Should I consider implants when doing a breast lift? I have gotten mixed answers by doctors in my area. (Photo)

22 year old woman with no kids wanting a breast lift with or without implants. I want natural yet perky and round breasts. I do not necessarily want to go bigger or smaller - my bras are 70-75 D/E and when wearing a bra and clothes, my breast size is right for my body. I want to change the shape and nipple area. Am I a good candidate? Should I consider anything specific? Implants or not?

Doctor Answers 22

Lift with or without implants

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 with augmentation such as silicone implants, you will get very nice results, contact a board certified plastic surgeon, I recommend you soft cohesive silicone implants about 350 cc's you will look pretty and they will be perky.

Patients who goes to a consultation for drooping breasts (ptosis) or volume loss after pregnancy (pseudoptosis) almost always have one very important question. "Can my drooping be corrected with just implants or do I need a lift".

Implants alone will correct drooping when:
  1. Breast drooping is mild
  2. The nipple is still near the center breast and does not point downward
  3. There is some visible skin beneath the nipple/areola when looking at the breasts straight on.
  4. The patient is okay with being at least a cup size larger
A breast lift (with or without an implant) is better when:
  1. Breast drooping is moderate or severe
  2. The nipple is at the bottom of the breast or points downward
  3. There is no visible skin under the nipple/areola when looking at the breasts straight on.
  4. The patient is already a C or D cup breast size and doesn't want to be larger
  5. The areola is too large and the patient wants it reduced
I also show the patient photographs of a spectrum of breast scar present after a breast lift in order to check their tolerance for this scar. Most patients are surprised how little the scar shows and are okay with proceeding. If the patient really needs a breast lift, but is concerned about the scars, I will suggest they wait on surgery. In time the breast appearance problems will usually outweigh their concern about the scars.

I use implants in combination with a lift when:
  1. The patient wants to be larger in addition to being less droopy
  2. The patient desires to maintain projection and roundness of the breast mound
  3. The drooping is severe..... I recommend to see a board certified plastic surgeon for a personal evaluation and also to talk about your goals. Good luck :)

Dominican Republic Plastic Surgeon
4.5 out of 5 stars 398 reviews

Breast lift

You are an excellent candidate for a breast lift and could have it done with or without implants.  Having a lift without implants you will probably be around a C cup and I think your shape would be quite nice.  If later you decide you want to be larger, implants could than be added at a second stage.  There's  nothing wrong with doing the lift only first if you are not sure whether you need implants.  In fact , I prefer this approach in many patients.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

What you want is what will determine if implants are needed...

if you want upper pole fullness and the roundness that implants provide, you will need an implant.  If you don't want to be any larger, you can have the implant along with a reduction that will diminish your native tissue volume so if you have to get rid of the implants down the road, you will be smaller.

If you will be happy with natural, concave upper poles, the lift alone will be good enough to accomplish your goals.  And you avoid the costs and risks of having implants.

So you have to decide what you really want and that will determine what option would be best for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Should I consider implants when doing a breast lift

Performing a breast lift and augmentation is a challenging procedure. Some surgeons will recommend performing the lift first and consider augmentation at a later time. Both procedures can be done at the same time with good results if the patient's breasts are a good candidate for the combination procedure. Based on your photos and your comment about not wanting to be larger, breast lift alone should meet your expectations without use of an implant. The main reason to add an implant to a lift is to obtain a better upper pole fullness on the breasts that is sometimes hard to obtain.

Shahriar Mabourakh, MD, FACS
Sacramento Plastic Surgeon
4.9 out of 5 stars 208 reviews

Breast lift

Thank you for your question and photos.  It appears that you would benefit most from what I call "The Natural" at my practice, which is a breast lift without implants using the natural breast tissue to improve the appearance of the breasts.  Given that you appear to have sufficient breast tissue, you would benefit from a breast lift and areola reduction without implants.  If you want to increase the size of the breasts though, you should consider getting small implants.

All the best,

Dr. Results
Miami, FL

Jose M. Soler-Baillo, MD
Miami Plastic Surgeon
4.7 out of 5 stars 92 reviews

Should I consider implants when doing a breast lift? I have gotten mixed answers by doctors in my area.

Thank you for the insightful questions and pictures. It is extremely common to receive different opinions from different plastic surgeons about the best way to proceed after surgery. Each plastic surgeon may have his/her opinion that is based on their specific/unique education, experience, and personal preferences. Their opinions may also be shaped by unfavorable results they have encountered in their practices. It is quite amazing how adamant each plastic surgeon can be about the superiority of his/her recommendations…
Although specific advice would necessitate in person consultation involving physical examination and a full communication of your goals, some general thoughts may be helpful to you.  

 Generally speaking, breast augmentation/lifting surgery is more complicated than either one of the procedures done separately. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 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" 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.

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. I also suggest that patients TIME the procedures carefully in relation to their life circumstances (such as relationships, pregnancies…).
Obviously, much to consider… The attached link may also be helpful.
Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast Lift with or without Breast Implants

This is a commonly asked question and you have the options of either a lift alone or placement of small implants to enhance your fullness and roundness as you describe.  Without implants I think you run the risk of regretting the lack of roundness that is likely to develop 6-18 months after your procedure.  Of course implants could be placed later if you are hesitant now.  It becomes a personal choice and there probably is no right answer for everyone.  I would lean toward recommending implants (only small to moderate in size) with your uplift but would give best advice after meeting and discussing your goals and concerns in person.

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

Breast augmentation and lift

I appreciate your question.
If you want upper pole fullness, I would consider an implant.
You can also stage the procedure and have the lift first and see what you want after.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 91 reviews

Breast lift

It sounds like a breast lift is a great surgical option for you and you are a great candidate for it. It would give you a more perky breast with a change in the shape and nipple area as you desire.  The implant is a very personal choice in your decision. There are 2 things it would change for your:  
-Give you a larger volume &
-More upper pole fullness

Given that you don't want to go bigger, maybe a breast lift alone is just right for you.  
Good luck

Khashayar Mohebali, MD, FACS
Bay Area Plastic Surgeon
4.9 out of 5 stars 11 reviews

Breast LIft

The most important factor here is your expectations.  An implant will fill up your upper pole but will make you larger. You can always put an implant in later.  You will look much better with a lift.

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 32 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.