Wondering if I would need a lift if I get breast implants? (photos)

Question

I am wondering if I would need a lift if I were to proceed with implants and if I have enough tissue where I could go for subglandular implants (under the muscle would be out of the question for my lifestyle). I am fine with the augmented look but am concerned about potential sagging and ideally they would be high profile. I would ideally like them to be closer together to have nice cleavage without needing to manipulate them too much.

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on these photos, it’s unlikely that you will need a breast lift during your augmentation surgery, especially if you are planning above the muscle.

Semih Yildiz, MD, FEPOBRAS · Answer

You may need a lift, but this cannot be decided accurately from photos alone. The key measurements are where the nipple sits compared with the inframammary fold, how much lower-pole skin laxity there is, your breast base width, tissue thickness, and how much the nipple/areola needs to be moved for the shape you want.

In the photos, the nipples and areolae appear relatively low on the breast mound with some lower-pole laxity, so implant-only augmentation could add volume and upper fullness, but it may not reliably create a higher breast shape. If the nipple is at or below the fold on exam, or if there is significant loose skin, adding an implant alone can sometimes leave a heavier or more "bottomed out" look. In that situation, a mastopexy with implants may give a better contour, with the tradeoff of breast lift scars.

Subglandular placement can be reasonable in selected patients, but it requires enough soft-tissue coverage. If your tissue is thin, subglandular implants can be more visible, more palpable, and more prone to rippling, especially with high-profile implants. A subfascial or carefully planned subglandular pocket may be discussed if you truly do not want a submuscular/dual-plane approach, but the decision should be based on pinch thickness and exam findings.

For cleavage, implant choice helps only within the limits of your anatomy. A high-profile implant gives more projection but often has a narrower base, so it does not automatically make the breasts closer together. Trying to place implants too far toward the midline can create complications such as symmastia or unnatural contour. The safest plan is to choose an implant width that fits your chest and breast footprint, then decide whether a lift is needed to position the breast tissue and nipple correctly over the implant.

I would recommend an in-person consultation with a board-certified plastic surgeon who can take measurements, show you the likely scar pattern if a lift is needed, and use sizers or imaging to compare implant-only versus lift-plus-implant options.

Jake Thayer, MD · Answer

Great question. Whether to add a lift to an augmentation can be a challenging question. In your case, your right breasts do appear to have some pseudoptosis or breast descent, with the left looking slightly lower than the right. Given your concern of avoiding sagging, I would lean towards adding the lift with the augmentation. This would give you best chance (in my opinion) at achieving a nicer overall round aesthetic breast shape. Other considerations I would have would be the addition of resorbable mesh ("internal bra") if you were considering having them placed above the muscle for longer term support of the implant to avoid malposition or bottoming out down the road. Hope this helps!

Eric Swanson, MD · Answer

Basically, the deeper the cleavage you want the greater the volume. You do have a little sagging but as long as you accept this, it is fine. Implants do little in the way of lifting, but are great to fill out your upper poles the way you want.

Daniel Barrett, MD · Answer

Dear sage2400,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Daniel Butz, MD · Answer

A lot of patients are worried about the breast lift scars - fortunately they do tend to fade nicely and provide a much better overall breast aesthetic when performed properly. 
Based on your photos I think you would likely get a better result with a lift. AND it would likely last longer. 
If you skipped the lift they may look okay initially but you'd have a higher chance of "waterfall" deformity sooner - which is where the breast tissue hangs off the implant. 
I would seek out a few consults from board certified plastic surgeons. I prefer to do the right surgery the first time - not the easiest or the one with the smallest scars -this mentality often leads to more revisions in the long run.

Ira H. Rex III, MD · Answer

Is hard to make a judgment just looking at your photos, but I think you might be quite disappointed with just implants and no lift. You should not expect nipples to change position much, or may be even become lower with just augmentation. This would especially look awkward on your left, more saggy side. Also, your left nipple may be pointed more sideways. He should talk to a board certified plastic surgeon to discuss what would best meet your expectations.

Gary M. Horndeski, MD · Answer

You are an excellent candidate for a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Your breasts are sagging now. With only implants, you will still be low, still sag, but will be bigger. Implants cannot correct sagging breasts. I suggest a lift with implants and recommend placing them behind the muscle for better upper breast fullness, hiding the implant edge, and better long-term support.

Camille Cash, MD · Answer

Based on the photos alone it appears you would have the best outcome from and augmentation with a lift.  This would raise the nipple position and provide more volume.  With augmentation alone you may have sagging in the future and it appears one breast sits lower than the other already.  I encourage you to meet with a few board certified plastic surgeons to discuss your options and learn more about the procedures.

Wondering if I would need a lift if I get breast implants? (photos)

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