Breast Lift Without Implants?

You only get implants if you want to be larger. Period.

I don't know who it was...but someone started telling patients that they needed to get an implant to get a nice result wtih a lift. Rubbish! In fact, it is better to avoid implants if having a lift.

By definition, any patient needing a lift has skin that has already failed to hold up the existing weight of their breast. Adding weight to that makes no sense. Sure, you have removed skin, but the skin that remains is the same skin that gave way once already.

But for you, who doesn't even want to look any larger, for sure you don't need implants.

Yes, you can definitely get a breast lift without getting implants. A breast lift without implants will give you a natural and more youthful breast shape by raising the position of the nipple, reducing the size of your areola (if needed), and removing the excess skin. If you want more fullness at the upper chest, then you will likely need implants in addition to the lift.

The amount of lift you need is also an important factor. A small degree of lift can be accomplished by adding implants. A larger lift means longer scars no matter what, anywhere from just around the areola, to the anchor type scar. Keep in mind sometime patients feel they look smaller once the excess skin is removed, even though no breast tissue is removed, because some of what fills your bra cup is the excess skin. I would recommend consulting with a board certified plastic surgeon and seeing what would be the best option for you.

Good luck!

Mastopexy (breast lift) deals primarily with improving the shape of the breast by modifying the skin envelope around the breast tissue. Both breast augmentation and mastopexy can have an effect on the amount of sag that a breast has however individuals with a significant amount of breast sag typcially require a mastopexy (lift) as breast augmentation alone will not adequately correct the shape.

Since you asked about mastopexies let's talk about them a bit.

Believe it or not the first mastopexies were done as early as the late 1800s and principally used "suspension" techniques placing sutures to try to lift the breasts (think thread lifts).
More modern thinking recognizes the need to change the skin envelope around the breast tissue to get good correction of sagging breasts.

How common is a mastopexy?
In the US in 2004 there were reported over 98,000 mastopexy procedures performed.

Why do breasts sag?
Gravity is the master of us all. Women with large breasts have a natural tendency to sag more over time. The structural elements that help keep the breast in a more youthful position include things called "Cooper's ligaments" and of course the skin. In addition weight gain, weight loss and post-pregnancy changes can cause breast ptosis (sagging).

Plastic Surgeons rank breast ptosis (sagging) in the following manner:

• Grade 1: Mild ptosis - Nipple just below inframammary fold (your inferior breast crease) but still above lower portion of breast

• Grade 2: Moderate ptosis - Nipple further below inframammary fold but still with some lower pole breast tissue below nipple

• Grade 3: Severe ptosis - Nipple well below inframammary fold and no breast tissue below nipple; "Snoopy nose" appearance

• Pseudoptosis - Inferior pole ptosis with nipple at or above inframammary fold; usually observed in postpartum breast atrophy

Treatment options:
For patients with mild breast sagging (grade I) sometimes increasing breast volume can correction ptosis. Obviously ways to increase breast volume include breast augmentation or autologous fat transfers (I'd be happy to discuss these techniques in more detail - just contact me).

Some surgeons will combine a "peri-areolar mastopexy" with breast augmentation to try to get a lift in patients with a bit more sag. This technique invoves excising a donut of skin around the areola (the darker area around the nipple) and suturing the area closed.
- it is important to understand the limitations of this technique both in terms of what it can achieve in terms of lift and the longevity of the lift.

More typically
Patients require more extensive remodelling of the skin envelope. Techniques include "Wise Pattern" skin excisions which are the typical "anchor" scar, and a more vertical "lollipop" scar. Some surgeons employ additional suture techniques to suspend the breast mound however I have found that typically suture techniques do not improve the appearance or longevity of the lift and that the scar tissue that forms naturally is adequate to gettin a lasting result.

Recovery is typically quick with the final breast shape settling in in about 2-3 months.

I hope this helps!

If you are happy with the volume of your breasts, or you're a little on the large size, then you are an excellent candidate for a breast lift without an implant. Using techniques such a  vertical mastopexy, great upper pole fullness can be provided with your own tissue.     While implants are safe, there is no question that if an implant can be avoided, it will eliminate likely procedures in the future related to the implant. It is also much more difficult to do an impant and breast lift at the same time.  

It is true that the longevity of upper pole fullness is more variable, and some women may elect to add a small implant later. In the long run, this well be a safer and more predictable outcome.  

The first question I ask patients when they see me for a Breast lift is "are they happy with their size".

We then tailor our conversation to a lift alone or adding an implant for better fullness. I would say that 20-30% of my lifts do not include implants.

The patient must understand that the size will be a bit smaller, but more round and full. Similar to a good support bra. No breast tissue is removed, but you are packing the same tissue into a smaller envelope.

Find a experienced Plastic Surgeon to help you with this and you should get a great result.

Good Luck!

The ideal breast lift (mastopexy) candidate is a patient who is happy with her amount of breast tissue when wearing a bra, but unhappy with the amount of sagging that occurs when her bra is taken off.

Thank you for your question. Generally, if you have adequate breast gland tissue, a Breast Lift will produce an excellent result without Breast Implants.

When there has been significant loss of breast gland tissue after pregnancy, called Postpartum Mammary Atrophy, often a Breast Implant is added to the Breast Lift to give a full firm appearance to the breast.

Breast lifts can be performed with or without breast implants depending on the degree of breast upper pole fullness and the particular desires of volume enhancement of the breast. In most cases, a breast lift can later be modified to include a breast implant, even years later, so you are never burning any bridges.

Dear Anon,

     The only way to lift the breast without increasing its size is to perform a a breast lift.  A lift can raise  both the nipple/areola complex as well as the breast itself to a perkier position.  What a lift cannot do with any reliability is to produce upper pole fullness, that is, it cannot produce convexity at the upper part of the breast.  The only reliable way to produce that fullness is with an implant.  I, respectfully , disagree with a few of  my  colleagues who are making the argument that implants should be used for volume increase only and not for shape.  I believe they are mistaken.  Their argument may be valid if implants are placed in front of the muscle, where the implants are sitting against the breast tissue and exert direct weight on the breast.   However, today, implants are preferentially placed behind the muscle.  In this position the muscle supports the weight of the implants with very little, if any, force imparted onto the breast tissue and skin outside it.  This phenomenon is easily illustrated by women who originally had breast implants and then became pregnant.  Very often after child birth and postpartum atrophy you see the implants sitting in their original position but the breasts have deflated and dropped to a lower position below the implants.  This finding would never be the case if their argument was valid.  As a second illustration to dismiss their claim that implants are for volume only and not for shape is that it is relatively simple to to tell the difference visually between women who underwent a lift alone versus women who underwent lift with implants.  The women who underwent lift with implants generally have much more upper pole fullness and a fuller cleavage.  This, again, would not be true if the statements that implants are only for volume and are actually contraindicated in cases where lifts are desired without desire to increase volume. 

Good luck,

Ary Krau MD FACS

The answer to your question all depends upon what you think a perkier breast looks like. I have been extremely happy with the vertical technique for both breast lifting and breast reduction surgery. With breast lifting, it involves removing a small component of the lower portion of the breast tissue. When the breast tissue gap is closed, the breast shape becomes tighter at the base and the remainder of the breast tissue is lifted including the nipple and areola. They will certainly become more perky. It will give you some more volume in the upper portion of the breast, but still not as much as with the use of an implant. But unless you are dead set on having significant upper pole fullness, you will most likely be very happy with breast lift alone if you have a surgeon use a breast shaping technique instead of a skin only procedure.