SAMBA Diagnostics


Evaluating your breast and deciding on the correct procedure for you

Definition of “Ptosis” (Pronounced, TOESIS): a sagging or prolapse of an organ.


Dr Kirwan explains that this is a simple guide and does not replace a personal consultation with him. [He encourages you to call and schedule an appointment so that he can evaluate your breast and recommend the appropriate treatment. There are other deformities of the breast, which are not included in this classification (such as tubular breast) which can only be evaluated adequately at the time of a consultation. This page is presented, as a guide to help you better understand what surgical treatment may better suit your needs. It is not intended as a final diagnosis or an opinion.

Figure 1 – Kirwan Classification Stages A-F


(IMC: Infra-Mammary Crease-fold below the breast) Staging of Breast “Ptosis” published in the Proceedings of the Breast Surgery and Body Contouring Symposium, Eldorado Hotel, Santa Fe , NM , August 23rd and 24th 2001.

First, Stage your Ptosis. Place a 12″ ruler horizontally at the crease (IMC) under your breast.  Mark the level of the crease in the midline between the breasts. Now mark this point in the middle of the breast above the nipple. [Note that the nipple may not be in the middle of the breast. Measure the distance between this point and the level of the nipple in centimeters. Is the nipple above or below the level of the crease?


[See Figure 1 to stage the Breast Ptosis between A and F Stage the Ptosis A-F depending on how many centimeters the nipple is above or below the crease. [(See Figure 1)

Second, Take the Pencil test.  Will a pencil stay under your breast if placed at the crease under the breast? Alternatively, does it drop to the floor?

Figure 2

PencilTestSMIf a pencil stays, advance your stage one level if you were a level A or B to start with. If the nipple is greater than 2 cm. above the crease and the pencil test is negative then you don¹t have significant breast Ptosis or a breast implant alone may correct it. See Figure 2. To understand the best procedure for your own breast See Table 1 if you want a lift without an implant or Table 2 if you want a lift with an implant.

Definitions and explanation of abbreviations:

AM: Areolar Mastopexy (scar limited to margin of areola) with a purse-string closure gathering the extra skin around the areola-no vertical scar

SAMBA: Simultaneous Areola Mastopexy Breast Augmentation. Areolar Mastopexy (scar limited to margin of areola) purse-string closure combined with a breast implant.

Breast Auto-augmentation see: Breast Auto-Augmentation

Table 1

Stage A-F Without Implant
Stage A, B AM alone
Stage C, D, E.F. AM or Breast Auto-augmentation With vertical mastopexy
Table 2
Stage A-F With Implant
Stage A, B, C SAMBA
Stage E, F Augmentation / Mastopexy with vertical mastopexy or same with short horizontal scar at IMC


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