Breast Lift versus Breast Augmentation

At what point do you know if you need a breast lift vs breast implants (or both)?

Doctor Answers 200

My Breasts Have Fallen and They Can't Get Up - Augmentation or Breast Lift

Patients who I see in 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".
Here is the answer based on what I look for and ask each patient in my practice setting in Sarasota, Florida.
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 do a series of breast measurements to make sure they confirm what I believe from my observations and questions.
  1. If there is a long distance from the nipple and areola to the crease beneath the chest (more than 7 cm stretched skin, about 21/2 inches) a breast lift is often needed.
  2. If the patients breasts are large and pendulous a lift or reduction may be needed.
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

Sarasota Plastic Surgeon
4.6 out of 5 stars 16 reviews

Breast augmentation or breast augmentation plus lift Augmentation mammoplasty

Some patients I see in consultation are primarily interested in a breast lift procedure. For those with a significant amount of existing breast tissue, a breast lift alone may produce an aesthetically ideal breast appearance. However, it can difficult to achieve significant fullness in the upper poles of the breasts (the upper aspect of the breasts, above the nipple-areola area) in many patients by means of a breast lift alone. I ask patients who are considering a breast lift procedure how important it is for them to have the appearance of some fullness in the upper part of the breasts, and to thereby achieve a significantly more youthful breast profile. For patients who confirm that this appearance is important to them, and who do not have enough natural upper pole breast tissue to achieve this appearance with a mastopexy alone, I recommend an augmentation mastopexy.
Other patients are primarily interested in increasing their breast volume, but have enough breast ptosis to make the appearance of breast augmentation alone odd and unappealing. Placing implants behind breasts with significant ptosis creates the appearance of breasts hanging off of a pair of implants, which looks distinctly unnatural and aesthetically unappealing. These patients are also best served by augmentation mastopexy, which in addition to increasing breast volume restores the position of the nipple-areola complex to the top of the breast mound, tightens the lower pole and lifts the breast.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast Lift versus Breast Augmentation

Although there is some indication cross-over, a breast augmentation has a different goal than an uplift (mastopexy). Adding an implant to a breast is designed simply to make it larger. Generally it even has the same shape, but it is just larger. If the nipples are too low and there is sagging, an implant will make it larger, but with some minor exceptions, it will be a larger sagging breast with the nipple pointing downward. An abstract rule many plastic surgeons go by is, if the nipple is below the crease under the breast, an uplift is needed.

If the breasts sag and are also too small, both a mastopexy and an implants are usually indicated. Often a mastopexy without an implants leaves the upper aspect of the breast too flat after the swelling has subsided. Frequently an uplift is accompanied with a small implant to solve this problem. Or an uplift can be combined with fat grafts, which can be very effective.

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 78 reviews

Breast lift versus augmentation?

A breast implant is simply a bag of filler material designed to add volume to the breast.  It is not designed to do anything else.  I tell my patients that their breasts should look just like they do before surgery, only fuller.  If you look at your breasts and determine that that will not work for you then perhaps you need a different procedure.  Some patients who have lost volume from  pregnancy or weight loss simply have loss of volume to their breasts leaving them with a "scooped out" look.  The shape of their breasts may be fine.  They may simply need to "re-fill" the empty skin.  If that is the case, then an implant is the perfect choice!  There are a couple of criteria that we, as plastic surgeons, use to determine if a patient needs a lift or not.  If the nipple is below the level of the crease under the breast then a breast lift is probably necessary.  We also measure the distance from the small notch at the base of the throat to the nipple.  Ideally, this distance should be 18 - 22 centimeters.  Anything more than that probably means a breast lift is indicated.  There are several ways to do breast lifts and this should be discussed in consultation with the surgeon.  Some surgeons do breast augmentations at the same time as the breast lift and others prefer to do the augmentation at a second operation later one after the tissue has recovered.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast lifting with or without implants vs implants alone

Basically, if you pad your bra and want more volume than you have, you need an implant regardless of the lift issue. If you want upper pole fullness, you also need an implant because a lift alone won't usually do that.

You need a lift if the nipple areola has descended down from a youthful elevated position. Remember that the best looking breasts have the nipples on the front pointing forward. The farther down they have gone the more lift and scars you need. If they are still above the crease below the breast, often a lift just around the areola will be enough. If the nipple is at the level of the lowest point of the crease or below that or is pointing down toward the floor, you need a full lift to get the best shape.

Many examples are on the site below.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

It all depends :-)

Typically for a younger women before pregnancy and without significant weight fluctuation who wants to increase her size all she would need are implants.  Some young women develop droopier breasts with normal development and a lift may be indicated.

A breast lift is needed if the breast and/or nipples fall well below the fold beneath the breast.
This is more typical for older women after child bearing or with significant weight fluctuation. If such a woman had sufficient breast volume and does not wish to be any larger, a lift will work.  If however, the breasts are droopy without much volume then a lift with implants is indicated.

The optimal way to determine what is best for you is to schedule a consultation with a plastic surgeon.  

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 75 reviews

Breast Lift vs. Breast Augmetation

It's a bit hard to make any determinations without photos.  Depending on the look you are going for and your current breast would be one factor.  Another factor would be if you have loose skin and excess tissue that would have to be removed. 

Leonard Hochstein, MD
Miami Plastic Surgeon
4.4 out of 5 stars 203 reviews

Check your nipple level

Although the answer to this question is a long winded one, a good rule of thumb would be to make a note of where your nipples are sitting in relation to your breast crease. If they are at or below the level of the breast crease then some form of a lift is usually required. This can be done in conjunction with or without implants. 

Do I lift them or just make them bigger?

This is a very good question but also a difficult one to answer. The reason I say that is because the only way to know for sure is by being evaluated by a board certified plastic surgeon. Two of the main factors however, are the position of the nipple and the amount of breast tissue that has descended past the crease under your breast, which is known as the infra-mammary fold. Ideally the nipple should be at about the level of the infra-mammary fold and you dont want a majority of the breast tissue hanging down beneath this fold. If the nipple is below the fold and/or you have breast tissue hanging down beneath the fold then a lift is LIKELY needed. During an evaluation, breast measurements should be taken and a decision can usually be made from these measurements. If the nipple doesn't need to be lifted and excess skin/tissue does not need to be removed then augmentation alone can be possible. Sometimes, based on what the patient is looking for as a final result, an augmentation AND a lift maybe required. I hope this helps!

Ankur Mehta MD

Ankur Mehta, MD
Sugar Land Plastic Surgeon
5.0 out of 5 stars 17 reviews

Lift vs augmentation vs combination

This is a great question and one that we get asked quite a bit in my practice. As a general rule if you look in the mirror and see skin below the areola (the pigmented part) and the bottom of the breast then you could get away without a lift. If your nipple position is so low you cannot see skin, you just see areola, then you would require a lift as well. This being said there are many patients that are “on the fence” and could use a lift, but they do not want the scars yet. Many times, we use a slightly larger implant which can get a very small lift and it “buys them time” for a few years before a lift is needed.

Christopher T. Maloney Jr., MD
Tucson Plastic Surgeon
4.8 out of 5 stars 66 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.