Breast Lift versus Breast Augmentation

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 okay 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 lift in order to check their tolerance for this scar. Most patients are surprised how little the scar shows and are okay 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 usually 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

I often encounter patients who are unsure about the differences between breast augmentation, mastopexy, and augmentation mastopexy. These procedures, often referred to as "boob job", "breast lift", and "breast lift with implants" respectively, offer different solutions to various aesthetic concerns.
Breast augmentation, also known as breast enlargement, is a surgical procedure that aims to increase the size and improve the shape of the breasts. This is typically achieved through the use of implants. The procedure is ideal for individuals who are unhappy with the size of their breasts or those who have experienced volume loss due to factors such as weight loss or pregnancy.
Mastopexy, commonly known as a breast lift, is a procedure designed to lift and reshape sagging breasts. This is achieved by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. The procedure can also reduce the size of the areola if it has become enlarged over time. A mastopexy does not significantly change the size of the breasts, but it can offer a more youthful and uplifted breast profile.
An augmentation mastopexy, or a breast lift with implants, combines the benefits of both a breast augmentation and a mastopexy. This procedure is ideal for individuals who wish to increase the size of their breasts while also addressing sagging. By combining these procedures, patients can achieve a more youthful, fuller appearance with improved breast shape and position. This is sometimes done in two stages.
Each of these procedures offers unique benefits and can be tailored to meet the individual needs and goals of the patient. It's important to have a thorough consultation with a plastic surgeon to discuss your aesthetic goals and determine the best approach for you.

A breast lift is really a nipple lift. The question we really need to answer here is: is the nipple at the correct position above the inframammary fold. How do we find the inframammary fold? Place a pen under your breast where your breast meets your chest. Using a mirror, is your nipple above or below the pen? If the nipple is above the pen then you can get a breast implant to enhance your breast. If the nipple is below the pen then you should consider getting a breast lift with or without implants.

This is a very common question in my clinical practice as lots of patients are not sure if they need only augmentation or uplift or both. this is very much dependent on their breast shape and volume and their expectations from surgery. IF you are only looking for increase in volume and you are happy with nipple positions and size of areola, then you need only breast augmentation with implants. IF you are happy with overall volume and size of breast and would like areola made smaller and nipple at a higher position and tightening of breast skin, then you would benefit from an uplift procedure. IF you are looking for increase in breast size as well and bringing the nipple up and skin tighter, then you might consider an augmentation mastopexy at the same time. In some case where there is a very small descent of nipple position and overall lack of volume, then you can achieve desired result from only an augmentation using a higher profile implant. Please discuss with your consultant to discuss different options available and see before and after pictures of different patients to get a realistic idea of what to expect from different procedures.

Hello there and thank you for such a great question, The need for a lift is determined by the nipple position and/or amount of loose skin present. Generally speaking if the nipple is below the level of the inframamorry fold (crease) some form of a lift will likely be required to elevate the position of the breast. In these situations, if only an implant is used, the result will be a “rock in the sock” which looks awful.

Generally, a breast augmentation can be combined with a mastopexy in those women who want to enhance their breast volume, but also address concerns with breast droopiness. The implants are used to enhance the volume, whilst the breast lift allows repositioning of the breast tissue and the nipple to a higher position, as well as removal of the excess skin.
Breast augmentation in patients with moderate to significant breast ptosis (nipple sitting well below the breast crease) need to be combined with a lift in my opinion. This can be done with either a "lollipop" or inverted "T" scar. Periareolar (Donut) mastopexy can only work in cases with mild degree of ptosis and little amount of excess skin, and can only provide a limited amount of nipple lift.
In some cases, where either the breasts size is relatively small or the degree of ptosis is very mild (nipple sitting at the level of the breast fold), it is possible to achieve a satisfactory result by using an implant only, without the need for an uplift. For this purpose, a dual plane type-3 technique is used whereby the implant is a placed in a pocket partially under the muscle, whilst the breast tissue is disattached from the underlying muscle, up to a level just above the nipple. With this manoeuvre a small nipple lift can be achieved and in my practice it works well for small breasts that underwent mild deflation.
A dual plane augmentation on its own however, is not suitable for saggy breasts in which the nipple has dropped below the level of the breast fold. In cases of moderate to significant breast ptosis an augmentation on it’s own can give a temporary lifting effect, however the breast tissue will soon drop and fall over the implant. This effect will create a deformity know as the “waterfall” effect or “snoopy” breast. This is unfortunately an unsatisfactory distortion, which will get worse relatively quickly and can only be corrected with revisional surgery.
The use of breast implants in patients considering a breast uplift is indicated for patients who either want a volume increase along with the lift, or have severely ptotic breasts and are looking for a fuller upper pole. Severely ptotic breasts have lost volume and support and in these cases the use of implants can provide the necessary structure to achieve a fuller and tighter look.

Hi and thank you for your question. Simply stated, a straight breast augmentation without lift is great for patients with mild or no sagging (ptosis) who are interested in increasing the size of their breasts. A breast lift is typically required if the degree of ptosis is moderate to severe, the nipple is pointing downward, the nipple is at/ below the level of the breast crease or if the areola needs reducing. Implants are also used in conjunction with breast lift depending on the patient and their individual goals. I recommend you meet with a Board Certified Plastic Surgeon to discuss your goals and find a treatment plan that works for you. I hope this helped. Best wishes! 

Breast implants are used to address loss of breast volume.  The indication for a breast lift, also called a mastopexy, is a function of the position of the nipple relative to the inframammary fold, which is the location where the base of the breast meets the chest wall. Placement of a breast implant may raise the position of the nipple a small amount, but when the nipple falls too far below the inframammary fold to be compensated solely by the placement of a breast implant, a condition called breast ptosis,  the surgical treatment indicated is a mastopexy.

This is a very important question which has to be addressed by both you and your board-certified plastic surgeon. 1 Simple way to consider this is that if you're nipples are below the inframammary fold, you may need a lift. This does not apply for all circumstances. Make plans for a consultation.

Excellent question! There are several parameters we use to determine wether a patient needs a breast lift or not. Patient's expectations are a big part of that decision. Generally speaking a breast lift is needed when there is Breast Ptosis or sagging of the breasts. In cases when patients have only mild sagging, implants may produce a slight lift by providing the added volume and firmness.The degree of sagging  and excess skin will determine whether a breast lift is needed and if so what type. A breast lift with implants in used in cases where patients want a lift plus added volume and upper pole fulness. The implants do not guarantee a longer lasting lift, they guarantee long lasting fulness. But if we go too big, the implants weight can pull down on the breast and make them sag faster. There a several degrees of ptosis. Breasts with no Ptosis have no sagging of breast tissue beneath the breast fold. Grade 1 ptosis: mild sagging of breast tissue beneath the fold but some of the areola is at or above the fold. The areola is usually facing slightly downward. Grade 2 ptosis: moderate sagging beneath the fold with most of the areola at or bellow the fold. Grade 3 ptosis: significant sagging, most tissue is bellow the fold as is the areola. The areola sully faces down.Pseudotosis has some sagging of the lower third of the breast but the areal is completely above the breast fold and is therefore facing forward in most cases.Parenchymal Maldistribution has most, if not all the breast tissue below the breast fold as well as the areola.Pseudoptosis and Grade 1 Ptsois (most of the time) can get away with implants alone. Sometimes a small lift like a Donut Lift can be performed in these cases if extra lift is needed. Everything else will need a lift or a breast lift with implants... assuming the patient wants her breast as perky as possible.Hope this helps, Dr. Miguel Mota

The decision to recommend a breast lift is based on measuring where your nipples are relative to the ideal breast.  If the nipples are too low, a lift may be recommended.  There are various types of lifts as well and sometimes an implant is necessary and sometimes not.