Do I need a lift or would implants alone be okay? (Photo)

Question

I have breastfed 2 kids and am wanting implants - unsure if I will also need a lift. Thank you

Kenneth Odinet, MD · Answer

One of the most common questions I hear during a breast augmentation consultation is, “Do I really need a lift, or can I get away with implants alone?”
Sometimes the answer is very clear. Other times, a patient is right on the borderline, and that is where the conversation about your final goals becomes extremely important.
A breast implant and a breast lift accomplish two different things. An implant primarily adds volume and fullness. A breast lift, or mastopexy, removes excess skin, reshapes the breast and repositions the breast and nipple when they have begun to sag. An implant can create the appearance of some improvement in a patient with very mild laxity, but an implant by itself does not truly correct significant breast sagging.
When I evaluate a patient who is borderline for a lift, I look at much more than breast size. I evaluate the position of the nipple in relation to the breast crease, how much breast tissue sits below the fold, skin elasticity, the amount of natural breast tissue, and how much volume has been lost from the upper breast.
Then we talk about what you actually want your breasts to look like.
If your priority is more volume and upper-breast fullness and you are comfortable with some natural droop remaining, an implant alone may be a reasonable option in a borderline patient. However, if your goal is a higher, tighter breast with the nipple in a more youthful position, adding a larger implant simply to avoid the scars of a lift may not give you the result you are expecting. In fact, adding additional weight to an already loose skin envelope can contribute to recurrent or worsening sagging over time.
There is always a tradeoff. Avoiding a lift means fewer scars, but it may mean accepting some remaining sagging. Choosing a lift means accepting additional scars in exchange for greater control over breast shape and nipple position.
That is why I don’t believe the decision should be made by looking at a photograph or measurement alone. During your consultation, we discuss what bothers you, what result you are hoping to achieve, how you feel about scars, and what compromises you are willing&mdash;or unwilling&mdash;to make.
For the patient who is truly borderline, there may not be one procedure that is automatically “right.” The right surgical plan is the one that safely matches your anatomy with realistic expectations for your final result.
&mdash; Dr. Kenneth OdinetBoard-Certified Plastic Surgeon

Mert Demirel, MD · Answer

After breastfeeding, the breasts can lose volume and the skin can stretch. Implants can restore volume, but they do not truly lift the nipple or tighten loose skin.
From the photo, you may have mild to moderate sagging. If the nipple position is still above or near the breast fold, implants alone may be possible, especially if you want a natural result and only need more fullness. But if the nipple sits at or below the fold, or if there is loose lower-pole skin, a lift will likely give a better shape.
Choosing implants alone when a lift is really needed can create a “waterfall” look, where the implant sits higher and the natural breast tissue hangs below it. That is why nipple position and skin quality are more important than cup size alone.
If you want to avoid lift scars, it is reasonable to ask your surgeon whether implants alone would be enough. But if your goal is a higher, tighter, more youthful breast shape, a lift with implants may be more predictable.
My advice would be to have an in-person exam and ask specifically where your nipple sits compared with the breast fold. That will usually determine whether implants alone are safe or whether a lift is recommended.

Serdar Bora Bayraktaroglu, MD · Answer

A breast lift (mastopexy) restores a firmer, more youthful contour by elevating the nipple-areolar complex, tightening the skin, and reshaping underlying tissue after pregnancy, breastfeeding, or weight fluctuations. During a physical examination, a specialist evaluates skin elasticity and nipple position relative to the inframammary crease to determine the necessary incision pattern. Consult a board-certified plastic surgeon to discuss personal aesthetic goals and receive a tailored surgical plan.

Gary M. Horndeski, MD · Answer

Implants will add volume to your breasts. Unfortunately, you have not told us your bra size. If you are size 32 or 34, each 100 cc of implant corresponds to 1 cup size change. If you are size 36 or 38, each 200 cc of implant corresponds to 1 cup size change. You may also benefit from a donut mastopexy at the same time. This will lift the nipple-areola complexes higher and more medial and implants can be placed at the same time.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Emre Guvercin, MD, FEBOPRAS · Answer

Based on your history of breastfeeding two children and the degree of breast tissue descent visible in your photos, you have true ptosis (sagging) rather than simply volume loss. In this situation, implants alone will restore fullness but will not correct the position of the breast tissue or nipples. In fact, placing implants without addressing the ptosis can lead to a "waterfall" appearance, where the implant sits high while the natural breast tissue remains low.For the most balanced and long-lasting result, I would recommend a breast lift combined with augmentation. A supportive Push-Up Lift can reposition and reshape your existing breast tissue while the implant restores upper-pole fullness, creating a more youthful and natural breast shape. This approach addresses both the sagging and the volume loss, whereas implants alone would only solve part of the problem.

Leila Kasrai, MD, FRCSC · Answer

It depends on the location of your nipples in relation to your breast fold. If they are in line or lower, then a lift is recommended. A side photo would help confirm this. Based on the photo showing just your front however, a lift may be recommended.

Joel Patrick Maier, MD · Answer

A vertical mastopexy (lollipop lift) can help center the nipple areolar complex on the breast mound along with a conservative implant. If you are not overly concerned with the nipple slight low, then you can always wait and see if you have concerns about scarring. Thank you.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Do I need a breast lift? You might not need one. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Daniel Barrett, MD · Answer

Dear hannahb28,

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

Jeffrey M. Darrow, MD · Answer

Thank you for your photo. Whether you should proceed with a lift in addition to your implants, depends upon whether you are happy with the present position of your nipple and areola in relation to the fold underneath the breast. In a youthful breast, the nipple and areola level is 2 to 3 cm above the level of the fold underneath the breast. Adding implants to your breast will increase their weight and they will settle slightly more. If you’re unhappy with the position of your nipples, then in addition to your implants, you would need a lift to elevate your nipples up to a better aesthetic position.  If, on the other hand, you are happy with the position of your nipples and breast then no lift is required. Best wishes.

Do I need a lift or would implants alone be okay? (Photo)

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