26, Recommendation for a suitable breast lift procedure? (Photos)

Question

Age -26, Indian. Lost weight a couple of times. Nothing drastic. But breasts have been for 4-5 years now. I'm worried about the vertical scar because of my ethnicity and scars are hard to fade. Is there a procedure that requires only the horizontal and circumareolar incision? What about RF micro needling? Is it safe, if so, what results can I expect? Or will a combination of RF micro needling and circumareolar lift work?

Emre Guvercin, MD, FEBOPRAS · Answer

Thank you for your detailed question &mdash; your awareness about scarring and skin type is important, especially with your background.You mentioned that your breasts have been sagging for several years, and from what you described, it sounds like you have:
True ptosis (genuine breast sagging),Flattened upper pole (loss of fullness),Significant skin laxity and reduced elasticity &mdash; all of which are common in patients with a history of weight changes.In these cases, non-surgical options like RF microneedling unfortunately won’t provide meaningful lift or reshaping. These treatments may slightly improve skin texture over time but cannot reposition breast tissue or restore youthful shape.You also asked about a circumareolar (donut) lift combined with RF &mdash; this approach can work in mild cases, but it’s not sufficient when there is advanced sagging and tissue deflation, as you seem to have.
In my experience, the most effective and long-lasting solution would be a Push-Up Lift using an inverted T (anchor) incision. This allows me to:
Precisely reshape and elevate the breast,Restore upper pole fullness using your own tissue,Maintain long-term results even in patients with reduced skin elasticity.Now, regarding your very valid concern: Yes, Indian skin types are more prone to pigmentation and visible scarring, but there are steps we take to reduce that risk:Careful incision placement (within natural folds),Tension-free closure techniques,Post-op scar care (including silicone sheets, sun protection, and optional laser therapy)Many of my patients with similar skin types heal beautifully with proper care and patience.A tailored surgical plan will always give better and safer results than trying to force a minimal-scar technique onto an anatomy that truly needs reshaping.

Stefan Mark Szczerba, MD · Answer

I have many prior patients with darker skin pigments and I have not issues with scarring.  The position of your nipple and areola is too low to really consider other options.  Periareolar incisions drift down with time and spread too far making the areola too wide to really be a option for anyone that needs their areola /nipple position to rise up to any significant elevated position.  There are techniques that skip the vertical incision, however they do leave the breast looking slightly more "boxy" after the breast settles. 
 The vertical incision geometically prevents that boxy look.

RF treatments are a really interesting option for small corrections of nipple/areola position. Best Wishes!!

Daniel Barrett, MD · Answer

Dear cniamh,

my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jonathan Heistein, MD · Answer

Hi.  I think your breast shape would be best if you had a full breast lift with anchor (Wise pattern) scars.  Although this puts the most scars on your breast, any lesser lift will not be able to correct the type of sagging that you have.  It would be better for you to not have surgery than to have a circumareolar incision since this would not provide a very nice shape.  Hope that helps.

Leila Kasrai, MD, FRCSC · Answer

Because your breasts are significantly affected by ptosis, an anchor breast lift would most likely be the most suitable for you. This requires the vertical line extending from your areola down to your breast fold. A donut lift or other less extensive procedure would most likely not give you pleasing results.

Krishna Vyas, MD, PhD, MHS · Answer

A Wise-pattern breast lift would provide the best shape to recontour the breast, but does involve an areolar scar, vertical, and horizontal. This technique is the most reliable for achieving optimal breast elevation and shape. The vertical scar is usually well-placed and fades over time with appropriate care, including post-operative laser treatments and silicone gel sheets. It's also worth noting that many patients, including those of Indian descent, experience satisfactory results with healing scars that tend to improve as time passes.

Regarding the circumareolar (donut) lift, while it can reposition the nipple and offer modest lifting, it may not provide the level of elevation you're seeking. This technique is typically less effective for more significant breast ptosis, which seems to be the case based on your photos. Additionally, RF microneedling won't likely give you enough skin tightening to achieve the desired results.

For the best results, you may also want to consider a breast lift with auto-augmentation (using your own tissue for fullness) or combining a lift with implants if additional volume is desired. However, it's essential to have a consultation with an experienced plastic surgeon who can assess your specific situation and discuss the potential outcomes of these procedures. Ultimately, while scars are a concern, they are part of the solution to restoring a youthful, lifted appearance to your breasts.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

ABOUT DR. VYAS
Dr. Krishna Vyas, MD, PhD, MHS, is a highly trained plastic surgeon specializing in aesthetic surgery and breast surgery, including breast augmentation, reduction, lifts, and gender-affirming surgery (such as chest masculinization and feminization). With advanced training from institutions like Harvard, Mayo Clinic, and Johns Hopkins, Dr. Vyas is recognized for his expertise in breast and chest sensory nerve restoration. His PhD in clinical and translational science focused on stem cells, fat grafting, and improving outcomes in aesthetic surgery and breast surgery. Dr. Vyas has served on the editorial board for several medical journals and platforms and has over 200 research papers and talks. His research focuses on aesthetic surgery, regenerative medicine, stem cell biology, fat grafting, breast surgery, and gender-affirming surgery. Recognized for his expertise, Dr. Vyas was appointed an Instructor of Surgery at Mayo Clinic and served as an Assistant in Surgery at Harvard Medical School and Massachusetts General Hospital.

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. There is some underdevelopment of the inner portion of both breasts, which make the outer portion of both your breasts look over developed and your nipples medically located. It appears that in order to elevate your nipple/areolar complex to the correct aesthetic position they would need to move more than 2 cm. Therefore a Wise pattern breast lift with some liposuction of the lateral portion of your breast, to make your breasts more symmetrical, would likely result in your best result. Immediate treatment of your incision lines to suppress pigmentation and prominent healing should help you achieve an excellent aesthetic result.  I don’t believe a circumareolar incision would allow enough elevation of the nipple/areola to achieve the correct level and a horizontal incision only would not allow any superior movement of the nipple/areola. I am not aware that radio frequency or micro needling would allow you to tighten the skin enough to give you the results that you’re wishing.  Have a detailed consultation with a plastic surgeon so you understand your best options for the best result.

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

Surgery without scars is dream of both surgeon and patient. Unfortunately it’s not possible. After vertical scar breast lift surgery you may have excellent results. There are many maneuvers to reduce scarring after surgeries, like using strips for 3 weeks, using silicone gels, laser resurfacing etc. For grand majority of patients scar doesn’t an issue after surgery. Of course we’ll use all that tools I mentioned before but there will be a scar anyway. You should do the math, on one side you will get beautiful and perky breasts on the other hand you may have a scar which might be barely noticeable.

Payman Danielpour, MD, FACS · Answer

Thank you for your inquiry.  You are a good candidate for a breast lift with auto augmentation.  This is a procedure in which your own tissue gets rearranged into a psudo implant and makes the breasts look perkier and fuller with no implants.  You still require the normal breast lift scars but over time they fade and we implement a scar care regimen that includes post operative lasers and silicone sheets.  See the before and after that I uploaded for an example.  Take care

Eric Swanson, MD · Answer

First, never mind the RF microneedling. That would be a waste of time. There are lifts that avoid a vertical scar and they are poor choices. The "donut" lift simply does not effectively lift the breast. The "no vertical scar" Wise pattern lift produces a very boxy looking breast. Usually the vertical scar heals nicely. So you just have to accept the vertical scar to get the best result. A vertical mastopexy is the best choice. Often I combine it with implants to restore upper pole volume. Your ethnicity doesn't really matter.