Donut Lift with Augmentation or Augmentation Only?

I am 5'5 and 110 pounds. I am a B cup and have had a pregnancy. I have grade one ptosis and have been recommended by my ps to have a donut lift and augmentation with 325cc. I am very concerned about scars, and my husband also. He wants me to have only the augmentation.

Doctor Answers 18

Breast augmentation plus lift?

I think breast augmentation alone will work just fine. Mastopexy can be done if necessary in the future.

It is very important to communicate your size goals with your surgeon.  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 cup” or "fake looking" 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.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Pseudoptosis of breasts

Most women after having babies indeed have a " pseudo ptosis"  like you. It means cleavage and upper fullness decrease.  Implants alone will fill the "envelope" of your breast, lift your nipple sligthly and give you cleavage and upper fullness back. If not enough for you (or your husband) a ptosis procedure can be done later and would depend how your surgeon and you feel about it. With implants the "bigger the better" is not the solution but a size which is appropriate for your chest size and tissues. There comes the expertise of your treating Plastic Surgeon and only his examination, his expertise, skills  and your (reasonable) expectations  can give you an optimal result.


Guido P. Gutter, MD
Evansville Plastic Surgeon
4.9 out of 5 stars 18 reviews

You would do better with augmentation now

You have pseudoptosis and would have good result with high profile augmentation, You may need to have lift later on. The nipple lift will make your pseudoptosis more pronounced.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Recommend doing augmentation first

From your preoperative photos, it appears that your ptosis is relatively minor.  I believe that implants under the pectoralis muscle of at least 300 cc's will most likely give you the fullness that you want.  Also, it would give your breasts some lift, very likely enough for you.  If you develop more sagginess later or decide you still want more firmness afterwards, you can always go back for a breast lift.  But you do not need to do that now.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Breast augmentation with or without lift


If you and your husband have significant reservations about breast scars you can proceed with breast augmentation only and reassess later on about undergoing a breast lift.  As others have already mentioned you have something called pseudoptosis, where your nipple and areola are above the breast fold but the lower portion of your breast is drooping excessively below your fold.  If you underwent a breast lift its the vertical incision that would be the most powerful.  The vertical incision would tighten your lower breast pole to correct the pseudoptosis.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Donut Lift with Augmentation or Augmentation Only?

With every operation there are as number of things to be considered and weighted. In your case the amount of improvement vs how much scarring you can tolerate.  i would suggest that you have the breast augmentation alone as both you and your husband are  (quite rightly) concerned about scars. If you are not happy with the shape  following the breast augmentation then consideration could be given to doing  some type of lifting operation (Mastopexy). The size of the implant is also going to be an important consideration but this is something that is best discussed in person with a board certified plastic surgeon.  Best of luck. 

Donald M. Brown, MD (retired)
San Francisco Plastic Surgeon
5.0 out of 5 stars 8 reviews

Silicone breast implants over the muscle with internal lift will correct mild sagging.


1)  Going by your pictures you do not need a breast lift with external scars. Implants over the muscle will give you a nice result.  But implants under the muscle do not correct sagging, and can lead to a "double bubble" in a woman with your anatomy.

2)  325 cc's looks reasonable, but it is best to make the final decision about implants during surgery.  Sterile implant sizers are inserted into your breasts, and then the surgery can actually see how a particular size looks in your body.  Anything else is just an educated guess.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Lift or no lift with augmentation?

I am in agreement with Dr. Laverson.  With your current breast shape (pseuoptosis, empty upper pole, adequate nipple position) I would not recommend a peri-areolar lift.  It would further flatten your breast and leave you with a scar.  I think that it is very likely that you will have an acceptable appearance with an implant alone.  The implant will help fill the upper pole of your breast, although your breast will still appear somewhat "mature" because of the excess glandular tissue beneath your inframmary fold.  The decision really comes down to shape versus scar. If you wish to have the best possible shape, then I would recommend a lift (such as the circum-vertical or vertical techniques) that eliminates some of the excess tissue/skin beneath the fold.  

This is something to discuss in detail with your surgeon.  My instincts would be to do an augmentation alone.  If the shape is not acceptable, you can always proceed with a lift at a later date.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.7 out of 5 stars 28 reviews

Augmentation only Vs lift and Augmentation

I agree with the comments made. However, you have to see photos of patients with and without lift. Since you are concerned about the scars, I suggest you go with an augmentation only. But, you will need a larger implant to fill the skin envelope. I prefere the preiareilar incision and submuscular placement of the implant.  If you agree to have a lift, than the type of lift will depent on how big of an implant you want. The bigger the implant the less skin needed to be taken out. I am not in favour of a donut lift in your case as it may flatten the areola and looks un natural. Good Luck

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Breast Lift/Augmentation or Just Augmentation

As you have been told, your breasts would be defined as having pseudoptosis, in which the nipple position is fine but you have significant breast tissue below the breast fold. This is not a terrible problem to have and you would probably be happy with a breast augmentation alone, but the implants would not lift this breast tissue above the fold. Instead, you would have more volume and fullness above and below the breast fold. If you were disappointed, you could have a breast lift later but you would need a vertical lift ("lollipop" scar), not just a donut lift, and it might be hard to justify the additional scars for an improvement that would not be noticeable in a bra.

Joseph Fata, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 101 reviews

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.