Is Having a Circumareolar Maxoplexy Necessary if You Are Only Looking for Increase in Size in Your Breasts? (photo)

I am interested in having a breast aug, However, I was told that, with the aug, I should also consider a circumareolar maxoplexy. I honestly am not interested in a lift. I want my breast to look as natural as possible , with a bit of an increase in size. How horrible would it look if i skipped the lift? I just figured, the circumareolar maxoplexy is only for a small lift, and is it really going to make much of a difference ? Does anyone have any pictures to display of augs without the lift ?

Doctor Answers 13

I do not recommend that you skip the lift. I don't think you will like the results.

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Thank you for your question and the photos.

A breast lift with implants is likely your best option. Implants alone do not lift breasts. Breast implants restore lost volume but do not provide lift.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. I hope this helps.

Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Minimal scar Mastopexy

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Thank you for your question and photo.

It appears that in order to accomplish an esthetic result, you most certainly would need a lift. I discourage and frown upon using a large implant to 'take up the slack' because this option not only does NOTHING to correct the problem; it actually makes it worse down the line. I would suggest a small submuscular implant and a Mini Ultimate Breast Lift. This new technique actually elevates your existing breast tissue directly over the implant to avoid the much dreaded 'double bubble' look. This is accomplished through a single incision around the areola. It is a full lift. No need for a vertical or inframammary scar. Please resort to my gallery for examples.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast augmentation and lifts (mastopexy)

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Although it is not possible to be certain from a single front-view picture, it appears that your nipple-areolas are too low relative to the inframammary crease behind them to avoid a lift. An implant cannot be positioned correctly behind the breast without lifting the breast and implants don't lift the breast (and larger ones don't lift them more). 

In general, circumareolar lifts or mastopexy are not true lifts and merely reposition the nipple-areola a bit. I would recommend a true lift with a lollipop incision for the most natural looking result at the same size/volume. Properly lifted breasts also look somewhat larger without actually adding any volume. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast augmentation/lift

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You appear to have large B to small C cup breasts with quite a bit of sagging (ptosis).  If you were to undergo a modest breast augmentation alone and the implants were placed properly, you would most likely have a very unattractive "double bubble" appearance.  So, that is not a good option.  The only two viable options, in my opinion, are combination breast augmentation and breast lift (mastopexy), or augmentation with a very large implant.  The former would be the preferred treatment.  A peri-areolar lift may work, but a vertical lift is probably more reliable and well worth the additional incisions (and scars).

Breast Lift Necessary?

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Thank you for the question and picture.

 I think that the  appearance of your breast will not be aesthetically pleasing if you undergo breast augmentation surgery alone. Unfortunately, a vertical mastopexy will probably be  necessary to achieve the best shape/contour possible.

For some patients  in your situation the presence of a scar ( that results after breast lifting surgery) is is not acceptable; these patients should avoid surgery. For some patients (If properly selected and who are doing the operations and the right time of their lives) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do and the field of plastic surgery.

I hope this helps.

Sagging breasts need mastopexy to get best result with augmentation

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This is a great question.  The answer is somewhat lengthy.  Thank you for sending the picture as it is extremely helpful and illustrates a number of points.  Judging from your picture, I believe you would benefit from a mastopexy.  The reason you need a lift is because you have breast tissue sitting below the level of your fold (inframammary fold).  The implant, when properly positioned, is going to sit above the inframammary fold.  You would then have breast tissue hanging off the edge of the implant.  In my opinion, this is not an acceptable aesthetic result and I would not recommend augmentation alone in this scenario.  The breast tissue should be repositioned higher.  Second, your nipples are positioned low on your breast.  If you only had this situation but most of your breast tissue was above the fold, you could still have an acceptable result with augmentation alone.  However, you do have tissue below the fold.  Raising the nipple position will enhance the aesthetic result.  Third, I agree with your statement that peri-areolar is usually best for only small lifts; in fact, you may need more than a peri-areolar mastopexy. It is possible you would benefit from a lollipop pattern scar.  Be sure and discuss all the possibilities with your board certified plastic surgeon.  Patients must be carefully selected for peri-areolar mastopexy.  Also ask your surgeon about using a non-absorbable suture to help minimize chance of areolar enlargement after mastopexy. It is possible that with the implant in place, the aesthetic result will be acceptable to you with implants alone.  However, you and your surgeon should have a clearly defined plan in place in the event the result is not acceptable.  Finally, keep in mind that even if you are initially happy with the result of implants alone, there is a high likelihood that you will need a lift in the future.   Hope this helps.

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Is a breast lift really needed

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The purpose of the breast lift, even if you wish only a small increase in the size of your breast, is to keep the nipple up front and center rather that low and pushing downward. The around the nipple lift is a small one and you do only want the volume, but your photo supports the thought that the lift might be right.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast Augmentation with or without Lift

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You are right, a circumareolar lift is a small lift, designed for small breasts with little sagging.  It would not be helpful to you, and in fact would make matters worse.  Your breasts are too large and too saggy, and need a full lift. Your results with just a breast augmentation alone would also be unacceptable by most people's standards.  

Breast lifts are not designed to make you look fake, they are designed to make you look normal.  Performing a breast augmentation alone without a lift in a large, sagging breast creates an unnatural, unattractive result.

If you are not interested in a lift, you should not have any surgery. 

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Is a Breast Lift Necessary?

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While I can understand your desire to avoid a breast lift from your photo, I do not believe you would be happy with your results if you proceeded with only a breast augmentation and skipped the lift.  You noted that you wanted your breasts to look as "natural as possible" which is exactly what they will not look like if you add implants and not a lift.  If you place the implants under the breast but above the muscle, the end result will be a "rock in the sock" look.  If you place the implants under the muscle, you are likely to have the breast mounds up high on your chest and the breasts and nipples falling off the bottom; often called a "Snoopy dog nose deformity."  Neither one is a "natural" appearance.


The goal of the breast  lift is to re-center your nipples back up on the breast mound and reshape the bottom of the breasts.  Implants then can be used to regain the volume you desire.  


Please meet again with your plastic surgeon and discuss your concerns.  Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Augment without lift will not achieve a good result

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Given your nipple heights, you will need a  lift, whether with or without implants. Small implants will not be enough under these circumstances and large ones will produce an unnatural appearance. 

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.