A surgeon suggested a lift with a reduction before getting implants. Is this actually necessary?

Question

I recently had a consultation for a breast lift + implants. Currently I have severe hang with nipples pointing downwards and a C cup bra size. The surgeon suggested a lift with a reduction, before the implants. What is the benefit of this? Is this actually necessary? TIA

Daniel Barrett, MD · Answer

Dear Tough700123,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

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

Chet Mays, MD · Answer

Thank you for your inquiry! Yes, sometimes a staged mastopexy is necessary depending on how low your nipples sit. If your nipples sit too low then the procedures need to be separated in order to give your nipples a good/healthy blood supply and keep them alive after surgery. A staged mastopexy is where a breast lift / breast reduction is completed and then in 3-6 months post-op implants are placed. We would love to meet with you in person and discuss this in depth. Schedule a consultation with a Board-Certified Plastic Surgeon like myself to help you reach your goals and create a surgical plan for you.

Joel Patrick Maier, MD · Answer

What your surgeon recommended is a very safe, conservative approach which will lead to the highest, tightest, most predictable and durable breast shape. In many cases, the lift alone is satisfactory and implants not desired depending on the patients expectations. In some cases where the breast is not that large, the implants can be placed at the same time, but this is a decision that is carefully made and discussed and depends on the surgeons experience. But the approach suggested by your surgeon is a totally valid approach, Thank you.

Leila Kasrai, MD, FRCSC · Answer

The lift would help create a perkier breast shape, so your implants would not sit so low on your chest. In some cases, more tissue is removed during the lift to provide more “lift”.

Gerald Minniti, MD, FACS · Answer

25 years ago this wasn't too uncommon. Today, we can safely perform both procedures together.  Find a new surgeon.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us your bra size. However, the breast lift technique I recommend is 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 can be performed if additional volume is desired. I would not recommend a reduction if you are wanting more volume.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

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

Eric Swanson, MD · Answer

Many surgeons are concerned about the safety of doing a breast lift or reduction simultaneously with implants. In fact, if they are not in favor of doing them together it is time to find another surgeon who is comfortable with this combination. It is important that the surgeon use the vertical technique and not the traditional "anchor scar," which risks nipple blood supply. It is advantageous of course to have one operation rather than two.

Camille Cash, MD · Answer

Typically an augmentation and breast lift can be performed together.  Your surgeon may take a more conservative approach if there is concern for blood supply to your tissues if they are very thin.  By separating the two procedures it gives the body the chance to heal from one without the stress of the other.  The best person to ask is your surgeon who can explain her/his reasoning.

Connie Hiers, MD, FACS · Answer

There are two reasons why surgeons do this in two procedures. First, with a reduction or lift, the blood flow to the nipple might be compromised if an augmentation (which applied pressure on the areola) is done at the same time. Second, most women who need a reduction/lift have skin that is stretched and thin. It is best to lift/reduce first and let the new scar tissue help support this thin tissue before the additional weight of the implant is added. Another reason to delay the implants is that some women are quite happy with just the reduction/lift and realize they have plenty of volume and no longer want implants.

A surgeon suggested a lift with a reduction before getting implants. Is this actually necessary?

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