Do I need a breast lift, just implants, or both? (photos)

At my consultation with my PS, I was told I had grade 1 ptosis. I told him I really wanted augmentation without a lift and he said we can see if the implants alone would make me happy and revisit the lift after surgery. I really want to just "refill" my breasts and obtain a natural look. I don't mind a bit of droop but am terrified I will regret my decision. Any advice would be great. Thanks!

Doctor Answers 15

Crescent Lift

Dear gothmomof232, You may have grade I ptosis on the left, but the right side is definitely grade II. That being the case, you really need to have a breast lift with or without a breast implant placed. Grade II means the nipple is now below the level of the underlying fold. Grade III would be the nipple pointing straight down. With grade I ptosis, it is sometimes possible to do implants only as a compromise procedure, though they will not be as perky as most women would prefer. Another option to consider is you may be a candidate for a minimalized right crescent lift. That is hard to say without actually seeing you in person. I hope this has been helpful. Robert D. Wilcox, MD


Dallas Plastic Surgeon
4.2 out of 5 stars 14 reviews

Do I need a breast lift, just implants, or both?

Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 358 reviews

No lift

With no lift, your nipples will stay fairly close to the level they are now. You do appear to have one nipple sitting a little lower than the other. You will have fuller breasts, just not higher.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Do I need a breast lift, just implants, or both?

Thank you for your question. I think you would benefit from a lift with augmentation, but if you choose not to do the lift at the same time you could of course revisit that option later. Please consult with your board certified plastic surgeon. Best wishes!

Mary Jo Wright, MD
El Paso Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast Implant together with Mastopexia

Thanks for submitting your photos.Based on your photos  you have asymmetric breasts and in my opinion you will benefit from a Mastopexia procedure with implants. Only an implant procedure will not be enough and will not make you happy.  Please consult with a board certified plastic surgeon.

Good luck...Dr Oz

Ozge Ergun, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 12 reviews

Do I need a breast lift, just implants, or both?

Thank you for the question and pictures.   Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone. You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly. 
Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.  Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications. 
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" or "implanted look" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).  Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.   Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful. Best wishes.

Breast lift and implants?

Based on your photos, it does appear that you have breast ptosis or droopiness of your breasts.  This means that your nipple areola complex is no longer centered over your breast mound (but is actually positioned on the lower aspect of the breast tissue); the goal of a breast lift will be to relocate your nipple areola complex so that it is centered over the point of maximal projection of your breast (or the central portion of your breast tissue).  What this means is that if you only have a breast augmentation without a lift, your breasts will not be centered over your implants, and your implants will appear high while your breasts will still be below your implants.  However, ultimately, the best recommendations can only be made with an in-person consultation.  I would suggest that you consult with a board-certified plastic surgeon who can best discuss options to meet your goals and expectations.  Good luck!

Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 17 reviews

Breast lift with augmentation

Thank you for your question and photos. From your photos and desired results, it looks like you would be best served with a combination of breast lift with augmentation.  The parameters of both the breast lift and the position of the breast implants should be designed to keep the implants relatively low while lifting the breast tissue and nipple to sit directly over the implants. Having a breast augmentation alone will leave your breasts with more volume but saggier. Many techniques exist in breast surgery, and combined lifting with augmentation is especially tricky.  The key is working with an expert, board certified plastic surgeon to get the best plan for the individual.

Do I need a breast lift, just implants, or both

can be difficult at times to give you a 100% evaluation from a photograph, but in looking at the pictures you have posted, I do not think you have Grade 1 ptosis. It appears that you have Grade 3 ptosis on the left and 3+ on the right. That would point to needed a breast lift with the implant, in my opinion. An implant alone would leave you with saggier breast and poorly placed nipples.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Do I need a breast lift, just implants, or both?

Thank you for your question.  Based on your photos, it appears that you would benefit from implants and a breast lift.  The implants would increase your size, upper pole fullness and cleavage while the lift would reposition your nipples and make things perkier.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 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.