Breast Lift versus Breast Augmentation

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.