Can a breast lift be avoided? (Photo)

Question

I'd like to get a breast augmentation with implants placed above the muscle. Can a lift be avoided in my situation? Thank you.

Semih Yildiz, MD, FEPOBRAS · Answer

Your photos show breast tissue sitting low on the chest with some skin laxity and the nipple/areola position close to the lower part of the breast mound. In that situation, implants alone can add volume, but they do not reliably lift the nipple or tighten loose skin. Placing an implant above the muscle may fill the breast envelope a bit more, but it can also make a low breast sit on top of the implant, creating a heavy or "waterfall" appearance over time.

Whether a lift can be avoided depends on your nipple position compared with the breast fold, skin elasticity, breast width, and how large an implant you are willing to accept. If your main goal is fuller breasts with the nipple centered on the new mound, a lift, often with implants, is usually the more predictable option. If avoiding scars is your top priority, an implant-only approach may be possible only if you accept a lower nipple position, a more natural droop, and a higher chance that you may want a lift later. An in-person exam with measurements is the best way to decide between implants alone, augmentation-mastopexy, or a staged plan.

Stanley Castor, MD · Answer

Hello,
I don't feel that you definitely need to have a lift done now. You can always do a breast lift later. Keep in mind that the weight of the implant above the muscle will make you sag further in the future. Putting implants under the muscle may help to camouflage your breast tissue sitting lower on your chest. Your pec muscle will hold up the weight of the implant, so your natural breast tissue will take longer to sag. Hope that helps!

Guray Yesiladali, MD, FEBOPRAS · Answer

Whether you can avoid a breast lift while opting for augmentation with implants placed above the muscle largely depends on the degree of sagging (ptosis) you have. If the sagging is minimal, implants alone might achieve your desired outcome by filling out the breast tissue and providing some lift. However, for moderate to severe sagging, a lift is often necessary to reposition the nipple and areola, and to achieve a more youthful and lifted appearance. It's important to consult with a plastic surgeon who can assess your specific condition and provide a tailored recommendation. This way, you can achieve the most natural and satisfying results from your surgery.

Leila Kasrai, MD, FRCSC · Answer

Your nipples are located below your breast fold. The implants are centred behind the nipples, which means that they would sit rather low on your chest.  A lift would be recommended for this reason.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Ramin Behmand, MD, FACS · Answer

Judging from the photos you've shared, the main breast procedure you require is a breast lift. This procedure would reposition the breasts to the ideal position. When combined with an augmentation, you would gain better shape and fullness.

A breast augmentation alone would produce disappointing results for you, and you will likely need a revision surgery for a proper lift much sooner than you would wish to have a revision.

Dr. B.

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Monicker,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

I've been doing this for 24 years, and in the very early stages of my career I saw that prepectoral implant placement (above the muscle) was a favorite of surgeons who's patients didn't want a lift. Well, it didn't take me long even then to see that this has two unwanted outcomes: implants that sit too high with persistently sagging breast tissue (what no one liked ever), or implants that dropped into the soft tissue envelope. The latter was typically appreciated by the patient for a short while because their breasts looked ok, and sometimes for a few years. But even these people realized that their breasts were just as or more saggy, hanging further and further below the fold and leading to a 'rock in sock' appearance. Further, people who choose above the  muscle have much higher rates of capsular contracture and implant rippling. It's just not worth it. You're not doing yourself any favors and in fact will ensure you will need a revision surgery that would have been unnecessary had a proper under the muscle augmentation and breast lift been performed in the first place, leading to a result far superior to what your entertaining.

Tyler Frew, MD · Answer

Hi there,
In order to answer this fully we would love to see photos of the results you are looking for. But based on what you have show, you could just go for implants alone. Your breasts will be lower on your chest overall and you may not achieve the upper pole fullness you want as the implant needs to be centered around the current nipple position. 
All the best

Can a breast lift be avoided? (Photo)

Answers (19)

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