Breast augmentation: Confused about pencil/pinch test. Do I need a lift?

Don't worry about trying to do a pencil or pinch test. That's not how we decide who needs a lift. ;) I'm glad you are doing your research though and trying to learn who is a good candidate for a lift. Generally speaking it depends on where your nipple areola complex sits in relation to your inframammary fold, and where in relation to the overall breast mound. There really is no substitute for an in person exam with a board certified plastic surgeon with experience doing breast lifts, and whose results you like. I've seen patients that were told they only needed large implants, and no lift, when they clearly needed a lift to get the kind of shape desired. If you have scheduled consultations, this is a good first step. If you have pseudoptosis, this will affect how your implants sit and look, and the surgeon can discuss with you what to expect. Typically during the consultation, and exam is done to assess the breast size/shape/volume distribution/skin quality/drooping/asymmetry, measurements are taken, and photographs are taken. All of this information will help determine the range of implants that will suit you, and also whether or not you need a lift.

Lennev. First off, forget about these tests.  Photos and physical exam are optimal because I try to tailor each breast augmentation operation to my patient's desires and body type. There are pros and cons regarding saline and silicone implants, and patient anatomy and preference play a role in selection. The same is true regarding implant projection. Be sure to consult with a board certified plastic surgeon and go to your consult with all your questions written down so you don't forget to ask something. Good Luck!

Thank you for your questions. I can understand how things can get confusing with all these home tests. There is no substitution for an in-person exam and consultation with a local plastic surgeon who is board certified by the American Board of Plastic Surgery. So make sure that during your "shopping" you have checked that specific credential. If so, then you will be well served with the consultation and it should answer the majority of your concerns.Good luck!

HiI'll try to make sense out of this for you even though I haven't examined you,  Here is how you can nail it down in your own mind.  Please
put an index card in your breast fold. If your nipple is at the edge of the
card or below, then you would be a candidate for a lift, either a vertical or
anchor or areolar incision. If your nipple is above the edge, you could be a
candidate for an internal lift called the dual plane. The
video below explains the dual plane internal lift.  I also attached an article from a peer-reviewed
journal to give you an even better idea.  I believe the dual plane and implants alone
will do it for you, and that you will not need a lift. Be sure to seek a
consultation with a BC PS to be sure. All the best, “Dr. Joe”

It is hard to determine if you are a good candidate for a breast lift or augmentation without being examined in person or without seeing photos from multiple angles. A general rule to determining if a lift is needed is if the nipple is below the breast fold and how much breast tissue is below the fold. I recommend consulting with a plastic surgeon in person so they may better determine which procedure is best for you and what is needed to help you achieve the aesthetic results you desire.Kamran Azad MD, Board Certified Plastic Surgeon

Hello! Thank you for your question!  The mastopexy procedure raises the breast, which ultimately provides a more youthful and perky breasts. This is done by removing the extra loose skin and rearranging the surrounding breast tissue in order to reshape and support the newly formed breast. At the same time, the nipple-areolar complex (NAC) is raised to the ideal position above the fold beneath your breast (the inframammary fold) as well as being placed at the most projecting portion. Oftentimes with age or following pregnancy, the NAC becomes widened and enlarged. This may be reduced in size during the breast lift procedure.  It is common for the breast to lose its firmness and uplifted appearance over time, which is also accentuated with age, pregnancy/breast feeding, weight gain/loss, and gravity. This results in breast ptosis, or sagging of the breast, with a “deflated” appearance. Women seek the mastopexy procedure to regain the previous youthful appearance of her breasts and women report increased confidence, self-esteem, and femininity once achieving this desired shape and fullness. Breast lifts may or may not be performed with implants – the implant would add increased size but also greater fullness in the upper pole of the breasts which creates more cleavage.  If you are content with your size, a breast lift is all you would need to improve the shape of your breasts. Given your description but without photos or exam, I would suggest at least a lift, as this would shape your breasts, along with consideration for an implant to restore some volume/fullness of your breasts. Hope that this helps!

Thank you for sharing your excellent question. Unfortunately without an in-person examination, or a full series of photographs, it is difficult to say if your results would benefit from a lift at the same time as implant placement.  In the majority of cases if the nipple is above your breast crease a lift is not necessary.  Hope this helps.

Thank you for your question. It can be definitely difficult to determine whether you'll need a lift with your augmentation, and often you'll have several completely different recommendations by your plastic surgeons. In my office I use your specific goals, nipple position and measurements to determine whether to add a lift. See attached link. After I see women in clinic I'm able to help them determine whether they "definitely need a lift," "definitely not need a lift," or are "borderline." When someone is borderline they always have the option of having an augmentation first and then having a lift only is needed, six months later. In this situation, I find that most women will be happy with their results and not return for the lifting procedure. Good luck with the process! When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options. I spend an hour with all of my new consults. 

The question of needing a simultaneous lift with the breast augmentation is common.  The goals of the surgery are to create an attractive breast with correct nipple/areolar position.  If the nipples are low to begin, this can potentially be more noticeable after an implant is placed.  You have mentioned different rough guides that surgeons can use during the consultation to help determine and demonstrate the need for a breast lift.  Providing pictures can be helpful to determine to what degree of ptosis or pseudo-ptosis you have.  Good luck with your upcoming surgery.

Dr. E Wright

Dear lennev,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