Will an augmentation without a lift result in more upper pole volume and an increased cup size? (Photos)

Question

46 healthy female, 5ft 1, 125 pounds. I’m interested in more upper pole volume, moderate size increase of 1 cup and minimal downtime. With the degree of ptosis that i have will I need mastopexy in addition to augmentation? TIA

Zoran Potparic, MD · Answer

Considering position of your nipples you will need breast lift. There is no satisfactory correction with augmentation only. Good luck.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos alone, without the benefit of a physical examination, I believe you would have a better long term results with an augmentation combined with a breast lift. Without a lift, two outcomes can happen: 1. implant placed too high to create upper pole fullness, will result in a waterfall deformity (lower breast tissue hangs off the implant) or 2. if the implant is placed in the lower breast behind the nipple areolar complex, you will get a "rock in the sock" deformity. Empty upper pole and heavy stretched out lower pole. Combining a breast lift with an augmentation takes an experienced surgeon, since the augmentation expands the tissues, but a lift tightens the tissues. Alternatively, one can do a breast lift first, and later add an implant when the breasts heal and settle. See a board certified plastic surgeon experienced in all aspects of breast surgery for an in person consultation/evaluation. You can start your search using the RealSelf Doctor Directory to find qualified professionals near you. Good luck.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos, you appear to demonstrate some degree of glandular/pseudoptosis (areola position preserved but descent of breast gland). You would likely benefit from a lift in conjunction with an augmentation.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Semih Yildiz, MD, FEPOBRAS · Answer

A physical exam is needed to judge this accurately, but the visible photos suggest enough breast ptosis that augmentation alone may not give the nipple and lower breast position you want. Implants can add volume and may improve upper pole fullness, but they do not reliably lift the nipple or tighten the lower breast skin. In some patients, placing an implant without a lift can make the breast look heavier or create a waterfall appearance, where the natural breast tissue hangs off the implant.

If your goal is only a modest one-cup increase and minimal downtime, it is reasonable to discuss whether a small implant alone would be an acceptable compromise. But if you want a higher, more youthful breast shape with better nipple position, a mastopexy with or without a modest implant is more likely to match that goal. I would ask your surgeon to show you examples of augmentation alone versus augmentation with lift in patients with similar ptosis before deciding.

Yasemin Aydinli, MD · Answer

Thank you for the helpful details and photos. Based on what you describe and the degree of ptosis shown, my honest recommendation is that you will need a mastopexy (lift) together with your augmentation &mdash; an implant alone will not give you the result you want. The key factor is where your nipple sits relative to the inframammary fold (the crease under the breast). When there is real ptosis, an implant placed on its own pushes the breast volume forward and downward rather than truly lifting it; this tends to create a "ball-in-a-sock" appearance, the nipple stays low, and the upper-pole fullness you're hoping for simply isn't achieved. In your case, I would advise an augmentation-mastopexy rather than augmentation alone.
I want to be straightforward about this because choosing an implant by itself in this situation usually leads to disappointment and an early revision. The lift repositions your nipple and tightens the loose lower skin so the breast is reshaped, and the implant then sits behind well-supported tissue and restores the upper-pole volume and the roughly one-cup increase you're after. Done together, you get a fuller, lifted, and far more durable result. The trade-off is some additional scarring from the lift and a slightly longer recovery than an implant alone, but the aesthetic payoff and longevity are well worth it for your goals.
I'd recommend an in-person exam so we can measure your nipple-to-fold distance and skin quality and choose the right implant profile to pair with the lift, ideally with sizers and 3D imaging so you can preview the result. But to answer your question directly: with your degree of ptosis, I would not advise augmentation without a lift.

Camille Cash, MD · Answer

Based on the submitted photos you will have the best result from an augmentation with a breast lift.  This will give you increased volume and upper pole fullness in addition to raising the position of the nipple.  The look will be a fuller, more balanced look.  See a board certified plastic surgeon near you for a consultation to learn more.

Bryan C. McIntosh, MD · Answer

A breast augmentation will certainly improve volume through the breasts, and upper pole volume is important in you based on your pictures. However, only performing a breast augmentation would still leave your breast with a significant amount of drooping that can only be corrected with a breast lift at the time of augmentation or at some point later. If you're uncertain how happy you'd be with only an augmentation, do only the augmentation, wait three months, and then consider a breast lift at that point. The main drawbacks with this two-stage approach are the increased expense of two surgeries rather than one, two exposures with general anesthesia, and two recovery periods.

Will an augmentation without a lift result in more upper pole volume and an increased cup size? (Photos)

Answers (7)

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