At Age 46 I Feel That my Breasts Are Starting to Sag. Implants or a Lift with Accompanying Scars? (photo)

My breasts are 34DDs and measure 17cm. There is slight asymmetry, maybe 50cc. I have always liked the way they look and wondered if implants would keep them up for a while and keep the nipples reasonably high. I like the natural look, where the breasts are bottom heavy. I do Not want to increase the size, I want them to sit where they sat when I was 35 years old. I guess that means my breasts are the same size now, but the profile is easing downwards. LOL

Doctor Answers 15


Actually I think you look great but if you wish there are some simple and less simple thngs to do.  Simple is an augmentation with periareolar incisions and sub muscular placement.  You will get an implant induced breast augmentation - lift.   This will make breast larger and more perky.  Eventually you will need a lift but that may be 5 years.   The very best lift is the VERTICAL LIFT SHORT SCAR.    This results in a vertical scar and incision around the nipple but none other.   Avoid the unattractive and totally unnecessary anchor lift of ancient times that is unfortunately still being done.  AVOID any version of the Benelli - donut lift which is even more offensive that the anchor lift.   Go simple.  Do a breast aug now and enjoy it for years and then do an uplift.  Better to separate these.   Combination procedures of breast lift and implant simultaneously are associated with a very high incidence of redo  (possibly 80%}.   Be simple, go simple, look fantastic.   My Best  Dr C

Palo Alto Plastic Surgeon
4.5 out of 5 stars 36 reviews

Alignment after lift increase projection

You are an excellent candidate for a new technique called The Ultimate Breast Lift.  This technique uses a circumareola and inframammary incision and avoids the ugly vertical scars of the boat anchor incisions.  This technique reshapes your breast tissue creating upper pole fullness, elevates them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola and breast tissue over the bony prominence of the chest wall maximizes anterior projection without the need for implants.  The weight of the breast is transferred to the underlying muscle producing long term stability.    


Best Wishes,


Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Reshaping of the breasts without augmentation requires a mastopexy and accompanying incisions.

Since you don't want to be any larger clearly you do not want a breast augmentation. A mastopexy with the incisions it entails is another option. Whether the aesthetic trade-off is worth it is a matter of opinion.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Lift rather than implant

A breast lift will serve you well. This can be achieved with little or no loss of your own breast tissue. You will maintain the same volume but acquire are more pleasing shape. As to the scars, they fade in time.

All the best,


James Southwell-Keely, MD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 17 reviews

A lift Would Work Well

Thank you for your pictures.  You have a very nice breast shape.  A lift without implants would improve your breast position but they will get somewhat smaller with the lift.

Dr. ES

Breast lift with or without implants?


Thank-you for the high quality photos. What is best for you really depends on what your goals are. If you would like to be lifted, a mastopexy, your will get a lift, be a little smaller and there may be some loss of upper breast fullness. If you would like to maintain this upper pole fullness you would benefit from a proportionate sized breast implant. There is no replacement for an in person examination where your options can be reviewed and your questions more thoroughly answered.

I hope this helps.

Dr. Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Lifting breast back up to where they used to be requires a lift and (small) implants

First you need a lift.  Implants will not take up the slack and you'll be too large.  Second, you probably should have small implants at the same time as your lift to restore upper pole fullness (implants do this better than your own breast tissue).  This combination is very common in women over 45.  If you have a lift alone, you may be a little dissatisfied with your upper poles, which will not fill out the way they used to do.  I've attached a link to this section of my website so you can read more and look at some examples.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 56 reviews

Options for Breast

Your pictures make it a little difficult to assess your breast since your arms are raised in most of them which elevates the breast. If you are happy with your breast volume, I would recommend either doing a breast lift procedure or doing nothing. I don't think that adding an implant is going to lift your breast much, but it will make them larger and heavier and potentially lead to earlier recurrence of sagging. The trade off to a lift is scarring, but this is the only way to make your breast more perky.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

Breast Lift vs Breast Augmentation

I would recommend a breast lift.  Since you aren't interested in increasing your size I would discourage you from breast augmentation.  Also, if you were to place an implant in without a breast lift it would typically be like putting a rock in a sock.  Good luck with your research.

Ben Hugo, MD
Virginia Beach Plastic Surgeon
4.7 out of 5 stars 14 reviews

Lift or implants for Breasts

Lift or implants for Breasts
I think you will do well with  a small lift and no implant
 there are a variety of techniques for these operations. Lollipop lift (vertical lift), donut (periareola) lift, Benelli lift, crescent lift, anchor lift (inverted T ). Most commonly, we prefer the lollipop or donut lift because of the shape, small scars and easier healing. Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive scarring and a less optimal result in many cases. These newer techniques are utilized in the vast majority of cases, the rare exception being extremely large breasts. The nipple-areola complex is repositioned higher, the excess skin is removed, and the breast is reshaped in a pleasing contour and in a more normal position.
The crescent lift removes a small amount of skin at the top of the areola. We find that there is very little lift and the areola becomes oval in shape and distorted with this method.
The Benelli lift as performed by most surgeons is just the donut lift, removing a donut shaped piece of areola and skin then using a #Pursestring or double purse-string suture to tighten the skin. A true Benelli actually will expose much of the breast through this incision and then the breast itself is shaped and lifted with sutures. This is a more complex procedure and is often not done as describe by Dr. Benellil.
The insertion of an implant as well, may be advisable to restore superior fullness, which is lost with aging and after pregnancy despite the rest of the breast being overly large. Fat grafting can be used instead of implants to improve the contours of the breast.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

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.