Ptosis? Augmentation and/or a lift? (Photos)

Hi, I am 45 years old, 5'3" 118 lbs. I have had 2 children, no breastfeeding. I recently started lifting weights and my breast size has decreased by a whole cup. I am considering augmentation, but wondering if I need a lift as well? What grade ptosis would you say I have? i am considering 350 cc silicone unders with no lift. Thank you!

Doctor Answers 18

Ptosis? Augmentation and/or a lift?

Thank you for the question and pictures.  As you can see, responses will vary; plastic surgery is very much an art as well as a science.

 I n your case, exactly what breast operation you should undergo will depend mainly on your goals. If you simply want to achieve a larger version of your current breasts, then breast augmentation surgery alone will likely suffice. However, if you wish your breasts to sit higher on your chest wall and/or  change anatomic features such as breast skin "sitting" on top of abdominal wall skin, then breast lifting will also be indicated.

Generally speaking, patients undergoing  breast augmentation/lifting combination surgery should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery.   It will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery. Only after doing so can you make an informed decision whether or not to proceed. You will find a lot of information on this website and on the attached link.

  Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work. 

2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.

I hope this, and the attached link, helps. Best wishes.


Weight lifters should avoid submuscular implants

You do not need breast lift. You need 325 cc implants placed in front of your muscles to have beautiful breasts. Submuscular placement is a bad choice for girls who like weight lifting.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

Ptosis? Augmentation and/or a lift

You have grade 3 of 4 ptosis of your breast. An implant alone will fill in your skin  and make you look fuller, but the new breast mound will remain where it is on your rib cage. I think that would leave you with a natural look and be larger while in a bra. If you are looking to have fuller breast that are also higher on your rib cage, a breast lift would be needed

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Breast Augmentation - Size Selection

Thank you for your question. You appear to be an excellent candidate for breast augmentation surgery.  "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.



Unfortunately, your degree of ptosis can not be determined by photographs. Go visit a few ABPS certified/ASAPS member surgeons that perform all forms of breast surgery, not just implants. These surgeons are most likely going to give you the best information possible for you to make a decision. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews


Thank you for your questions and photos. I am basing my comments on your photos which is not a good substitute for an examination and taking breast measurements. You look like you have a Grade one ptosis. Your base diameter is about 12 cm. Your implant choice sounds Good there is a small possibility that you may still need a lift. Please consult with experienced board-certified plastic surgeons.  Good luck.

Mehdi K. Mazaheri, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 20 reviews

Most Pseudoptosis do not need a lift

You have typical signs of pseudoptosis..  Which is most of the volume of the breast is in the lower pole of the breast and your nipples are still pointing straight out.  Your breasts need volume and projection.  The more volume and projection will help to correct the sagginess of your breast and lift the nipple up to a more perky level.  You go not need a breast lift.  It's best to be conservative regarding a breast lift since you can look much improved with just implants alone without the scars of a breast lift. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 78 reviews

Implant alone should do

Thanks for your question and the photos. Sounds like your workouts have gotten you in shape at the expense of your breast shape. Your nipple areolar complex is at/above the fold and so you are a Grade 1-2 ptosis. A dual plane hybrid dissection with implant alone will give you a great result and can avoid additional scarring seen with a lift. 350CC is probably a good size, but implant selection must be done by using measurements and an exam. I like the Vectra 3D imaging to show patients what their result will look like. The software can also simulate with and without an lift to let you make an informed decision. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 83 reviews

Lift ot breat augmentation alone?

HI gymmom,

 Whether you need a  lift or not depends on how big you want to be. If you want to stay small and perky, you may need a lift. If you want to be very big, maybe not.

Sometimes, I make this decision on the operating room table when I seat the patient to see how the breasts look.  You should discuss this issue and your goals with your surgeon.


Dr. Christine Rodgers

Ptosis? Augmentation and or a lift?

It looks to me from your pictures that you may well be a candidate for augmentation alone. However I would strongly counsel you to have the implants placed on top of the muscle for maximum lift. Much depends on your expectations of the nipple height.

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.