Do I Need a Lift Before Having Breast Implants? (photo)

I am 40, a mother of 1, fluctuate between 145-160pds and am 5'10". I have slight stretch marks on my breasts from my pregnancy 8 years ago. I would like to achieve a teardrop look with a cohesive gel implant as i am under the impression that I will not have to have a replacement surgery with these types of implants. Could you tell me if you believe i would need a lift first? Also which implants and type should i be looking at? Under the muscle or above with my fibrous breast tissue? Mod profile?

Doctor Answers 19

Augment and lift? (or not).

You have a condition called glandular ptosis of the breast in addition to having ptosis of the nipple , (a low nipple relative to the breast). Most of your breast is near the lower half and not much at the top. I think that you will need a "lollipop" mastopexy in addition to a breast implant as the nipple needs to move up on the breast for some distance. Whether a circumareolar mastopexy would work  would depend on the distance from the nipple to the breast fold at the chest. The procedure could be done at the same time with a breast implant unless you want to go to a large size, in which case I would do the mastopexy first. A form stable implant does not eliminate the possibility of needing replacement and they fail too. I would place the implants under the pectoral muscle. The form stable implant doesn't really offer any real advantage over a round silicone cohesive implant as you have a lot of "teardrop" to your breast already. I have used shaped implants since 1995 and they can be nice in some cases, especially in taller women so I wouldn't rule it out although you already have pretty conical breasts .Subpectoral implants  are superior as there is less destruction of the breast tissue attachments to the chest and less risk of complications with a mastopexy. 

Bellevue Plastic Surgeon
4.1 out of 5 stars 13 reviews

Lift to reshape breasts and increase cleavage

Your photographs show that your areolas are too low, too lateral and you have very little cleavage.  More important that the implant is the lift.  I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast tissue to increase upper pole fullness and displace the breast higher on the chest wall and more medial to increase cleavage.  Aligning the areola, breast tissue and implant high on the chest wall over the bony prominence will give maximum projection.  This technique will allow you to use a smaller implant, which is more stable long term and has less complications.  Silicone gel implants placed retro-pectoral look and feel the most natural.  The profile of the implants is irrelevant since it is compressed by the overlying muscle.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Breast lift should be done together with implants.


1)  Don't have two operations. You a need a minor lift (more on the left) done through a circular scar around your nipples.  Implants are placed under the muscle through these same incisions.

2)   Avoid "gummy bear" implants.  Regular cohesive gel, smooth surface, moderate PLUS profile implants are good.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Breast Augment with Lift

First, you are a great candidate for augmentation with a cohesive gel implant combined with a vertical (lollipop) mastopexy.  You will not need an extension of the incision into the inframammary fold.  However, all implants have a finite life and choosing a cohesive gel does not eliminate the possibility of replacement down the road.  If you have a superior outcome today any revisional surgery or implant replacement later is usually very straight forward and with little downtime.  The key is getting a great result now to minimize issues and shortcomings in the future.  That is why it is very important to choose a surgeon that specializes specifically in cosmetic breast surgery.  Make sure you look at lots of pictures of their work to make sure you will be happy.  Remember this is as much artistry as science.  Hope this helps.

Brian K. Reedy, MD
Reading Plastic Surgeon
4.9 out of 5 stars 145 reviews

Breast Implants and Lift

You can have the breast lift and the augmentation at the same time, and you would benefit from both.  The implants should be placed under the muscle.  As far as sizing, sizers should be tried on in the office to get an idea of what size you would like.  Please find a board certified plastic surgeon with GREAT CREDENTIALS who performs hundreds of breast augmentations and lifts per year.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Breast lift and implant

Thank you for the question and photos.  It does appear that your nipple-areolar complex should be positioned higher.  Also, an implant would achieve the fullness that you desire.  Performing these two procedures together is a very common and safe method to achieve your desires and can produce excellent results.  The position of your nipples now would likely require a vertical lift.  

Both cohesive gel and smooth round implants would be adequate for you, but the shaped-anatomic implants that you refer to may give you the teardrop appearance that you wish for.  In terms of position of the implant and the profile, it is difficult to accurately answer that question without an examination.  Since you are on the thinner side, you may consider submuscular placement for decreased visibility and palpability of the implant, however, with the disadvantage of increased animation with contraction of the muscles.  Given you photos, I would think that at least a moderate profile plus implant would be necessary to provide adequate projection for your breast type.  I would recommend a consultation with a plastic surgeon to assist you in determining which procedure(s) would be best for you along with having a detailed discussion about all of your concerns that you state above.  Hope that this helps!  Best of luck!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews


You do not need two separate procedures. Although I do not see a lateral photograph for your left side this nipple areola complex looks a little low. This can be repaired with a periareolar mastopexy. The right side seems to be OK and just needs augmentation 

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

You need a lift

I would echo the other doctors and say you need a lift but it can done at the same time as your augmentation.  A cohesive gel implant has the amount of revisions as a round implant.  The main difference is the look in the upper pole with the anatomic implants appearing more natural 

Chad K. Wheeler, MD
Spokane Plastic Surgeon
5.0 out of 5 stars 53 reviews

Lift with Breast Augmentation


You absolutely do not need a lift before a breast augmentation. Whether or not you need a lift, however, is another question. From the angle of the pictures, it is hard to tell if you have any real droop. If you do, the most you will need is a periareolar mastopexy (lift). This, if needed, is done at the same time as the augmentation. If, on actual examination, you have no real droop, then all you need is an implant placement. As to placement, if you have adequate tissue superiorly, I prefer over the muscle placement as the rupture rate is less, postoperative pain is less, there is less problem with movement of the implant and you can use the arm normally without any bounce or movement of the implant.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Do I Need a Lift Before Having Breast Implants?

My choice based only on the posted photos is a silicone UHP 400 cc +/- under muscle with a possible donut mastopexy. Please reply after your operation with photo and the decision you made Thanks 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 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.