27, 60 pound weight loss - breasts sag and areaola is too big. Donut Lift? Breast Lift with Minimal Scarring options? (Photos)

First, congratulations on your weight loss — losing ~60 lb is a big achievement. What you’re describing is very common after significant weight loss and has much more to do with skin and tissue laxity than age.Why a donut lift alone won’t be enoughA donut (periareolar) lift can slightly tighten the areola, but it:Provides minimal liftDoes not reliably correct true saggingOften causes areolar widening or flattening over time when used for larger liftsIn cases like yours (from 36DDD → 32C with hanging tissue), a donut lift alone typically leads to under-correction and disappointment.How to lift without a “major lift” lookA modern Push-Up Lift (supportive mastopexy) allows us to:Reshape and elevate your own breast tissue (not just tighten skin)Fill the upper pole (1st pole) using your existing tissueReduce areola size and raise the nippleMaintain breast volume rather than sacrificing itUse low-tension closure, which helps scars fade and soften over timeAlthough this often uses an anchor-type pattern, the scars are:Strategically placedUnder minimal tensionDesigned to fade significantly and become much less noticeable with timeMany patients are surprised by how subtle they look long term.Do you need implants?Not necessarily. Many patients can achieve:Upper-pole fullnessA perkier shapeBetter support without a brawithout implants, especially when volume is redistributed correctly.If you want a small size increase, a modest implant or fat grafting can be added — but the lift is the key step.

The scar burden of a breast lift varies directly with the degree of ptosis/sagging. The more significant the correction needed...the greater the scars.

Slight ptosis can be corrected by a "donut" or circumareolar mastopexy/lift. Moderate ptosis may be addressed via a "lollipop" lift or vertical mastopexy. The most significant degree of ptosis will necessitate an "anchor" or Wise pattern scar.

Based on your photos alone, it is difficult to say whether or not you would likely need a Wise pattern/anchor lift. You do not appear to have a significant degree of droop relative to the fold. However, the goal degree of lift may not be achievable with a "donut." There is always a surgical trade off-scars for results.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Donovan Rosas MD

Board Certified by the American Board of Plastic Surgery

Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons

RealSelf Top 100

RealSelf Hall of Fame

emmygeorgia,
Thanks for your question. Based on your fold position and location of your nipple, a lift of more than 1-2 cm will be needed, which removes a "donut" lift as an option. Most peri-apolar (donut mastopexy) can lead to post-op aerolar widening if a lift of more than 1-2 is attempted or a large implant is placed. A lollipop or anchor incision is the most predictable option if you plan to get a lift or a lift with an implant.
Hope that helps.

Dear emmygeorgia,

my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

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

From the submitted photos and stated objectives you are a great candidate for a breast lift with implants. No one is excited about the scars that come along with breast lifts, but most patients find the incisions heal very well and are unobtrusive once healed. The key is to closely follow post op instructions and use scar treatments consistently once given the okay to use them. I've included a video I hope you find helpful.

Hi there! Thank you so much for your question and for sharing this here.
Congratulations on your weight loss — that’s a huge accomplishment. Based on your goals and the changes that come with significant weight loss, a donut (periareolar) lift will not provide the degree of lift, shape, or upper-pole support needed to achieve the look you want. A donut lift is very limited; it can slightly tighten the areola but cannot elevate the nipple enough, reshape the breast, or correct sagging in a meaningful, long-lasting way.
To achieve a perkier, rounder shape — and to feel confident without a push-up bra — most patients in your situation require a full lift (circumvertical/lollipop lift). This technique reshapes and tightens the breast from the inside, giving you a more youthful contour.Implants may also be helpful if you want added volume or upper-pole fullness, but they alone cannot lift the breast.
Don’t fear the vertical scar — with time, it usually fades beautifully and often even better than the scar around the areola. The quality of the shape and long-term result far outweighs the incision.
I also recommend continued bra use long-term. Gravity is real, and even beautifully lifted breasts — with or without implants — benefit from support to maintain your results.
Every patient is unique — anatomy, history, physical exam, tissue quality, goals, skin elasticity, and surgical risk profile all change what is indicated / recommended. Because of this, this should not be taken as personal medical advice. The next step is always an in-person evaluation with a board-certified plastic surgeon that can examine you and discuss individualized plan options.
Hope this helps!
— Georgina Nichols, MD FACS