The alterations brought about by pregnancy and breast-feeding on the vertical reduction mammaplasty have not been previously evaluated.  Hormonal changes during these periods affect the female breast resulting in enlargement of the gland.  After breast-feeding has ended, involution of the gland requires that the stretched skin envelope re-drapes properly.  Young and elastic skin may successfully accommodate to the fluctuations in breast volume but less elastic skin may not be able to do so. In an effort to evaluate the effect of pregnancy and breast-feeding on the operated breasts a retrospective study was performed.  The study group consisted of 57 women who had pregnancies after their vertical reduction mammaplasty.  Of this group, 24 breast-fed.  The control group consisted of 103 women who had vertical mammaplasty but had no pregnancies.  All patients had breast measurements routinely performed at the time of suture removal, on the second postoperative week.  For this study the women were requested to return for evaluation at about 24 months (range 18 to 26 months) after the surgery.  The following measurements were made for comparison with those made early postoperatively: 1) mid-clavicle to nipple and 2) inframmamary fold (IMF) to inferior areola.  In the study group no measurements were made until at least 6 months after completing pregnancy or breast-feeding.  A standardized evaluation form was completed that included the age, body mass index, amount of tissue removed per breast, pregnancies after the mammaplasty, history of breast feeding, and breast measurements.  The results demonstrated no significant difference between the control and the study groups regarding age (27±12 vs. 29±10), body mass index (26±5 vs. 27±4), and amount of tissue excised (610±201 grams vs. 598±279 grams).  The breast measurement between the mid-clavicle to nipple was not significantly altered by pregnancy with or without breast feeding.  A statistically significant (p<.05) lengthening of the distance between the inframmamary fold and the inferior areola occurred in the study group when compared to the control.  No significant difference was found in the lower breast pole measurement between the study sub-groups. Lengthening of breast measurements after 24 months:
	Control Group	Study Group
		Pregnancy only	Breast-feeding
Mid-clavicle to nipple	0.2±0.3 cm	0.3±0.2 cm	0.3±0.3 cm
IMF to inferior areola	1.2±1.5 cm	3.5±2.6 cm	4.1±2.3 cm

In conclusion, in women who have had vertical mammaplasty and subsequent pregnancy with or without breast-feeding, the distance between the inframmamary fold and the areola increased significantly more than in patients who did not have pregnancies after their surgery.  This finding could explain the complaint of breast ptosis among this group of patients who were initially very satisfied with their breast surgery.