Breast Lift Alone, Implants Alone or Breast Lift + Implants? (photo)

Hi! Can't figure this out, I'm 25, 5.15 ft 150lb, weighted up to 165 but my breasts have looked so since I was a teen, with lots of strech marks and "empty". I wanted to avoid the scars of the lift, although I think it will be needed in the future, do you think implants alone would look ok, less droppy, for maybe 5-10yrs? I dont mind a little sagging, since it has some more "fullness" n doesnt drop much further. If lift, which type? If implants, under or over? If not together which first? THANKS

Doctor Answers 8

Breast Lift Alone, Implants Alone or Breast Lift + Implants

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To answer this, one question I have and don't see answered in your query is whether or not you wish to have larger breasts. If not, obviously the only option is a lift (other than doing nothing, of course).

A breast lift is usually done for one of these reasons:

  • elevate the nipple and areola
  • remove excess skin from the breast (after weight loss, pregnancy, aging)
  • create or restore symmetry

From you photos I see some excess skin, which would be adequately filled out if you elect to have a breast enlargement. 

As far as nipple and areolar position, yours appear to be borderline. We look at the distance from the top of the breast bone, normal being 8 to  9 inches. Because that can vary some with patient height and the position of the breast on the torso, our principal landmark is the breast fold, and the bottom of the areola should be even with or above the fold.

Yours looks quite even, so with the hesitation for added incisions, an enlargement alone seems reasonable. However, at an in person consultation, other factors which we cannot tell from photos alone will factor into any recommendation.


You seem ready for an in person consultation. RealSelf has listings of surgeons in your area. The American Society of Plastic Surgeons (plasticsurgery dot org) also has listings for your area, and a listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.

Thank your for your question, best wishes.

Seattle Plastic Surgeon

Breast Lift Alone, Implants Alone or Breast Lift + Implants?

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Your photos are quite helpful, but do not replace a formal examination. I agree with Dr Pousti in that you appear to be on the borderline of needing a lift at the same time of the implants.


The fact that you are willing to have some ptosis is good and may only be visible when you are topless. One option for the lift is a circumareolar approach in which the incision is only around the areola.


I would recommend consulting with a well respected plastic surgeon with plenty of breast surgery experience to get a personal opinion. Good luck.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Best Breast Procedure for Me?

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Thank you for the question and pictures. Based on your photographs, I can see why you have some concerns about the best way to proceed. Your breasts are in a “borderline” position;  therefore a variety of options are available to you.

Unfortunately, I think by using this forum you may end up with lots of information that may be potentially confusing and/or more anxiety provoking.

The best advice I can give you (as with limited information” online is:

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This if communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural”  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the best operation (and breast implant size/profile) that will best meet your goals.

 Best wishes.  


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From your pictures you look like you would be a great candidate for a Breast Augmentation with a modest implant going under the muscle. You can do without a lift if you go with a bigger size implant. What size breast are you right now and what size do you want to go up too?


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

You can have a very nice result with implants and a small lift

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You will get several different recommendations from my surgoen colleagues here at RealSelf so filter them out carefully.  You should consider a sub muscular implant, and either a donut/Benelli lift or even just a crescent ift.  Without reducing your areolar tissue however they may stretch out from a larger implant so I would prefer the Benelli.  If you will tolerate a little bit of tissue lying under the fold you don't need a very large implant.  The higher the volume the more the need to lower your fold,such as in a dual plane pocket formation.  But there is nothing you have going on here that will impede a very nice result with several realistic options.

Lift or lift/aug?

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Thanks for your question. You would be a great candidate for a lift. If you like your general size then a lift would be the procedure of choice and you would loose very little volume. The best way to evaluate ptosis (sag) is by physical exam but a picture can give a preliminary idea. The best picture is a side profile. In general breast lifts are done to not only raise the nipple but also to make the areolar/nipple complex smaller and raise the breast tissue to a more natural youthful position. Of course, the key to a great breast lift is patient selection and technique selection. Areolar lifts are generally good for women with good skin quality, breast tissue reasonably placed and a nipple/areola that are sagging no more than 2 cm. Once the breasts sag past that point, it is necessary to perform a lollipop lift which not only repositions the sagging breast tissues but also the nipple and areola. The final and most aggressive lift is an anchor lift which places both a vertical and horizontal incision. Again the determinant is the degree of sagging, skin quality and amount of breast tissue. Last, if there is a deficiency in breast tissue, an augmentation can be done either together with the lift or as separate procedures. Make sure you visit with a board certified plastic surgeon get get specifics on your situation.


Breast lift/augmentation and placement of implant

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Hi..........It seems that you would like implants with your "empty" and discussion of implants.  They certainly add to the shape and youthfulness of the breasts.  I think you should have implants, the size of which can be determined by you and your ps and a lift.  You would be a candidate for a donut mastopexy and placement of the implants under the muscle (so many reasons for and few against).  Let your ps show you pictures of patients that have implants and breasts like yours and there might very well be a "double bubble" effect.  Too much drooping of the breasts over the implant/breast tissue mounds.  Get several opinions from ps's that do a great deal of breast surgery.  I think you will find that the sloping above the nipple complex after a tuck alone will not be as attractive as filling this in with an implant, even a small one.  Good luck.

Avoiding the 'Double-Bubble' Effect

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Dear Kelly,

Thank you for your question and photos.

It is important to understand that:

   breast implants do not lift breasts

   the bigger the implant the sooner you will need another lift

   submuscular implants have an extra means of support other than just the skin

   breast tissue must be repositioned/lifted in order to achieve a round, perky younger    appearance

So, in order to avoid the 'double-bubble' effect when using an implant your breast tissue must be repositioned directly over the implant. In your case, your breast tissue must also be moved toward the center (breast bone). A Benelli lift will not achieve this. A technique that is successful is the Mini Ultimate Breast Lift. The Mini UBL successfully lifts/moves breast tissue regardless of ptosis or position. By aligning your breast tissue and anchoring it, the lift is given longevity.

Now, if you choose not to have an implant, the Mini UBL is also applicable.

Hope this helps.

Kind regards,




Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 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.