Is a lift on the right breast necessary? (Photo)

Based on your photo, the right areola is positioned lower than the left, and the right breast also shows more laxity. Since breast implants are typically centered under the areola, the right implant would likely sit lower due to the areola’s position and the looser breast pocket. You have two options: 1. You could opt for augmentation alone and, once healed, decide if a periareolar lift on the right side would be worth considering. 2. You could have the periareolar lift on the right side at the same time as the augmentation for a more balanced result from the start.

Dr. B.

Dear kitkat107,

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

I would not suggest a unilateral right sided lift. You have natural breast shape with mild, normal asymmetry (everyone has asymmetry). You will do well with an appropriately sized implant (subpecotral saline best if you do not want the hassle of implant rupture surveillance). Thank you.

When distinguishing a lift there are different things that we like to look at and consider. Basing a decision primarily off a photo would not be the best advice. Although your right breast does seem to be slightly lower than your left, that does not always mean that a lift is needed. One of the things we look at when distinguishing needing a lift is nipple placement . Is the areola at the very bottom of the breast or does it point down? Your areola's look very centered on both of your breasts. The next thing we take into consideration is the measurement from the nipple going to the crease underneath your breast when lifting the breast off the chest wall. Generally anything over 10 cm could be considered candidate worthy for a lift. For your situation , if you are looking to increase size, just putting some implants in will be just fine and may even slightly correct the symmetry for you. You would also want to distinguish if there is a size difference and if two different size implants are needed.

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

If your nipples are located above your breast fold on both breasts, then a lift would not be necessary. Augmentation alone may be sufficient in improving symmetry.

Every surgery involves a risk vs benefit analysis. Your breast asymmetry, at least in that one photo, is minimal. To make an attempt at achieving symmetry would likely require a scar around the areola. All scars are permanent and visible, some just are less visible. I tend to use a breast crease incision and therefore, the scar is better camouflaged in the crease or on the bottom of the breast. When standing in front of a mirror or someone else that scar is very difficult to see. Even though some scars around the areola heal very nicely it is still visible and it catches the eye, if you will, if there is a scar only on one side versus the other as these are primarily matched structures. I think the benefit of a lift that would leave additional visible scarring would not be suggested by me. Best of luck.

Implants infrequently even out nipple position out much. Depending on your expectations, it seems a minimal lift may be required if you want excellent symmetry.. If you are a fine with some asymmetry, then it seems you might not need a lift. I would have to examine you, and then could have a better understanding of your expectations and I could give you my advice.

Your breasts are slightly asymmetrical in the photograph. The advantage of using a circumareola approach is the implant can be placed and the nipple-areola asymmetry can be changed.

Best Wishes,

Gary Horndeski, M.D.

Based on the submitted photo there is some asymmetry noted. If you proceed with augmentation alone you will have the same amount of asymmetry after surgery. If that is not bothersome to you that is fine. If you would like it improved then a lift could be performed along with the augmentation.