Will I need a breast lift and/or an implant for a full breast? I believe I'm at ptosis II doing my own ruler test. (Photo)

I breastfed twice and have very saggy breasts. I am 5'1" and 110 lbs, I did the ruler test and the nipple looked at or slightly below, which would indicate ptosis II. Is it possible to just do a breast augmentation without a lift? or at this point are my breasts too far gone? I don't really care what size my breasts are, I just want a full breast that looks attractive, unsure of size. My breasts are so empty my nipples look puckered. I was a full D while breastfeeding now a B of pure loose skin.

Doctor Answers 11

Will I need a breast lift and/or an implant for a full breast? I believe I'm at ptosis II doing my own ruler test.

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, hugs!

Dominican Republic Plastic Surgeon
4.5 out of 5 stars 396 reviews

Augmentation Mastopexy


You are a good candidate for an implant and lift, but not for augmentation alone. This is a complex operation and should only be performed by ABPS certified/ASAPS member surgeons that specialize in cosmetic breast surgery. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 89 reviews

Breast Lift with Implants

Breast Lift surgery will reshape the breast for a pleasing cosmetic result.  Implants will add volume.  Based on your photos you are an excellent candidate for these procedures. Discuss your options wth a board certified plastic surgeon.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 60 reviews

Will I need a breast lift and/or an implant for a full breast? I believe I'm at ptosis II doing my own ruler test.

Thank you for your question and photo. based on your photo and goals a combination breast lift and implants (for fullness and firmness) may be your best option. Please read the link below for more information:

Will I need a breast lift and/or an implant for a full breast? I believe I'm at ptosis II doing my own ruler test.

If your goal is to have larger, lifted breasts, then your best option would be to combine breast augmentation and breast lift surgery. If you are ok with the size of your breasts, and are looking to achieve, lifted, perkier breasts, without the added volume of implants, then you could consider undergoing a breast lift alone. Breast implants alone will give you larger breasts, but the relative position of your nipples and areolae will still be at the lower part of the breasts. Thank you for sharing your photos and question. Best wishes.

Dr. Gregory Park

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 164 reviews

A breast lift and implants would give you the results you want

I agree with your assessment. You do have some ptosis, and you would benefit from a breast augmentation and lift. For your information, the results of surgery could change with  future pregnancies and significant weight changes. To see photos of women similar to you and their post-op results, click on the link below. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."

Ted Eisenberg, DO, FACOS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 78 reviews

Will I need a breast lift and/or an implant for a full breast?

From your photos it appears that you would benefit from restoration of breast volume with an implant combined with some form of breast lift.  Without a lift the implants would be expected to exaggerate your droopiness rather than improve it.  During your consultation and ultimately during the surgical procedure one can determine whether a vertical lift or a full mastopexy will give you the most optimal shape, size and nipple position.  if you're willing to compromise to reduce the surgical incisions you MIGHT (but not definitely) be a candidate for a Benellit lift but I would generally recommend against it with your description of your nipple position.

Also, some surgeons recommend separating the surgery into two procedures however I generally don't and describe to my patients the possible need to reoperate if malposition or capsular contracture occurs when augmentation and mastopexy are combined.

Best wishes and regards,

Jon A Perlman MD FACS
Certified, Am Board of Plastic Surgery
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Will I need a breast lift and/or an implant for a full breast?

Thank you for the question and pictures ( although your description is certainly colorful you certainly do not have "Discovery Channel" breasts!).

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.  Given that you live in San Diego, I would be happy to give you definitive advice in person.  Utilizing computer imaging and goal photographs,  I think that you will find the consultation process very helpful.

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.
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.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,484 reviews

Aug vs AugPexy

Thank you for your question and photos
It appears to me that you do have ptosis and therefore will require a lift with your augmentation. In order to achieve fuller breasts an augmentation alone will provide that. Assuming you use implants and place them under the muscle the position of your nipple will be low on the breast mound and not give you a great result. If you place the implant over the muscle with your anatomy you are likely to achieve fullness but over a short period of time the ptosis you have will worsen and you will be left with larger and lower breast. A moderate size implant will give you long term fullness in the upper pole of your breast and help to reduce the length and potentially pattern used to perform your surgery. It is best to have a consultation with a board certified plastic surgeon so you can review all of your options and achieve the look you desire. You should do great
Best of Luck

Lee A. Gibstein, MD
Miami Plastic Surgeon

Do I need breast lift, or just implants? (Photo)

Difficult to be sure from photos whether or not lift (mastopexy) indicated in addition to augmentation to produce the beautiful, perky, proportional breasts you want.  Although the relationship you measured (nipple location relative to infra-mammary fold) is an important consideration, other factors influence the decision as well:  position of breasts on chest, skin quality, configuration of ribs, size and shape of implants you prefer, shape of breast you want to have, scar tolerance, etc.  One day, a computer may be able to offer an online answer from photos, but in 2016, in my opinion, office consultation still required.  What I CAN say is that if you need a lift, peri-areolar (scar only around areola, not down to bottom of breast) should be sufficient.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 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.