27, breastfed three children. I’m wanting silicone implants. But curious will I need a lift as well? (Photo)

Dear Modest759583,

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

It sounds like you’ve been through a lot of changes with your body after three pregnancies and breastfeeding, and what you’re describing is very common. Many women notice that their breasts expand during nursing and then deflate afterward, leaving behind some laxity or droop that implants alone may not completely correct.
Larger implants, like the 425–450cc high profile you’re considering, can sometimes mask mild sagging by filling out the breast and giving a rounder, fuller appearance, especially when placed under the muscle. However, if the nipple sits below the breast fold or points downward, implants alone won’t create the same lifted look as a mastopexy (breast lift). In those cases, a lift may still be needed for the best result.
Think of it this way: implants restore volume, while a lift repositions the breast tissue and nipple. Some women only need implants, some need just a lift, and many after multiple pregnancies need a combination of both. The exact recommendation depends on your skin elasticity, nipple position, and how much deflation there is.
You absolutely don’t have to go oversized to chase the illusion of a lift, in fact, choosing an implant size that’s right for your frame will give a prettier, longer-lasting, and more natural result. A consultation where your surgeon shows you sizers and explains whether your nipple position is in “lift territory” will give you a clear answer.

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 alone, it is difficult to say with certainty whether a lift will be necessary. You demonstrate some skin laxity and asymmetry but nipple position appears preserved.
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.

Hello - you do have some skin stretch/laxity, but the breasts/nipples are still at a good position. Your nipple is sitting above your breast fold which signifies that with a breast augmentation alone, your breasts will sit at a youthful position. The implant will give the appearance of a small lift, but this will take a full 3 months post op to fully visualize

Hello, and thank you for your clear question. While it would be helpful to have photos from both sides, based on the image you provided, I believe high-profile round implants placed over muscle—without the need for a lifting procedure—would give you excellent results. Since you have enough tissue to adequately cover the implants, there’s no need to increase the risk of complications by using large submuscular implants. In my experience, over-the-muscle placement would be the most suitable option for you.

From your photographs, it seems you do not need a breast lift. Your nipples are at or above the breast fold and this usually indicates there is probably no need for a lift. I would only be able to know for sure after a direct exam. Good luck with your adventure.

I recommend a circumareola approach to lift the nipple-areola complexes and placement of small implants.

Best Wishes,

Gary Horndeski, M.D.

Hi there, and thank you for your question. The size of the implant would not determine whether a lift is necessary or not. If there is significant ptosis of the areolas, a breast lift would need to be done so that you don't wind up with nipples that point downward at the floor once an implant is placed. Please consult with a Board Certified plastic surgeon who can properly measure you, and determine a surgical plan that is right for you.

From the photo it appears you have some sagging and some asymmetry. Depending on your desired look you may be able to have a nice result from implants alone. I've included a video I hope you find helpful. We'd love to meet with you in our Houston office to discuss your concerns!

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery in Frisco, TX:
Thank you for your question — and for sharing your photos, which give a helpful view of your anatomy and concerns.
After pregnancy and breastfeeding, it’s very common to experience skin laxity, loss of upper pole fullness, and a drop in nipple position, all of which can impact breast shape and projection. Based on your photos, you have a moderate degree of skin laxity, and your nipple sits slightly below the ideal position — which suggests that a breast lift (mastopexy) may be recommended to achieve the best result.
Here’s a quick breakdown: • Implants alone can restore volume and improve fullness, but in cases with significant laxity, they may not lift the breast enough on their own — and could even make sagging more noticeable over time. • A lift with implants would allow us to reposition the nipple, tighten the skin, and restore fullness, especially in the upper pole — giving you a perkier, more youthful contour.
At Lone Star Plastic Surgery, I always tailor the approach to your goals and anatomy. Some patients want the most natural shape possible, while others prefer more volume and upper pole fullness — and those details help guide the best surgical plan.
A consultation is the next step to measure breast position and discuss your desired look. Whatever you decide, make sure you’re working with a board-certified plastic surgeon who performs these procedures regularly and can offer an honest assessment of what will give you the best, most long-lasting outcome.
Warmly,Dr. Sean HillBoard-Certified Plastic SurgeonLone Star Plastic Surgery – Frisco, TX