I plan on getting a tummy tuck and breast implant. I would like to know how doctors determine if you need a breast lift. (Photo)

I have always felt like one of my nipples is a slight higher than the other, is there anything to do for that? Also with a tummy tuck will my "love handles" be smaller? Thank you!

Doctor Answers 23

BA with or without lift

Hello dear, thanks for your question and provided information as well.. The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift with augmentation such as silicone implants, you will get very nice results, contact a board certified plastic surgeon, I recommend you soft cohesive silicone implants about 350 cc's you will look pretty and they will be perky.

Patients who goes to a 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".

Implants alone will correct drooping when:
  1. Breast drooping is mild
  2. The nipple is still near the center breast and does not point downward
  3. There is some visible skin beneath the nipple/areola when looking at the breasts straight on.
  4. The patient is okay with being at least a cup size larger
A breast lift (with or without an implant) is better when:
  1. Breast drooping is moderate or severe
  2. The nipple is at the bottom of the breast or points downward
  3. There is no visible skin under the nipple/areola when looking at the breasts straight on.
  4. The patient is already a C or D cup breast size and doesn't want to be larger
  5. The areola is too large and the patient wants it reduced
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:
  1. The patient wants to be larger in addition to being less droopy
  2. The patient desires to maintain projection and roundness of the breast mound
  3. The drooping is severe..... I recommend to see a board certified plastic surgeon for a personal evaluation and also to talk about your goals. Good luck :)



Dominican Republic Plastic Surgeon
4.6 out of 5 stars 358 reviews

Mommy Makeover with Augmentation Mastopexy

The Mommy Makeover is a combination of procedures to bring a woman’s body back to the way she looked prior to pregnancy. Most commonly some variation of a #TummyTuck and #BreastSurgery are performed. Additional procedures can include liposuction, umbilical hernia repair.  The most common #breastprocedures include #mastopexy or #breastlift, #breastaugmentation, or #breastreduction.  #MummyTummy is a term given to modified tummy tucks which can use liposuction and skin tightening with radiofrequency such Vanquish, Vela3, thermage, thermiRF and others.  The actual fat contouring can be done non-surgically as well with #UltraShape or Cool-Sculpting.
#Combined operations are often performed with our #Gynecology colleagues. Tubal ligation is a common post pregnancy procedure which is done at the time of many of the surgeries included with a #MommyMakeover. If you require a gynecologic operation or study (laparoscopy) and are considering a plastic surgery procedure, discuss these issues with your physician and board-certified plastic surgeon. Also, combining these #procedures may decrease anesthetics, costs, and recovery time. Now, the intentional result of a Breast Lift (#Mastopexy) is to improve the shape and position of the breast without reducing their size. It is used especially for breasts which sag or droop (#ptosis) as a result of aging, weight loss, pregnancy, or breastfeeding. However, many women report more satisfaction if an implant is used at the time of #mastopexy. The implants further shape their breasts, restoring superior fullness or volume which may be decreased over time.
In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result.
Always talk to a Plastic Surgeon to discuss your issues and concerns. Information that you read online may not apply to your situation. Make sure your surgeon is boarded by the American Board of Plastic Surgeons.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Breast surgery and tummy tuck

In general, the start of any breast enhancement procedure usually begins with determining nipple location. Proper location of the nipple is determined by several methods, but an easy way to do this on your own is to stand in front of a mirror and place your thumb under your breast in the fold between your breast and chest wall. Next, use your index finger to pinch your breast. In general, the index finger marks the location that your nipple should be. If the center of your nipple is above this point, you most likely don’t need a breast lift. However, if center of your nipple is at or below this position, you will look best with some type of breast lifting procedure. Based on your photo, it doesn't look like you will need a breast lift, but your arms are raised in the photo.  This is not a great photo to evaluate your nipple position because your arms aren't at your sides.  The position looks fine to me. Remember that while your breasts are sisters, they aren't twins.  No one's breasts are perfectly symmetrical.  With that in mind, any asymmetry will be more noticeable once your breasts are enlarged. It is possible to reposition one or both nipples surgically.

A tummy tuck alone will flatten your upper and lower abdomen, but it doesn't address your sides.  Consider liposuction on your flanks to get rid of the lovehandles.  Best of luck!

Andrew Jimerson, MD
Atlanta Plastic Surgeon
4.4 out of 5 stars 523 reviews

Nipple asymmetry and love handles

Your situation is NOT unique. Many women possess asymmetry of the breasts or just the nipples, such as different locations, different sizes or different shapes. Most of the time, what asymmetry that is not corrected by the insertion of implants can be adjusted with one or another type of breast lift-- maybe just lifting the areola alone will suffice to correct the asymmetry.
Regarding the love handles, these are usually reduced by liposuction in the course of the tummy tuck. If sufficient loose skin exists on the love handles, then some degree of skin tuck and tightening will be need ed as well.

Tad Grenga, MD, FACS
Norfolk Plastic Surgeon
5.0 out of 5 stars 11 reviews

Mommy Makeover

Without seeing you in person, it is impossible to recommend the right procedure. And since your back is arching in your photo, hard to determine your "sogginess". Basically, a breast lift will lift your breasts to a higher plane on your chest, fix asymmetry and reduce your nipple size if needed. It sounds like you, like most, have some pre-op asymmetry. It may be able to be fixed with an implant alone, but you'll need an in person assessment with a board certified plastic surgeon to find out for certain. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 51 reviews

Lift

If you have only slight nipple asymmetry, a periareolar lift is all that needs to be done to correct this.  If one breast is slightly larger, then a vertical lift may be indicated.  A tummy tuck with lipo will correct your love handles as well.  However, you may be a candidate for only liposuction based on this photo. 

Breast lift - how do you know if you need one?

Thank you for asking about your tummy tuck, breast implants and breast lift.
  • Great questions -
  • With a tummy tuck, your flanks will be small IF you have liposuction of the flanks.
  • They are not smaller from the tummy tuck alone.
  • A breast lift is done if the breasts are sagging - which your do not appear to be.
  • Although one nipple is higher, your breasts also have the normal asymmetry.
  • Nipple position can be changed but it may not look right when breast position and size is a little different.
  • This is something to discuss with your plastic surgeon during your consultation.
  • Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Breast Lifts

Droop is defined as the nipple being at or below the fold under your breast. Based on your photo you have no droop. Thus a  lift is intended to move the breast tissue back above the fold. Now, a lift technique can certainly be used to adjust nipple position alone but at the price of increased scarring.

Breast questions

It does not appear that you need a breast lift.  If you have extra fat in the love handle area this can be liposuctioned at the time of your surgical abdominoplasty.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Breast lifts

We evaluate the breast shape, and the position of the nipple and the breast relative to the fold underneath the breast.  The lower these are, the more a breast lift is needed.

Fortunately, in your photo, you seem to have very little droop - but of course, your arms are elevated, which makes it a little more difficult to tell.

Regarding the "love handle" question - I often find that liposuction of this area, at the same time as a tummy tuck, really gives the desired hourglass shape.  Ask your surgeon about this option.

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.