Mastopexy with augmentation, limited in size profile of implant?

I am interested in getting a mastopexy with augmentation. I have ptosis that 4/5 surgeons have stated will require the anchor lift. I am now additionally reading that with breast lift there are complications that can be minimized by getting a smaller implant. I was hoping to increase cup size and therefore have a higher amount of cc's saline or silicone. Is it true that for breast lift you can only have small implants placed for the augmentation?

Doctor Answers 11

Mastopexy +/- implant.

A mastopexy will help elevate your breast tissue but most often leaves the upper pole of the breast (above the bra) a little hollow.  I have found that most women want a little bit of that "push-up bra" look in the upper part of the breast to look more youthful.  An implant is almost always necessary to get this look but it doesn't have to be a large implant.  The larger the implant, the more likely that the lift doesn't last as long.  Certainly there is nothing wrong with wanting an increase in size.  This is best discussed with a Board Certified plastic surgeon who can evaluate you and your desires to come up with a plan that suits you best.

Concord Plastic Surgeon
5.0 out of 5 stars 16 reviews

Breast lift

Thank you for your question.  Although you CAN get large implants with a breast lift, I definitely do not recommend it as they can reverse the effects of the breast lift.  Large volume breast implants can cause the breasts to sag further which can warrant another lift in the near future.  My patients who have gotten a breast lift with small implants are very satisfied with their results.  You should consider a breast lift with small implants rather than large ones.

All the best,

Dr. Results
Miami, FL

Breast lift with breast implants


Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Pictures would allow for a better valuation of your current situation. Please be so kind as to resubmit with photos from the side views of each side and from the front. Ideally, have someone else take the photos so that you can rest your arms at your sides.

Having said that, this is a decision that you should listen to the 5 PS you have already met with. You do not need more opinions. Look at the results of the surgeons that you are considering and trust the actual surgeon that has examined you.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Implant size with lift

It is better with small imnplant.there is less risk but with some of my patients I will do an implant plus suction fat say from their abdomen and place around their breast to augment it and give them more cleavage.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 reviews

Lift and augmentation

Putting a lot of stress on your  mastopexy closure may not be a good idea, and that is why putting really large implants in may not be reasonable. Best to be seen in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Risks of mastopexy with augmentation

A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Implant size with lift

The implant size that is safe during a lift depends on the amount of breast tissue, the amount of loose skin, and the current position of the nipple. Some surgeons feel safe placing large implants (400ml or bigger) during a lift, and others perform the lift first followed by implants a few months later. 

For or this type of question, there is no right answer. It depends on how much risk you are willing to take to avoid a second surgery. You should go with the physician that makes you feel most comfortable and who has experience performing the surgery with the size implants you want. Good luck. 

Dana Goldberg, MD
Jupiter Plastic Surgeon
5.0 out of 5 stars 31 reviews

Mastopexy with augmentation, limited in size profile of implant?

Thank you for your excellent question. The answer to your question depends.  Breast lifts and placement of implants at the same time are causing competing effects on your skin, which may lead to complications if not planned appropriately. Implants actively stretch the skin and increase breast size, while lifts remove excess skin, elevating your natural breast tissue, and tightening the breast.  These two forces can cause wound healing issues.  Depending on your desired outcome, a board certified plastic surgeon can make the recommendations as to the appropriate size implants to help you reach your goal and minimize the risk of any issues.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

Breast lifts and mastopexy

I tell my patients the following. Larger implants will take up more space under the skin and weigh more than smaller implants. This weight can make for an early recurrence of the droppy look. Because larger implants require skin to cover them, less skin can be removed at the time of the lift. A small implant and a large amount of the stretched out skin removed, will have a longer perky look than a large implant and a small amount of skin removed. It's all a balance of size for perkiness. Good luck

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Mastopexy with augmentation, limited in size profile of implant?

Yes in most cases the size of implant is limited by the vertical incision component of the full anchor lift operation. In my cases I offer doing 2 separate operation 3 months apart. The lift first than placing a larger 450 cc ++ implant. Best to seek more consultations. 

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.