Breast Lift versus Breast Augmentation

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:

Breast drooping is mild
The nipple is still near the center breast and does not point downward
There is some visible skin beneath the nipple/areola when looking at the breasts straight on.
The patient is okay with being at least a cup size larger

A breast lift (with or without an implant) is better when:

Breast drooping is moderate or severe
The nipple is at the bottom of the breast or points downward
There is no visible skin under the nipple/areola when looking at the breasts straight on.
The patient is already a C or D cup breast size and doesn't want to be larger
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.

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.
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:

The patient wants to be larger in addition to being less droopy
The patient desires to maintain projection and roundness of the breast mound
The drooping is severe

This question is best answered by the board certified plastic surgeon that you choose to do the operation.  Basically, it is dependent on the distance from the bottom of the neck (sternal notch) to the nipple, and the distance from the nipple to the breast fold.   It is dependent on the position of the nipple on the gland, the position of the nipple with respect to the fold, and the amount of skin excess of the breast.  All of this must be combined with the patient's goals and the surgeon's experience and ability.  

The question of whether a patient needs a breast lift of simply an augmentation can depend on several factors. There are two extremes where that answer is simple, in patients that have a great shape to their breast and just want to increase the size typically all that is needed is an augmentation. Patient that have breast that are down, with the nipple pointing toward their toes need a lift with or without an augmentation. The grey is for patients that have a less than perfect shape but their breasts have not completely fallen. The goal at the end of the surgery is to have the implant centered behind the nipple; this is going to give the most aesthetically appealing appearance to the breast. There are three different types of lifts and which one to use can be tailored to the individual. Many women who only need a small lift can have a peri-areolar lift; this is where the only incisions are at the border of the areola and the normal skin. These incisions tend to hide very well as it is at a natural transition.
There is also a vertical and full mastopexy (anchor lift) for patients that have extra skin or breast that have completely fallen. The most import part of making this decision is having a discussion about your goal with a board certified plastic surgeon. He or she can help guide you as to which procedure will be best for you to accomplish your goals.

Hello and thank you for your question.
This is the most commonly asked question for women who are seeking improvement in the shape and volume of their breasts. This is not an exact science and although as plastic surgeons we try to create criteria in order to decide whether a patient will benefit most from a lift versus a breast augmentation, there is not always a concrete answer.
That being said, I have found that the best way to determine whether a patient will require a lift is during their physical exam. Being able to palpate the breast tissue and view the breast in multiple directions helps to make a decision on whether a lift is necessary. During the consultation, I am able to measure each breast individually and make a decision in concert with the patient about whether the added scars of a breast lift are necessary.
There are a variety of techniques that can be used to lift the breast but it all depends on the tolerance of the patient for added scars to the breast. There is nothing wrong with initially performing a breast augmentation and seeing the results after a few months and deciding whether a lift is actually necessary. 
In general, if the nipples are below the crease of the breast than a breast lift will usually give the best result. If there is sagging of the breast with the nipple below the breast crease as well as a lack of volume at the upper portion of the chest, then a breast lift in combination with an augmentation will provide the best aesthetic result.
Hope this helps answer question. All the best!
Alex Zuriarrain, MD, Plastic Surgery

This decision is made easier by measuring where the nipples are in relation to the breast. In general younger women with little drooping can use the implant alone. Women who have had children and breast fed have more significant drooping and may need a lift and an implant.

Hi SaskGirl

Breast lifts and breast implants perform different functions. Breast implants provide volume and can either enhance or restore the size of the breasts. Breast implants alone do not provide substantial lift to the breasts. If the primary concern is sagging or ptosis to the breast, the better operation is to formally lift he breasts through a mastopexy. Sometimes patients desire both, i.e. increased volume and lift to the breasts. In this situation both operations are performed. As to when a breast lift is "required", one condition is often quoted as a guide. If the nipple position is lower than the inframmary fold, i.e. the crease beneath the breast, then a breast lift is usually recommended.

I hope this is helpful to you.

Wayne Yamahata, M.D.,F.A.C.S.

I often encounter patients who are unsure about the differences between breast augmentation, mastopexy, and augmentation mastopexy. These procedures, often referred to as "boob job", "breast lift", and "breast lift with implants" respectively, offer different solutions to various aesthetic concerns.
Breast augmentation, also known as breast enlargement, is a surgical procedure that aims to increase the size and improve the shape of the breasts. This is typically achieved through the use of implants. The procedure is ideal for individuals who are unhappy with the size of their breasts or those who have experienced volume loss due to factors such as weight loss or pregnancy.
Mastopexy, commonly known as a breast lift, is a procedure designed to lift and reshape sagging breasts. This is achieved by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. The procedure can also reduce the size of the areola if it has become enlarged over time. A mastopexy does not significantly change the size of the breasts, but it can offer a more youthful and uplifted breast profile.
An augmentation mastopexy, or a breast lift with implants, combines the benefits of both a breast augmentation and a mastopexy. This procedure is ideal for individuals who wish to increase the size of their breasts while also addressing sagging. By combining these procedures, patients can achieve a more youthful, fuller appearance with improved breast shape and position. This is sometimes done in two stages.
Each of these procedures offers unique benefits and can be tailored to meet the individual needs and goals of the patient. It's important to have a thorough consultation with a plastic surgeon to discuss your aesthetic goals and determine the best approach for you.

A breast lift is really a nipple lift. The question we really need to answer here is: is the nipple at the correct position above the inframammary fold. How do we find the inframammary fold? Place a pen under your breast where your breast meets your chest. Using a mirror, is your nipple above or below the pen? If the nipple is above the pen then you can get a breast implant to enhance your breast. If the nipple is below the pen then you should consider getting a breast lift with or without implants.

This is a very common question in my clinical practice as lots of patients are not sure if they need only augmentation or uplift or both. this is very much dependent on their breast shape and volume and their expectations from surgery. IF you are only looking for increase in volume and you are happy with nipple positions and size of areola, then you need only breast augmentation with implants. IF you are happy with overall volume and size of breast and would like areola made smaller and nipple at a higher position and tightening of breast skin, then you would benefit from an uplift procedure. IF you are looking for increase in breast size as well and bringing the nipple up and skin tighter, then you might consider an augmentation mastopexy at the same time. In some case where there is a very small descent of nipple position and overall lack of volume, then you can achieve desired result from only an augmentation using a higher profile implant. Please discuss with your consultant to discuss different options available and see before and after pictures of different patients to get a realistic idea of what to expect from different procedures.

Hello there and thank you for such a great question, The need for a lift is determined by the nipple position and/or amount of loose skin present. Generally speaking if the nipple is below the level of the inframamorry fold (crease) some form of a lift will likely be required to elevate the position of the breast. In these situations, if only an implant is used, the result will be a “rock in the sock” which looks awful.

Generally, a breast augmentation can be combined with a mastopexy in those women who want to enhance their breast volume, but also address concerns with breast droopiness. The implants are used to enhance the volume, whilst the breast lift allows repositioning of the breast tissue and the nipple to a higher position, as well as removal of the excess skin.
Breast augmentation in patients with moderate to significant breast ptosis (nipple sitting well below the breast crease) need to be combined with a lift in my opinion. This can be done with either a "lollipop" or inverted "T" scar. Periareolar (Donut) mastopexy can only work in cases with mild degree of ptosis and little amount of excess skin, and can only provide a limited amount of nipple lift.
In some cases, where either the breasts size is relatively small or the degree of ptosis is very mild (nipple sitting at the level of the breast fold), it is possible to achieve a satisfactory result by using an implant only, without the need for an uplift. For this purpose, a dual plane type-3 technique is used whereby the implant is a placed in a pocket partially under the muscle, whilst the breast tissue is disattached from the underlying muscle, up to a level just above the nipple. With this manoeuvre a small nipple lift can be achieved and in my practice it works well for small breasts that underwent mild deflation.
A dual plane augmentation on its own however, is not suitable for saggy breasts in which the nipple has dropped below the level of the breast fold. In cases of moderate to significant breast ptosis an augmentation on it’s own can give a temporary lifting effect, however the breast tissue will soon drop and fall over the implant. This effect will create a deformity know as the “waterfall” effect or “snoopy” breast. This is unfortunately an unsatisfactory distortion, which will get worse relatively quickly and can only be corrected with revisional surgery.
The use of breast implants in patients considering a breast uplift is indicated for patients who either want a volume increase along with the lift, or have severely ptotic breasts and are looking for a fuller upper pole. Severely ptotic breasts have lost volume and support and in these cases the use of implants can provide the necessary structure to achieve a fuller and tighter look.