Breast Augmentation w/ Lift Needed?

I am getting a tummy tuck and breast augmentation. I am 41, 5'4" and currently weigh 120lbs. (normally 110 lbs. and more deflated) Had 5 children and nursed them all. I am single now. Will it look ok with just the aug? My dr. said it was up to me. I don't mind some sag.. Help!!

Doctor Answers 39

Breast Lift or Implants Alone

Based on what I see in your pictures, I would recommend a breast lift with augmentation.  It is true that implants placed above the muscle would give you fullness, but will just make the ptosis (sagginess) worse over time.  I feel that the most natural result would be to place the implant under the muscle and perform a lift at the same time.  In my hands, this would give you a beautiful, long-lasting result.

Austin Plastic Surgeon
5.0 out of 5 stars 83 reviews

When is a breast lift needed with a breast augmentation?

Based on your photos, I recommend a breast lift.  Please note, once a breast implant is placed, to have the best result, your nipple should be positioned at the highest point of the implant.  In your case, your nipple and breast tissue will sag over the implant.

The good news is you can have a breast lift at a later time. Therefore, if you are not sure, have the breast augmentation first, and see if you are pleased with the result.  This is a subjective matter and only you can determine what pleases you.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon
4.7 out of 5 stars 13 reviews

In your case I would recommend implant surgery alone.

Breast implants alone are certainly a viable option for you since as you say you "don't mind some droop". In fact, if the implants are positioned above the muscle then they will actually impart a slight amount of uplift but certainly not the equivalent of a lift procedure. Essentially, adding an implant creates mostly a larger version of your present breast. Although it would mean a second operation if you are unhappy with just the implant, having implant surgery alone will allow you to see the results without the scars associated with the uplift surgery. You do not burn any bridges this way as you would by opting for permanent scarring that at times negates the benefit of the lift. If you are unhappy with the results of the implant alone you will find the uplift surgery by itself to be quite benign with little to no post-op pain.

David A. Ross, MD (retired)
Chicago Plastic Surgeon
4.6 out of 5 stars 89 reviews

To lift or not to lift?

A common question is whether a breast lift is necessary with implants. The answer is rarely straightforward. The implant will fill out the breast skin and provide some upward rotation of the nipple. However, this depends upon the size and shape of the implant, with larger/more projecting implants providing more of a "lift." In certain cases, the nipple is too far down on the breast to achieve an attractive look without the addition of a lift. I believe that you are a borderline case. If you don't mind having the nipples slightly lower on the breast mound, then an augmentation is all you need. You can always have the lift afterwards if you are unhappy with the appearance. By staging the lift after the augmentation, you make the results more predictable, decrease the risks of surgery, and may find that the augmentation itself is all you need.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Breast implants with or without a breast lift

Based on your photos, I would recommend you have your breast augmentation alone.  Then, if after 3-6 months you and your surgeon feel you really need the lift, then you can do that at later stage, usually under local anesthesia.  This is called "staging" the procedures and is a great option in your particular case.

The reason to do this is that you may be completely happy with breast implants alone, therefore, avoiding the potentially unnecessary scars involved with a breast lift.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Augmentation mastopexy recommended

The problem you describe is a common one.  Given the photographic and clinical information you submitted, you would likely be happiest in the long run with an augmentation mastopexy.  In all likelihood, if you were to undergo only augmentation the implant would remain lower than desireable on your chest wall, in order to make certain that the point of maximum projection of the implant coincided with the nipple.  This would leave you with a larger breast, but in many ways not more aesthetically pleasing. It might  help if you clarify your desired result in terms of breast fullness, nipple position, areolar diameter and skin tightness.  This might assist your surgeon to better achieve the results you seek.

Do I need a breast lift ?

I try to avoid breast lifts with augmentations whenever possible. They add scars, expense and risk. Also they are notorious for requiring frequent revisions or touch-ups when combined with augmentation.

Working from your photos only (and not being able to examine you and take the measurements I would in the office) I would say you might be a candidate for breast augmentation alone. I have obtained good results in 'borderline' breasts such as yours using an aggressive dual-plane technique. This consists of extra dissection inside the breast to allow the implant to sit low enough so that the drooping breast does not hang below the implant.

The dual-plane technique does not result in additional scars on the outside.

You would have to understand, of course, that a breast lift might be required later. I have to say, however, that I have very rarely had to go back and do the lift.

Eric Pugash, MD
Vancouver Plastic Surgeon
4.9 out of 5 stars 136 reviews

Breast surgery and abdominoplasty - mommy makeover

Your case is borderline which is why the other surgeons have posted different answers. There is some drooping of the breasts but without measurements we cannot know how much drooping there is exactly or whether you have crossed that threshold for a lift or if you have by how much. There are other issues here including stretchmarks of the breast skin and the downward shift of breast tissue under the skin with some flattening of the breast contour. The correct answer to your question depends on whether you want the breasts of a 20 year old or a middle aged woman, what the current skin laxity is, whether the implants are placed over or under the muscle and what size implant you choose. Larger implants will fill more of the skin envelope and require less skin removal. Implants under the muscle will separate from the descending breast tissue and require more skin removal to re-elevate that breat tissue. A tummy tuck will create even more downward pull on the breasts and increase the need for the counteracting forces of a lift. Then you have to decide on what type of lift if you decide on the lift. You always have the option of a breast augmentation first followed by a lift if/when you need it especially if you do not mind some sag. You just need to know your options and the consequences of those options before proceeding with surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast Aug with or without lift

The photos are very helpful in that they show the nipple relationship to the fold.  You have mild ptosis(droop)  that responds well to an uplift with implant.    The lift will make the breasts look perkier and give you more fullness above the nipple where you need it, without the need for a bigger implant.  If you elect not to have a lift, your surgeon should opt to use a bigger implant that will fill out your shape and give you the desired fullness.  Your breast will look the same as it does now, only bigger if a lift is not done. If you are uncertain, a lift can be added later. 

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 16 reviews

Breast implants with or without the lift

For individuals caught on the edge, leaning between a breast augmentation alone or adding a breast lift, one of the first considerations is the breast scar. If you are scar averse then it only makes sense to complete the breast augmentation and see how things work out in terms of nipple position. Breast lift can be done after if the droop and nipple position is an issue. My vote is the augmentation alone.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 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.