Do I Need a Lift or Just Implants? 3-Kid Mom with Vitiligo Scars (Photos)

Dear Powerful290680,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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. Many patients, whether they are aware or not, will benefit from both.
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.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
With regards to your specific question, it is difficult to offer an opinion without an exam/measurements. Your nipple position appears to be preserved. This is the pivotal question. If nipple sits above the fold a lift is not necessary.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Thank you for your question. I think you are valid for comparing your options. Based on your photos, you would be a great candidate for a breast lift with augmentation. A breast lift will bring up your nipple position and give a more natural appearance to your breasts, whereas the implants will provide you with more volume and upper pole fullness. If you are concerned with how you scar, you can proceed with a augmentation alone, with understanding that it is a possibility that your nipples may only lift a little bit or be in the same spot.

Do I need a breast lift? You might not need one. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., US

Thanks for your question!You’re absolutely right to look into both options. In your case, a breast augmentation alone wouldn’t give you the lifted, natural result you’re hoping for — you would need a breast lift as well. If you’d like a fuller upper pole, an implant combined with the lift would be ideal.
The type of incision depends on your surgeon’s preference and your specific anatomy. In my practice, I usually perform an anchor (inverted-T) lift, but since your skin laxity doesn’t seem too pronounced, the scar would be relatively short.
Regarding your vitiligo, it’s important to know that new scars — whether from surgery, trauma, or even mild irritation — can sometimes trigger the Koebner phenomenon, meaning new depigmented (white) areas may appear along the incision lines.This doesn’t mean the scar will heal poorly, but it may lose pigment permanently in those areas.

Based on the degree of ptosis (nipple position) and elongation/stretching of the breast, an augmentation alone is unlikely to give a result that you are happy with. The lift is needed to reset the shape and position of the breast on the chest wall with the implant providing the improved fullness (especially in the upper pole) similar to the example photo you provided. What type of lift is largely dependent on your individual measurements and goals. You should meet with a well trained plastic surgeon who will review your anatomy and goals and discuss the implant selection and lift that would be needed for your specific case.
Sean M. Fisher, MD Aesthetic Plastic Surgeon Seattle, WA