Could I get a donut lift or only implants to restore volume / lift nipple? (Photo)

Question

Hi, I am 32 years old and my breasts looked like this for a while. Next to having fuller, perkier breasts I'd like to have a rounder nipple shape. The breast lift scar is a deal breaker for me so I am exploring other options. I ask myself if a simple implant might give me good enough results, maybe in combination with a periareolar lift but I am hearing mixed opinions on this procedure. Any advice would be much appreciated, thank you in advance.

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on this one view, you may be a good candidate for implants alone. A periareolar lift should suffice if one is deemed necessary after examination.

Daniel Barrett, MD · Answer

Dear HannaRosenfeld,

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

Ellen Ozolins, MD · Answer

Thank you for your question. You should have an in-person examination with a board-certified surgeon to measure nipple-to-fold distance, assess skin quality, determine base width, confirm candidacy, and choose the least-scarring approach that still meets your goals. If your nipples are at or above the inframammary fold, a small or medium implant alone can restore upper-pole fullness but won’t reliably change nipple and areola shape. If your nipples sit ≥1 cm below the fold, implants alone without a breast lift will worsen the droop. A periareolar lift is the wrong choice because it provides only about 0.5–1.5 cm of lift, often flattens the breast, risks areolar widening or puckering, and has a higher chance of relapse, so it rarely yields the perky, round result you want. For predictable, lasting perkiness and a rounder areola, the gold standard is a formal mastopexy&mdash;most often a vertical “lollipop,” with or without a small implant. Modern scars are usually fine lines and can be improved with taping, silicone, and laser therapy. However, avoiding a proper lift trades scars for ongoing or worse ptosis. If scars are a deal-breaker, you might consider fat grafting for subtle fullness and symmetry, but it won’t lift or center the nipple.

Ted Eisenberg, DO, FACOS, FAACS · Answer

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., USA

Leila Kasrai, MD, FRCSC · Answer

A vertical breast lift would be recommended as your nipples appear to be located below your breast fold. A donut lift would not be sufficient.

Gary M. Horndeski, MD · Answer

Women are afraid of breast lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called 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 or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mathew A. Plant, MD, FRCSC · Answer

Great question. While you would definitely require an in-person consultation to see if you’re a candidate there has recently been an no-incision version of the periareolar lift described that might be a great option for your situation. The majority of surgeons will not be aware of it so don’t get discouraged if you reach out to a dozen offices before you find one that has a surgeon who can perform this, but it seems like it’s worth looking into.
Hope that helps!

Donovan Rosas, MD · Answer

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 crucial to remember that these procedures are mutually exclusive and do different things. A lift will not restore volume and an augmentation will not lift. Based on your photos, you appear to be a reasonable candidate for augmentation (however, an exam is needed to be certain). Nipple position appears to be preserved making a full circumvertical/lollipop lift unnecessary. A donut lift is an option for very mild sagging.
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.

Camille Cash, MD · Answer

It's difficult to give a recommendation with the submitted photo.  Typically if the nipple position is below the level of the breast fold a lift is recommended.  If you are wanting your areola downsized this can often be done at the same time as a breast augmentation.  It will involve an incision around the areola.  It typically heals well and is hidden within the pigmentation.  I encourage you to visit with a board certified plastic surgeon near you to learn more.

Kamran Khoobehi, MD · Answer

I would recommend breast implants with the option of doing lift in the second stage. Your breast tissue is touching chest wall too much for implants alone.

Could I get a donut lift or only implants to restore volume / lift nipple? (Photo)

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