At what point do you know if you need a breast lift vs breast implants (or both)?
Breast Lift versus Breast Augmentation
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Depends on what you're looking for
Most women who come to me seeking a breast lift know why they are there. The sagging is usually quite noticeable and bothersome. Normally the nipple lies on an imaginary with the inframammary fold. Once the nipple falls below that line this is considered ptosis or sagging. This occurs after pregnancy, breastfeeding, aging etc.
An augmentation is used to enhance volume. In addition it can elevate the nipple giving a slight breast lift.
An augmentation mastopexy (breast lift) is performed when either a significant volume of breast tissue has been lost and/or there is loss of breast tissue in the upper pole of the breast.
My Breasts Have Fallen and They Can't Get Up - Augmentation or Breast Lift
Patients who I see in consultation for drooping breasts (ptosis) or volume loss after pregnancy (pseudoptosis) almost always have one very important question. "Can my drooping be corrected with just implants or do I need a lift".
Here is the answer based on what I look for and ask each patient in my practice setting in Sarasota, Florida.
Implants alone will correct drooping when:
- Breast drooping is mild
- The nipple is still near the center breast and does not point downward
- There is some visible skin beneath the nipple/areola when looking at the breasts straight on.
- The patient is OK with being at least a cup size larger
A breast lift (with or without an implant) is better when:
- Breast drooping is moderate or severe
- The nipple is at the bottom of the breast or points downward
- There is no visible skin under the nipple/areola when looking at the breasts straight on.
- The patient is already a C or D cup breast size and doesn't want to be larger
- The areola is too large and the patient wants it reduced
I also do a series of breast measurements to make sure they confirm what I believe from my observations and questions.
- If there is a long distance from the nipple and areola to the crease beneath the chest (more than 7 cm stretched skin, about 21/2 inches) a breast lift is often needed.
- If the patients breasts are large and pendulous a lift or reduction may be needed.
I also show the patient photographs of a spectrum of breast scar present after a breast lifting check their tolerance for this scar. Most patients are surprised how little the scar shows and are OK with proceeding. If the patient really needs a breast lift, but is concerned about the scars, I will suggest they wait on surgery. In time the breast appearance problems will outweigh their concern about the scars.
I use implants in combination with a lift when:
- The patient wants to be larger in addition to being less droopy
- The patient desires to maintain projection and roundness of the breast mound
- The drooping is severe
Breast augmentation or breast augmentation plus lift Augmentation mammoplasty
Other patients are primarily interested in increasing their breast volume, but have enough breast ptosis to make the appearance of breast augmentation alone odd and unappealing. Placing implants behind breasts with significant ptosis creates the appearance of breasts hanging off of a pair of implants, which looks distinctly unnatural and aesthetically unappealing. These patients are also best served by augmentation mastopexy, which in addition to increasing breast volume restores the position of the nipple-areola complex to the top of the breast mound, tightens the lower pole and lifts the breast.
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Breast lift versus augmentation?
A breast implant is simply a bag of filler material designed to add volume to the breast. It is not designed to do anything else. I tell my patients that their breasts should look just like they do before surgery, only fuller. If you look at your breasts and determine that that will not work for you then perhaps you need a different procedure. Some patients who have lost volume from pregnancy or weight loss simply have loss of volume to their breasts leaving them with a "scooped out" look. The shape of their breasts may be fine. They may simply need to "re-fill" the empty skin. If that is the case, then an implant is the perfect choice! There are a couple of criteria that we, as plastic surgeons, use to determine if a patient needs a lift or not. If the nipple is below the level of the crease under the breast then a breast lift is probably necessary. We also measure the distance from the small notch at the base of the throat to the nipple. Ideally, this distance should be 18 - 22 centimeters. Anything more than that probably means a breast lift is indicated. There are several ways to do breast lifts and this should be discussed in consultation with the surgeon. Some surgeons do breast augmentations at the same time as the breast lift and others prefer to do the augmentation at a second operation later one after the tissue has recovered.
Breast Lift, Breast Aug, and Implants with a Lift
Do I need a Breast Lift?
This is a question that gets asked so frequently that I have recently written a blog post just about this topic.
The most important question with respect to whether to get a Breast Lift is whether your nipple drops below the inframammary fold. If it does, you definitely need a Breast Lift. Whether or not you need implants is a matter of whether you want upper pole fullness and/or larger breasts.
Please read my blog post below to learn about the questions you should ask yourself. Also, you will see a case study of a patient who had breast augmentation performed twice--the first time without a lift, and the second time with a lift. In her case the nipple was just at the level of the inframammary fold, but the lift made a huge difference!
Ricardo L Rodriguez MD
Breast Lift vs Breast Augmentation
A general guidline to help patients figure out if they are a candidate for a lift, is to note the position of the nipple and the breast tissue in relation to the fold. If you like where everything is rightnow and you wish you were bigger then the answer is a breast augmentation. That means the nipple is still at most anterior and most projecting part of breast mound. The breast tissue has to be ideally above the fold.
Now if find yourself standing in front of the mirror pulling up on your breast tissue, wishing that the nipple and breast tissue were as high as they used to be before. Then that means that the breast tissue has descended below the fold and the nipple is usually pointing downwards. Then the answer is a breast lift. Finally if you want the nipple and breast tissue higher and the whole breast bigger, then the answer is a combination breast augmentation with a lift. I hope this helped in answering your question. Remember that by choosing a board certified plastic surgeon, he or she will have the training to guide you to the correct decision.
Breast Lift versus Breast Augmentation
Although there is some indication cross-over, a breast augmentation has a different goal than an uplift (mastopexy). Adding an implant to a breast is designed simply to make it larger. Generally it even has the same shape, but it is just larger. If the nipples are too low and there is sagging, an implant will make it larger, but with some minor exceptions, it will be a larger sagging breast with the nipple pointing downward. An abstract rule many plastic surgeons go by is, if the nipple is below the crease under the breast, an uplift is needed.
If the breasts sag and are also too small, both a mastopexy and an implants are usually indicated. Often a mastopexy without an implants leaves the upper aspect of the breast too flat after the swelling has subsided. Frequently an uplift is accompanied with a small implant to solve this problem. Or an uplift can be combined with fat grafts, which can be very effective.
Breast Lift versus Breast Augmentation
The best way to determine this is to have someone evaluate you. With that said, a breast lift is generally indicated when you have significant glandular (breast) and/or nipple ptosis (sag). Nipple ptosis is when the nipple sits at the level of the IM crease or lower. Breast ptosis is when the breast hangs over the crease. A lift procedure can range from a simple nipple elevation technique (ellipse lift) to a more aggressive lollipop lift (Vertical Mastopex) with or without an implant. An experienced Plastic Surgeon will give you the best treatment option. As I tell my residents: "Anybody can perform a cosmetic breast procedure, but it takes experience to properly diagnosis and come up with a proper treatment plan." A poor plan often times will lead to an unsatisfied patient.
Lift vs augmentation vs combination
This is a great question and one that we get asked quite a bit in my practice. As a general rule if you look in the mirror and see skin below the areola (the pigmented part) and the bottom of the breast then you could get away without a lift. If your nipple position is so low you cannot see skin, you just see areola, then you would require a lift as well. This being said there are many patients that are “on the fence” and could use a lift, but they do not want the scars yet. Many times, we use a slightly larger implant which can get a very small lift and it “buys them time” for a few years before a lift is needed.
Implants for cleavage, lifts for perkiness
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.