Will I need a breast lift to go with implants? Should I go under or over the muscle with saline? (Photo)

I want to get my breasts done around may or June of next year and I'm wanting to go with around 450cc saline implants.. not sure whether I should go over or under the muscle, but will I also require a lift as well?

Doctor Answers 11

Will I need a lift?

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Thanks so much for your question.  Based on your photos I would say that you could go under the muscle but a lot depends on your final goal. If you want a higher augmaented look then you will need a lift. If you want a more natural look then you probably don't require a lift.  Have a clear, honest conversation with your surgeon and you can make sure your goals are obtained. Hope this helps. 

Breast Lift With Implants?

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The answer to some degree really depends on your expectations for your outcome and what you are willing to invest. A breast implant alone will only result in an unattractive breast shape where the breast tissue hangs off the bottom of the implant, or with a very large and more saggy breast if the implant is placed on top of the muscle. 

In order to achieve an attractive, more youthful breast shape you will need a breast lift in addition to an implant. The combination of breast lift plus implant is very challenging operation in part because the two procedures work agains one another. The breast lift is elevating your nipple and breast tissue while at the same time reducing the skin envelop,  while an implant is expanding your tissues and stretching the skin. Doing both at the same time, particularly when using larger implants or doing a bigger lift, is associated with a very high complication and revision rate. Your situation is more difficult because you appear to have a good amount of breast tissue - it's just in the wrong place. 

Most surgeons today will recommend placing implants under the muscle because there a number of real benefits and that would be even more important with a saline implant. Most surgeons today are also using new generation highly cohesive silicone gel implants because they provide for much softer feel and more natural look. The bottom line is that there a number of things that you may want to rethink and you really need to some additional research and/or consults with surgeons who are certified by the American Board of Plastic Surgery.

Will I need a breast lift to go with implants? Should I go under or over the muscle with saline

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My opinion is to have abreast lift at the same time as your implants. Implants alone will not lift your breast and because of the location of your nipple and breast tissue there will be little implant underneath the muscle, making the ripples of a saline implant more palpable.

Vertical mastopexy and implant augmentation

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You are a great candidate for a vertical mastopexy with implant lift; you should always place your implant under the muscle and I would lean towards a silicone implant especially since you are getting a lift. Please see results below.

Augmentation Mastopexy

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Although you really deserve a long conversation about your options, it is too long for this forum. So, let me just say that you will need a total makeover in your thought process. You don't know what size you 'want' yet, you don't want saline implants, you don't want implants over your muscle, and you will need a complex surgery called an asymmetric reduction/mastopexy to establish symmetry in your soft tissue volume and skin surface area. Any thoughts of having symmetrical, pretty, perky and youthful breasts should be forgotten if you try to cut corners. Go visit a few ABPS certified/ASAPS member surgeons that specialize in all types of cosmetic surgery of the breast, not just implants. Best of luck!

Will I need a lift

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Hi and  thank you for the question. Based on the photos you sent I think a lift will give you a better result. Right now your nipples are relatively low on your breasts.  Your breasts will look more youthful if your surgeon performs a lift at the same time, placing them higher on the breast mound. I personally do not favor the use of Celine implants. They tend to result in a firmer  feel. They are also associated with more rippling. My preference is to place implants below the muscle in what we refer to as a dual plane position. You are less likely to develop a capsular contracture with this approach. My suggestion would be to see several board-certified plastic surgeon's who have a good reputations for breast surgery. Look at their photos, read the reviews, and make sure you're comfortable and confident with the plan they come up with for you. Good luck to you.

Dr West


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Thank you for the question and based on the photos without an examination you would benefit from a lift with the implants in a dual plane

Dr Corbin

Will I need a breast lift to go with implants?

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Thank you for your question. Based on pictures you need lift and implant for optimal results. I recommend implants under the muscle. Please consult with a board certified PS for evaluation.

Will I need a breast lift to go with implants?

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Implants alone do not adequately lift the breast when there is significant sagging, no matter the size or type of implant, and will not produce a good cosmetic result in a patient who also needs some variation of a lift.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to answer your other questions and tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person and be very realistic about your potential cosmetic result.

Robert Singer, MD FACS

La Jolla, California

Breast lift with implant

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Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, the best shape and contour could be achieved with an implant and a wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained 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.