I want implants but not a lift. How will my results look without a lift? (Photos)

Question

I have had 2 consultations and both have suggested I could have a lift. I really do not want the extra scarring. I'm not too worried about them looking 'youthful and perky'. My nipples still point forward not down so I am thinking i can get away with not having a lift. My problem is that I have lost a lot of the fat under my skin and it's very loose. If I only had implants will there be 'baggy' skin underneath the implant? I don't have much in the way of volume left so would the implant fill the skin enough to stretch the baggy skin?

Daniel Barrett, MD · Answer

Dear Emma Dent,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

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

S. Alexander Earle, MD, FACS · Answer

Thank you for sharing your photos!

Based on what I see, there is some natural drooping, so you could be a candidate for a lift—but I understand wanting to avoid scars. It is still possible to do implants alone, especially by choosing a slightly larger, fuller implant to help fill out the breast and create a rounder, more lifted appearance. Just keep in mind, implants won’t reposition the nipple like a lift would—they mainly add volume to improve shape.

With the right implant, you can still achieve a fuller, perkier look without a lift. A consultation will help determine the best size and approach for you. Best of luck!

Leila Kasrai, MD, FRCSC · Answer

The implants are centred behind the nipples. Without a lift, your implants would sit low on your chest and look more like “rocks in socks.” For this reason, a lift would be recommended.

Gary M. Horndeski, MD · Answer

Without a lift, the implants have to be centered underneath the nipple-areola complex. Your nipple-areola complex is low on the chest wall. The added weight of implants will make your breasts even lower on the chest wall. Many women do not like lifts because of the vertical scars associated with the traditional techniques. For that reason, an alternative was developed called the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos, you have some degree of pseudoptosis with nipple position preserved. Depending upon the size of implant, you may fill the envelope and minimize laxity. 
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon. Patient should discuss their concerns with their physicians in order to make an educated decision.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos, especially the photo with the pencils in your infra mammary fold which shows where your fold is in relation to your nipple.  First, the simplest way to think about a breast augmentation is that it will simply give you a larger version of the breast that you already have.  Your nipples are not ptotic, only a small amount of your breast tissue is, so your nipples should still be facing forward after your augmentation. The implant size that you choose will determine how snug and tight the skin of your breast is over the implant. Dimensional measurements done at the time of your consultation, ie, the width of your breast, and the distance from your nipple to your inframammary fold under stretch, will help your understand the optimal implant for you, by matching the implant width with your breast width, etc.  Your plastic surgeon can help clarify this at the time of your consultation. Best wishes.

Johnny Chung, MD, FACS · Answer

Thank you for your question. Based on your photos, it is possible to have augmentation without a lift. Your breast will look very natural with some degree of remaining sag. The limited dual plan if done correctly will elevate the nipples to a higher position, typically 2 to 4 cm depending on the type of implant you choose. I recommend finding a physician who is board certified in plastic surgery and has a lot of experience with this procedure. They will likely have many before or after photos for you to look at. The procedure will produce very natural looking breast but fuller. Best of luck with your surgical journey.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Do I need a breast lift?  You might not need one. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Finny George, MD · Answer

Hi, thank you for sharing your question. While, I don’t have the luxury of an in person evaluation, based on the photos, you have mild pseudoptosis which should not require a lift after the placement of a carefully planned implant. I think you will have a good result without the lift.

Brian K. Reedy, MD · Answer

Hello, thank you for your question and photos. Based on your description and the opinions from two consultations, a breast lift is likely the most appropriate option to address loose, excess skin. Implants alone primarily add volume but do not effectively tighten or remove sagging skin, which means you could still see a “baggy” appearance without a lift. A lift directly corrects skin laxity and reshapes the breast, making it the more reliable way to achieve a smooth, balanced result. Best of luck!

I want implants but not a lift. How will my results look without a lift? (Photos)

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