–areola malposition

• Acceptance of temporary results and potential repeat procedures

Contraindications

Contraindications

• Severe ptosis (Grades III–IV) requiring excisional surgery

• Pre-existing breast pathology

• History of keloids or poor wound healing

• Active infection or dermatologic conditions

• Unrealistic expectations or poor postoperative compliance

Therefore, careful evaluation of skin quality, breast volume, and patient expectations is essential to optimize outcomes and satisfaction.

Conclusion

Breast thread lifting offers a minimally invasive alternative for mild to moderate ptosis, combining aesthetic improvement with reduced downtime and surgical morbidity. Modern techniques, supported by evolving thread materials and imaging guidance, enhance precision and outcomes. While not a replacement for traditional mastopexy in severe cases, thread lifting is a valuable tool in the aesthetic surgeon’s armamentarium. Standardized protocols and continued research will be essential to define its long-term role in breast rejuvenation.

Reference:

1. Bogdan, R. G., Helgiu, A., Bloanca, V. A., Ichim, C., Todor, S. B., Iliescu-Glaja, M., Domnariu, H.-P., Leonte, E., Crainiceanu, Z. P., & Anderco, P. (2025). The Rise and Refinement of Breast Thread Lifting: A Contemporary Review. Journal of Clinical Medicine, 14(11), 3863. https://doi.org/10.3390/jcm14113863

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