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 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.
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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, 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 versus Breast Augmentation
Breast augmentation does not lift the breast...it fills out the breast where it is, resulting in a larger breast with more upper pole fullness. If the breast has a certain amount of overhang, it will still have that. If the nipple is low on the breast, it will still be low on the breast, though sometimes some stretching of the lower pole of the breast below the nipple by an implant will give the illusion of a somewhat higher nipple. If a breast is TOO low...too overhanging or a nipple below the level of the crease beneath the breast...then the deflated breast can be too low to be filled out by the implant, it will hang "empty" off of the breast, and the nipple if low will point downward. People choose augmentation because either they want larger breasts or they want more fullness in the upper portion of the breast as well as the increase in size. People choose lifts because their breasts are hanging too low over the crease or the nipple is too low or both, and they want the breast and nipple position lifted. People choose both lift and augmentation usually because they need a lift and either want to be larger or want more fullness in the upper pole of the breast than a lift alone would give them.
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.
Breast Lift or Breast Implants
A breast lift and breast augmentation are very different. If you need your breasts (and nipples) lifted, then a breast lift is for you. Breast Implants will only make you bigger, and will do nothing to lift you. Sometimes you need both procedures. I tell my patients that a breast lift is a push up bra and a breast implant is just a padded bra. Sometimes you need a padded push up bra - breast lift + implants.
Breast lift vs. augmentation
The goals of breast augmentation with implants versus a breast lift are very different even though the procedures are often combined. The breast lift is designed to restore the proper anatomic relationships of the breast. Classically, if the breast appears "droopy" or the nipple is low on the breast, the patient needs a breast lift. The nipple position can be determined to be "low" by looking at its relationship to the fold underneath the breast or the inframammary fold. If the nipple is at or below the fold, the nipple is too low and the patient requires some form of lift. There are many forms of lifts and in general, the droopier the breast, the more incisions are required to lift it. The goal of breast augmentation is to give volume to the breast. Patients who are candidates for breast augmentation alone, generally do not have droopy breasts and just need more volume. Patients who have droopiness and want more volume than what they already have, are candidates for a breast lift with an augmentation.
Web reference: http://www.epsmiami.com/
Breast lift vs. breast augmentation
There are couple of scenarios that might help answer this question:
1. You have deflation of your breast skin from either weight loss or after pregnancy. You don't want the scars of a breast lift and are hoping that a breast implant alone will give you the results you are hoping for. In this instance, the key factors will be the distance from your nipple to your inframammary fold, the size implant you are considering, and the importance of fullness in the upper aspect of the breast. Many patients can "get away" with just implants when the skin envelope is loose. It may be possible to position the implant slightly low on the chest wall and fill out the bottom aspect of the breast and avoid a lift. Often though, the native breast tissues seems to fall over the front of the implant which can be very bothersome, especially in certain positions. If bothersome enough, a breast lift procedure can be completed as a second procedure.
2. You have notable droop or drag to the breast (ptosis) and want primarily to lift them. You just can't decide if your existing breast volume will give you the look you are hoping for and want to know if an implant will be needed. In this case, you need to remember that with most effective breast lifts, there will be a slight decrease in breast volume. You also need to consider the flattening of the upper pole of the breast. Most breast lift or reduction procedures fail to provide significant upper pole volume. They can very effectively reshape the bottom of the breast and raise the position of the areolae, which may be all that is needed. If upper pole volume is the most important goal, then an implant will most often be required.
In the end, it all depends upon your physical exam, your goals, and your surgeon's experience.
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.
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