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

The simple answer is that augmentation improves the size of your breasts, whereas a lift improves their position. If you're unhappy with both, then a combined procedure may be right for you. However, each case deserves careful consideration by a qualified plastic surgeon. For example, a woman who appears to be a candidate for breast augmentation alone may benefit from a combined procedure to reduce the risk of premature sagging if the implants will add a significant amount of weight to the chest. I can say unequivocally that I don't recommend implants alone to correct drooping. In many cases, they can actually exacerbate existing sagging. Of course, an in-person consultation is the best way to know what's most appropriate for you. 

This question is best answered by the board certified plastic surgeon that you choose to do the operation.  Basically, it is dependent on the distance from the bottom of the neck (sternal notch) to the nipple, and the distance from the nipple to the breast fold.   It is dependent on the position of the nipple on the gland, the position of the nipple with respect to the fold, and the amount of skin excess of the breast.  All of this must be combined with the patient's goals and the surgeon's experience and ability.  

The question of whether a patient needs a breast lift of simply an augmentation can depend on several factors. There are two extremes where that answer is simple, in patients that have a great shape to their breast and just want to increase the size typically all that is needed is an augmentation. Patient that have breast that are down, with the nipple pointing toward their toes need a lift with or without an augmentation. The grey is for patients that have a less than perfect shape but their breasts have not completely fallen. The goal at the end of the surgery is to have the implant centered behind the nipple; this is going to give the most aesthetically appealing appearance to the breast. There are three different types of lifts and which one to use can be tailored to the individual. Many women who only need a small lift can have a peri-areolar lift; this is where the only incisions are at the border of the areola and the normal skin. These incisions tend to hide very well as it is at a natural transition.
There is also a vertical and full mastopexy (anchor lift) for patients that have extra skin or breast that have completely fallen. The most import part of making this decision is having a discussion about your goal with a board certified plastic surgeon. He or she can help guide you as to which procedure will be best for you to accomplish your goals.

Hello and thank you for your question.
This is the most commonly asked question for women who are seeking improvement in the shape and volume of their breasts. This is not an exact science and although as plastic surgeons we try to create criteria in order to decide whether a patient will benefit most from a lift versus a breast augmentation, there is not always a concrete answer.
That being said, I have found that the best way to determine whether a patient will require a lift is during their physical exam. Being able to palpate the breast tissue and view the breast in multiple directions helps to make a decision on whether a lift is necessary. During the consultation, I am able to measure each breast individually and make a decision in concert with the patient about whether the added scars of a breast lift are necessary.
There are a variety of techniques that can be used to lift the breast but it all depends on the tolerance of the patient for added scars to the breast. There is nothing wrong with initially performing a breast augmentation and seeing the results after a few months and deciding whether a lift is actually necessary. 
In general, if the nipples are below the crease of the breast than a breast lift will usually give the best result. If there is sagging of the breast with the nipple below the breast crease as well as a lack of volume at the upper portion of the chest, then a breast lift in combination with an augmentation will provide the best aesthetic result.
Hope this helps answer question. All the best!
Alex Zuriarrain, MD, Plastic Surgery

This is a somewhat complicated question as there are many
factors involved in the need for a breast lift, as there are many different
techniques for a breast lift as well. The mean rule of thumb is that if there
is loose and overhanging skin, which overlaps the crease under the breast it is
very likely that you will need some type of a lift, as simply placing the
implants will not generally correct for this skin looseness. Additionally, if a
large implant is used to compensate and fill up this loose skin envelope,
patients often have significant problems over time, as the heavy implants will
stretch out the skin and make the drooping worse. Ultimately the best way to
know if you need a lift is to have an evaluation with a Board Certified Plastic
Surgeon who if they have significant experience in breast augmentation and
breast lift surgery can explain to the patient why they may need a particular
type of breast position to an implant in order to achieve the best shape. In my
practice personally, with many patients I can tell immediately whether they
need a lift and which type of lift they need. However, there are some patients who are in a gray area
between lift techniques or between the need for a small lift or no lift at all
and in those patients, I make final decisions during surgery after the implants
are in place in order to give them the best overall shape and appearance.

Ah the million dollar question.  Well there are several key factors to your question.  Number one is what the patient will be happy with.  Some patients will be ok with a "natural" looking breast that's just fuller and hence can "get away" with an augmentation (seldom the case) but others want a higher, tighter look and will be very disappointed with simply an augmentation.  Next your doctors ability to guide you and make the correct diagnosis.  I can not tell you the number of patients I see for revisional breast surgery that hate their breasts because they are just larger but more saggy than before.  This is so classic...."lets try to get away with an augmentation rather than a lift".  As a doctor you have a responsibility to ask questions and figure out what the patient REALLY wants and then make the tough call.  Many doctors don't want to tell a young patient they need a lift because they are afraid they wont book and there is always a guy around the corner that will tell them what they want to hear.  Wrong.  You need to do whats right or do nothing.  So if a patients needs a lift and simply isn't ready for the exchange of some light scars for a better look than she should wait.  Trying to get away with it, often leads to a worse result in the long run.  Also keep in mind the augmentation may look amazing for 6 months but almost always bottoms out!Therefore the answer is it DEPENDS.Make sure your doctor will tell you the truth.Hope that helpsRR

This decision is made easier by measuring where the nipples are in relation to the breast. In general younger women with little drooping can use the implant alone. Women who have had children and breast fed have more significant drooping and may need a lift and an implant.

If your breasts have sagged a lot then some form of skin-tightening procedure (breast-lift) will be necessary.  If you have adequate breast volume then a breast lift alone may be the answer but, if not, then implants will likely be need as well.  In some cases, where there is a limited amount of droop, a breast augmentation alone may correct the problem especially if one on the new shaped highly-cohesive silicone gel (Gummy Bear) implants is used.  These implants can be extremely effective in camouflaging limited breast drooping.  The only way to know for sure is to have a consultation with, and careful examination by, a plastic surgeon.

Hi SaskGirl

Breast lifts and breast implants perform different functions. Breast implants provide volume and can either enhance or restore the size of the breasts. Breast implants alone do not provide substantial lift to the breasts. If the primary concern is sagging or ptosis to the breast, the better operation is to formally lift he breasts through a mastopexy. Sometimes patients desire both, i.e. increased volume and lift to the breasts. In this situation both operations are performed. As to when a breast lift is "required", one condition is often quoted as a guide. If the nipple position is lower than the inframmary fold, i.e. the crease beneath the breast, then a breast lift is usually recommended.

I hope this is helpful to you.

Wayne Yamahata, M.D.,F.A.C.S.