Scott L. Replogle, MD

 Breast lifts and breast implants is probably the area of most confusion and misconceptions of what they are and what they do even to plastic surgeons.

Breast lifts (mastopexy) come in all kinds of different techniques, many of which are considered outmoded or old fashioned and some of which are overrated in terms of what they accomplish. As was pointed out in some of the other responses, a modern breast lift involves truly repositioning and reshaping the breast gland itself with the nipple-areola still attached normally and then redraping the skin around it, usually with an incision around the areola and down to the crease (lollipop incision). Using the skin to lift, reshape, or hold the breast gland up does not work in the long run.

However, it is important to understand what a breast lift, properly done, does and does not do. A mastopexy will not add or subtract volume from the breast. It will not give it forward projection and it will not fill in the upper pole of the breast. Breasts that have been properly lifted look bigger but this is an illusion and makes it difficult to judge size when an implant is used at the same time. A careful view of before and after pictures following a lift will show the upper pole concavity to be very close to the same.

Only breast implants acting like pillow volume can give the breast forward projection and fill in the upper pole. The misconception is that implants lift the breast. Breast implants whether large or small DO NOT LIFT THE BREAST. They give the illusion of a lift because of the filled out volume and filling of the upper pole of the breast. The same thing happens in reverse. If an implant from an augmentation is removed, the breast does not sag or fall. It only appears to do that. The implant is pillow volume, not a lifter or weight.

The other misconception is that adding a "small implant" will solve the problem or fill in the upper pole concavity. Implants have to be positioned properly in order to fill the breast out properly and this means the implant has to be measured to fit the inner diameter of the breast, positioned properly behind the nipple-areola, and have forward volume based on the (forward) profile of the implant. The minimum increase in size of the breast is therefore a cup size with a low profile implant. Filling the upper pole of the breast will happen with a round implant if the width of the breast and therefore implant is also tall enough to fill in the upper pole space. If not, then a textured surface, shaped implant would be needed.

I strongly advise against "small implants", implants above the muscle in the upper pole, or implants in order to provide a true lift. You will be disappointed.