Do I Need A Breast Lift W/My Augmentation? (photo)

I am a 40yr old mother of 2 that breastfed. I am strongly considering breast augmentation and is actually researching doctors. My breasts are very small however one is larger than the other so I wanted to know if I may need a lift. Thank you!

Doctor Answers 11

Sagging Breasts Require Lift As Well As Breast Augmentation

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Thank you for your email. From your email it appears that you have breast ptosis or sagging of the breasts resulting in your nipples being positioned below your inframammary crease, the crease beneath your breast.  When you have breast ptosis and want to have a breast augmentation a breast lift in addition to breast augmentation is usually required.

This procedure is often called a SAM procedure which stands for simultaneous augmentation mastopexy.

I recommend that you consult a surgeon who is certified by the American Board of Plastic Surgery and if a combined procedure is recommended then follow that advice.  To undergo a breast augmentation without a lift when you have ptosis can create a "'Snoopy Deformity" which is very disturbing.



To lift or not too lift?

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Its very difficult to assess anything from the photo you posted (its very dark).   I can see some sagging present.  I'd likely suggest a breast augmentation with some form of a limited scar lift.  But a physical exam is needed to make any recommendations.  See a board certified PS to learn more about your options.

Dr. Basu

Houston, TX


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Hello. Judging by your pictures it looks like your nipples are lower you’re your inframammary fold. If this is the case I would definitely recommend a lift along with your implants. A consultation would definitely be helpful in determining your best option as it is hard to determine based on pictures alone.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Breast Lift and Augmentation

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Mothers may find that pregnancy and breastfeeding contribute to loss of volume and firmness. If you're looking for perkiness, you'll need a lift. A breast lift raises droopy breasts from one to several inches and excess skin is removed. To perk up a drooping breast, your surgeon will remove excess skin, reposition the nipple, and redrape and tighten the remaining skin to support the breast. The areola may also be reduced in size. The great thing about this technique is that they can now be done with minimal scarring and performed as an outpatient procedure without the need for general anesthesia.

When women with saggy breasts want to go bigger, I usually advise doing a breast lift along with the implants. Otherwise, the implants create what we call a “double bubble,” where the breast droops off the end of the implant like a sock. Some of my patients, however, don’t want a lift because they want to avoid additional scarring, so sometimes implants alone can fill out the skin and eliminate the saggy appearance.

Autologus fat transfer (autologous simply meaning "your own") can also be incorporated into a breast lift providing very natural looking and feeling, larger, perkier breasts. In this procedure your own fat is placed under the breast tissue to provide increased breast size without the need for artificial implants. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and fat transfer. And who doesn't have a little fat to spare?

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Need breast lift with sagging

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Thank you for your question.  From your photographs it appears you need both an implant and a breast lift.  Discuss with your Board Certified Plastic Surgeon your implant options and I recommend a conservative size implant, preferably silicone, which is lighter and therefore will stretch the tissues less over time.  Also, I am using Strattice for some of my lifts to promote longevity of the result.  After a lift the breast has a tendency to sag again, especially with an implant, so discuss with your surgeon his/her suggestions for improving the longevity the result.  Hope this helps.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Breast Lift Necessary with Breast Augmentation?

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Thank you for the  question. The photograph is somewhat dark, but from what I can tell, you will benefit from breast lifting surgery.

As you know, the trade-off with this operation is the presence of scars. Many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.

 Do your due diligence in the selection of plastic surgeon. Ask to see lots of examples of his/her work and communicate your goals clearly.

 Best wishes.

Breast Lift and Augmentation.

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I cannot evaluate with this photo. Breast Implants will add volume to the breasts but they will not lift the breasts. If a breast implant surgery is performed alone with women who really could benefit from a breast lift, the breasts may even look more droopy with a breast implant alone.
For patients with a full B or C-cup breast volume, an implant is often added at the time of mastopexy solely for the purpose of creating upper pole breast fullness. Breasts that appear 'deflated' after pregnancy are often most lacking in breast volume in what used to be the upper poles and in such cases mastopexy alone is not capable of creating lasting upper pole fullness. In these patients an implant volume of 150 to 240cc will often be adequate for this purpose.
The upper limit of implant sizes that work well for augmentation mastopexy is, in my opinion, in the range of 325 to 350cc - and that is in patients where the preoperative breast volume is an A-cup. Implant volumes larger than this only serve to stretch out the mastopexy in the weeks and months following surgery, and tend to result in heavy-looking, bottomed-out breasts. Which certainly is not the intended outcome of this surgery.
One goal I have for my augmentation mastopexy patients is giving them the freedom to go without a bra in some kinds of clothing if they so desire. Patients report that this is one of the most liberating and enjoyable benefits of this procedure. The perky breast profile comes at the expense, of course, of the surgical scars required by the mastopexy procedure, so those scars are certainly worth some discussion.
Most mastopexy procedures create a scar around the border of the areola (called a 'circumareolar' scar), a vertical scar from the bottom of the areola to the inframammary fold, and in some cases a curving scar in the inframammary fold. I use a vertical mastopexy technique, so-named because it is designed to create a lifted breast with only the circumareolar and vertical scars. However, the vertical mastopexy has an inherently limited capacity to tighten the lower pole of the breast, and I do not hesitate to add a horizontally-oriented excision of lower pole skin and breast tissue if I think that is required to create an ideal and truly youthful-appearing breast.
With very droopy B and C-cup breasts, the need for that additional lower pole tissue excision and inframammary fold scar is in most cases a certainty, and I tell patients preoperatively that it is part of the surgical plan. With smaller and less droopy breasts, the need for this part of the procedure is variable and I therefore inform patients that the decision will be made intra-operatively. In my opinion, it makes no sense to leave a patient with an overly full lower pole (and thus a less lifted-appearing breast) all for the sake of not having a scar in the inframammary fold - a scar that is almost always the least concerning one for augmentation mastopexy patients.
The color and texture difference between areolar skin and breast skin effectively conceals the circumareolar scar in most patients, and the inframammary fold scar (when present) is hidden in a skin fold and thus is only apparent if you are looking for it. The vertical scar is the least concealed one, and in most fair-skinned patients it, like the other scars, gradually fades to a faint white line that is minimally noticeable. In patients with deeper skin pigmentation, the vertical scar tends to be more noticeable.
In my practice we are very proactive about treating healing surgical incisions in order to reduce the likelihood of a problematic scar. Patients begin using topical silicone gel products, which have been shown to be highly effective in flattening and fading surgical scars, on a daily basis as early as two to three weeks following surgery. We also provide patients with a series of V-beam laser treatments of their healing incision sites. The V-beam is a vascular laser shown to be highly effective at modulating scar development. These treatments are provided at no cost to surgical patients of this practice, and are continued at intervals of three to four weeks for as long as necessary.
The reality is that many patients will have perfectly acceptable augmentation mastopexy scars without any specific postoperative intervention, but there is no way to identify in advance the subset of patients that may develop problem scars. Because mastopexy scars are so cosmetically significant, we treat all patients the same - as if they all are potentially at risk of ultimately having unfavorable scars. In doing so, we see very few patients who ultimately develop unfavorable mastopexy scars, and I do not often have patients who require mastopexy scar revision. I am more than happy to revise unfavorable scars if they develop, and this can be done quite easily in the office under local anesthesia. Fortunately, the need for that procedure in my practice is quite small.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Do I Need A Breast Lift W/My Augmentation?

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I think you will need a small lift with an implant in order to rejuvenate the size and shape of your breasts to a more appealing presentation.  Please see a board certified Plastic Surgeon for a consultation.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 117 reviews

Breast Lift Needed with Breast Augmentation

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    An augmentation will provide the volume you desire, but you will likely need a vertical lift or a full breast lift as well.  You will need an inperson consultation and exam to determine what exactly is needed.  Find the plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Kenneth Hughes, MD Los Angeles, CA

Do I Need A Breast Lift W/My Augmentation?

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The photo is a bit dark and out of focus, but from the detail I can make out I do think that a lift would be recommended, and most likely a vertical (lollipop) lift. An in person exam will be much more useful in making a plan. 

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.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.