Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive (some want smaller less droopy breasts and others want larger less droopy breasts). There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. With reagrds to your specific question, patients who are content with their size but are seeking to address laxity or ptosis (excess or loose skin) are candidates for mastopexy. This can often be performed with limited volume loss (depending on the degree of droop). While this will not directly address stretch marks/striae of the upper pole, it will re-suspend the breast, correct for sagging and address lower pole laxity. Alternatively, RF BodyTite is a minimally invasive approach to breast ptosis by tightening (via heating) the upper pole skin. This is a newer (and less reliable) technique which shows promise and may allow for a lower scar burden. It will also directly address the skin at issue in your question.Satisfaction is often a function of establishing a clear understanding of goals and management of expectations. Duration of result will vary with the individual (and is subject to both time and patient specific changes). There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon (ABPS). Patients should discuss their concerns with their physicians in order to make an educated decision. Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons Real Top 100 RealSelf Hall of Fame