To Lift with or Without Implant? Doc in SF Bay Area?

Mid 30's, no kids, 36 DD, 5'3' 130lbs, a lot of breast tissue; general doc says "Lumpier than most". Consult in '07 said grade 2 ptosis, a donut lift could suffice and implant would help the shape. Not sure about an implant for maintenance, worry, more weight for future sag & fake look. Is it common to remove tissue to put implant in to keep size same? I'm worried I'll look smaller after just a lift AND it will be flat/boxy. I'd like to gain a bit of upper pole fullness but stay natural. Options?

Doctor Answers 10

To Lift with or Without Implant

It is hard to give a useful response without some photos to look at. Consider reposting with a front and side view at least. 

As a rule, it makes little sense to use an implant in a patient with enough breast tissue, and even less to remove tissue and replace the lost volume with an implant. If you are indeed a DD, there is plenty of breast tissue to work with, and furthermore, do you really want to be larger than that? The amount of tissue removed during a lift is usually about a tablespoon per side, hardly enough to notice a size difference. 

Even if a periareolar lift were an appropriate choice 6 years ago, it is unlikely that that you be a sensible choice today. That would be determined during a consultation. 

When you are ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.


Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

To Lift with or Without Implant? Doc in SF Bay Area?

Since it has been 6 years I think it's time for another consult! It is a very common part of my practice to remove extra, droopy breast tissue, do a lift and place an implant to give fullness at the top, all at the same time, so that a woman can go from a droopy C or D, to a lifted more full at the top C or D...I usually try and counsel women to not try a DD and a lift...Very hard to keep all of that uphill!!!

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 45 reviews

DD and Implants with Lift

    I wound not recommend reducing the size of the breasts only to add an implant.  If you are happy with the breast size, a breast lift will be the best option.  The breast lift will not reduce the size of the breasts to any real degree as only skin is removed, not breast tissue.  An implant with DD breasts will create very large breasts and may not be the best idea either.  Your breasts can be made high and tight with the breast lift alone.  Find the plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Breast lift with auto augmentation

A breast lift alone can give you a perkier contour, however your breast size may decrease noticeably. If you would like to maintain breast size, then implants may be considered. However, you may also consider auto augmentation. 

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

36DD lift or reduction

Thanks for your question. You would be a great candidate for a lift. If you like your general size then a lift would be the procedure of choice and you would loose very little volume. The best way to evaluate ptosis (sag) is by physical exam but a picture can give a preliminary idea. The best picture is a side profile. In general breast lifts are done to not only raise the nipple but also to make the areolar/nipple complex smaller and raise the breast tissue to a more natural youthful position. Of course, the key to a great breast lift is patient selection and technique selection. Areolar lifts are generally good for women with good skin quality, breast tissue reasonably placed and a nipple/areola that are sagging no more than 2 cm. Once the breasts sag past that point, it is necessary to perform a lollipop lift which not only repositions the sagging breast tissues but also the nipple and areola. The final and most aggressive lift is an anchor lift which places both a vertical and horizontal incision. Again the determinant is the degree of sagging, skin quality and amount of breast tissue. Last, if there is a deficiency in breast tissue, an augmentation can be done either together with the lift or as separate procedures. Make sure you visit with a board certified plastic surgeon get get specifics on your situation.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

Best Breast Surgery for Me?

Thank you for the question.

 As you can imagine, it is possible to provide you with specific advice and validation. Your best option at this point would be to meet with well experienced board-certified plastic surgeons to discuss your situation and goals.

 Ask to see lots of examples of their work and communicate your goals carefully. In my practice, I prefer the use of goal pictures when it comes to this communication process.  Otherwise,  I find that terms such as “natural” and “upper pole fullness” may mean different things to different people and be a source of  confusion.

During this consultation you will be able to learn about the options as well as a potential risk/complications associated with surgery.  Keep in mind, that there are definitely limitations as to what can be accomplished with the circumareolar breast lift only.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

To Lift with or Without Implant?

Without photos, it is impossible to advise. Best to have in person consult and exam.  Good luckQ

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 107 reviews

LIft and implants

It is not common to remove a lot of tissue and place an implant. A lift will require some removal to get a proper shape, and the implant will add volume.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast lift with or without implants

It is impossible to say without photos what would be the best treatment for you. Adding a breast implant to a lift really allows to get the upper portion of the breast to be full giving the breast an eye catching shape.  If you are dead set against implants, fat grafting to the upper part of the breast can help as well.

Sacha Obaid, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 135 reviews

To implant or not to implant

Hi Newnose33,

     Without photos or a physical exam, I cannot give you a definitive recommendation, however, based on your description I can give you certain principles to build upon.  First of all, it sounds like your breasts have significant volume, you are a DD. At this size, it is practically impossible to give you a fake look.  You have enough volume that you should have a natural look regardless of whether implants are used or not.  Secondly, I am a bit concerned that a previous physician recommended a donut lift.  A donut lift is where there is only an incision around the areola.  This lift may work well for small breasts with a minimal droop. In your case, being a DD however, that does not sound to be sufficient.  The most effective way to lift and shape the breast is the Wise pattern.  That is a pattern that results in three incisions:  around the areola, a vertical, and a horizontal.  Surgeons have attempted to develop lifts that are as effective as the Wise pattern but do not have all those incisions.  There are lifts today that achieve this.  The vertical mammaplasty is a lift that only has the incision around the areola along with a the vertical, no horizontal incision is used.  This type of lift, I believe, would be best for you.  It is important to avoid the long horizontal incision if possible as it is the one that on many occasins heals poorly.  The vertical incision, interestingly, usually heals the best and is extremely difficult to see after the healing process.

     With respect to upper pole fullness, it is not possible to achieve this with any significance without an implant.  No matter how tight the lift is performed upper pole fullness will resolve relatively quickly if no implant is used.  Your concern that an implant will cause more sag is true only if the implant is placed in front of the muscle.  However, in a proper submuscular position, the implant will be supported by the muscle and should have very little influence on the position of the breast.

     With regards to maintenance of implants, that is a real consideration. However, the new silicone gel implants are quite good.  An argument can be made that even if a small tear occurs on their surface they are still effective and may not be changed.

     Finally, as far as size.  You should be aware that some breast tissue is removed when a proper breast lift is performed.  Additinally, a breast appears smaller when in a higher position.  Therefore, besides their effect on upper pole fullness, implants mat be appropriate for maintenance of volume.

Good luck,

Ary Krau MD FACS

Ary Krau, MD, FACS
Miami Plastic Surgeon
4.8 out of 5 stars 323 reviews

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.