I wish to avoid scaring but I want to make sure I get the best outcome possible. Can I avoid lift and do implants only? (Photos)

Hi. You could achieve a very nice result with breast augmentation without the lift to avoid extra scars. You could achieve a slightly tighter result with a lift, but I'm not sure that it would be necessary if you are ok with a more natural shape. It also depends on the size of implant you are planning to use. Speak to your surgeon in-person so that you can get a realistic idea of what to expect in each situation. Then you can make an informed decision about what will be the best choice for you. Best of luck!

Thanks for your question. From these pictures, it seems like you're a good candidate for a breast lift with implants in order to achieve optimal results. However, depending on your goals, I recommend an in-person consult to provide a proper evaluation. Be sure to always consult with a board certified plastic surgeon. Take care, Dr. Salama, Board Certified Plastic Surgeon.

Dear Friendly433953,

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

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.
Based upon your photos, you are a reasonable candidate for augmentation with mastopexy.
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.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You've stated your goal is "to get the best possible outcome possible." To achieve this would require a lift in addition to implants. You would have added volume and possibly an acceptable appearance with implants alone, but the contours would be far superior with the lift.

Hello, thank you for sharing those details — it helps give a clearer picture of your situation. Making a decision about breast implants (with or without a lift) is deeply personal, and it's great that you're gathering the right information to make the best choice. The nipple position in relation to the inframammary fold (crease) is a key factor. You are borderline however, some surgeons may feel you can get away without a lift, especially if you have good skin tone and a firm breast base (which you likely do due to bodybuilding and age) while others may recommend a small lift for best nipple positioning, especially if you want a rounder, perkier upper pole look. I personally would recommend doing a lift to get a great result. There are scar treatments and recommendations we can give to help you achieve the best scar results possible. Best of luck!

If you only do implants then the implants have to be centered underneath the nipple-areola complex, which is already too low and lateral. You will end up with almost no cleavage at all, low breasts and be very dissatisfied. I recommend a breast lift using 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.

Hello and thank you for your question.

In my experience, with the amount of sagging/ptosis of the breast that is present here, the best result will be to also do a lift at the same time as your augmentation. Usually this can be done in a "lollipop" or "short T" scar pattern, and over time the scars will fade very nicely. Right now, the position of the remaining breast glandular tissue and nipple/areola is too low to look "right" if only implants are placed (these will sit up higher on your chest).

Thank you and good luck on your journey!