I Want a BA and No Lift, How Can I Achieve This with my Saggy Boobs? (photo)

I'm 30 yrs old 5'4 112lbs and I have a mastopexy and BA scheduled for Dec. My PS has said I need a lift . I've been doing a lot of research and do NOT want a lift! I am looking to be a small D with a high profile, can I do this? Oh, and my plastic surgeon suggested that I get a subpectoral silicone gel augmentation mammaplasty bilateral. I don think I want to have a mammaplasty either. I don't want my nipples touched, I don't want to lose any or add any sensation. Thanks so much!

Doctor Answers 10

Breast Augmentation Without Lift Will Give A Nice Result

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Thank you for your question.  You are thin and fit with pretty natural looking breasts.  You do have some sag which is called "glandular ptosis" which means that although the breast gland is below the inframammary fold or the fold underneath your breast, your nipple is above the fold at least as it appears in your photos.

In my experience a sub-glandular, that is under the breast gland, breast augmentation will give you the fullness that you seek and should give you a nice result.

Your surgeon is correct, in that if the breast implant is placed under the chest muscle, a sub-muscular or sub-pectoral breast augmentation, then a lift will be required because the muscle holds the breast implant higher and can push the nipple downward and result in a "snoopy deformity".

Most of my patients share your opinion and feeling that you do not want your nipples touched but simply want your breast fuller. This certainly is possible.

Lift vs. implant

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You should ask yourself what look you want. If you show your plastic surgeon a photo of someone with small perky breasts, you should get a lift with implants. If you like the look of someone with large round breast, implants will do. Whatever the case, even with a mastopexy, your skin is the type that will stretch and you will ultimately have minimal superior fullness. All of this can easily be covered in the consultation and as long as it is presented correctly, you will be confident in your decision. Good luck!

I Want a BA and No Lift, How Can I Achieve This with my Saggy Boobs?

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Thanks for your question and for the photos. Unfortunately all the pics have arms elevated, and that simulates a lift, so your actual appearance may have more ptosis (sag) than is apparent here. 

FIrst a comment on terminology. "Augmentation mammaplasty" is breast enlargement, by whatever technique or incision. 

No one can guarantee that you will not have increased or decreased nipple sensation if you have breast surgery. And to the best available knowledge, the incision choice doesn't matter. Nor does adding a lift to the enlargement. 

Based on these photos I am not sure that a lift is needed or not. If it is recommended, the down side of implants is the possible sense of breast tissue draping off the implants, and this can be troublesome, and the only treatment (other than removal) is a lift. So if a lift is out of the question, you may need to reconsider the pros and cons of breast augmentation.

All the best 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

What to do when you need a lift

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I would recommend performing a dual plan breast augmentation.  This will help with the appearance without the scars of the lift.  However, no matter where you place the implant or what type, your shape will suffer without the lift.  It does help to come in for a consult so that measurements can be performed.  This gives me a better idea of what you can anticipate with an augmentation.  Be aware, any type of breast augmentation can effect your nipple sensation.  

Brian Dorner, MD
Columbus Plastic Surgeon

Need more information

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First of all photos need to be with the arms down at the side. Lifting your arms lifts the breasts, sometimes considerably. Second measure the distance from the notch at the top of the sternum to the nipple. If it is 25 cm or more, a lift is a strong consideration. If 24 cm or less and you don't have a high breast fold (underneath the breast) or the nipple position with the arms down is at the fold or higher, then implants alone may be fine. The larger the implant the better the correction, and a teardrop shaped implant also seems to correct better than a round. A biplanar placement of the implant also can help with mild degrees of droop. You don't appear to have severe droop but without measurements and the arms down in the photo, my assessment is guarded. And every now and then someone that does not appear to need a lift still does not look good with the implants and would have to consider a lift later. Augmentation mammoplasty means breast augmentation with implants, so you may not have understood exactly what he was saying. Implants alone sometimes can cause changes in nipple sensation. Subglandular implants may correct droop better but long term seem to have many more problems. At first glance my opinion is a larger teardrop shaped gel , cohesive gel placed biplanar would have the highest odds of avoiding a lift.

Keep your implants under the muscle and stay away from high profile

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Thank you for your question and photographs. Based on the information that you have provided, in my opinion, I think that you may be able to get by with implants alone but that is based only on your photos and not an examination. I agree that implants under the muscle are a lot better than on top of the muscle, but I would warn you about high profile implants. I feel that they look much more fake than mid-range or moderate profile implants.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 40 reviews

Ready or not?

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Dear Ready,

The textbook answer to your question is that you need a lift.  Fortunately, or unfortunately as the case may, plastic surgery is not a textbook discipline of medicine.  There are many ways to achieve a satisfactory result, even if it is not a perfect result.  There are a few things that you stated that are concerning.  The most important of which is that you don't want your nipple sensation to change.  Nipple sensory changes are a risk of ANY breast surgery.  So, if this is of the utmost importance to you, then you might consider not having surgery at all.  Otherwise, above the muscle augmentation with a tear drop shaped implant might allow you to avoid a lift.  However, because you are so thin, the implant outline might be visible.  So, overall, be prepared to compromise slightly on your result, if you are placing restrictions on the methods of surgery that are used.  Good luck!

Breast augmentation with or without a lift

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You probably do not absolutely need a breast lift (mastopexy). But your breast skin envelope is just a bit loose (ptosis) and without a breast lift, your implants and breasts will just sit a bit lower on the chest wall, but will probably still look quite good. You would be able to achieve a bit more of a youthful and "perky" appearance with a breast lift, but it is probably not necessary. I would suggest just having your implants placed (breast augmentation or augmentation mammoplasty), waiting for about 3 months, and then decide whether or not you want to proceed with the mastopexy procedure.       

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 90 reviews


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An augmentation mammoplasty is a just another name for breast implants. I would just try implants and see if you are happy. I bet you will be. Good luck

Timothy Fee, MD
Jacksonville Plastic Surgeon
4.3 out of 5 stars 58 reviews

I Want a BA and No Lift, How Can I Achieve This with my Saggy Boobs? (photo)

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You can still get a breast augmentation without a lift. Your breast will just sit lower on your chest. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 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.