Breast lift without implants. Is a donut incision possible for me? (Photos)

The scar burden of a breast lift varies directly with the degree of ptosis/sagging. The million dollar question is where does the NAC sit relative to the fold. The more significant the correction needed...the greater the scars.
Slight ptosis can be corrected by a "donut" or circumareolar mastopexy/lift. Moderate ptosis may be addressed via a "lollipop" lift or vertical mastopexy. The most significant degree of ptosis will necessitate an "anchor" or Wise pattern scar.
With regards to your specific questions, your nipple position appears for the most part preserved. A limited scar approach might be reasonable. Fat grafting is a less reliable means to add volume.
As always, discuss your concerns with a board certified plastic surgeon (ABPS). Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons RealSelf Top 100 RealSelf Hall of Fame

Your nipples are located in line with your breast fold. A donut lift may give you a subtle lift, however if you want something more dramatic then a vertical lift would be more suitable.

In my professional opinion small implant with donut lift or bigger implant without lifting would give you excellent results. Since you are not okay with implant or scar, fat grafting with donut lift seems like your only option. You should know that there is a slight possibility to repeat the fat grafting.

Dear martehelen,

my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

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

The donut incision sounds like a good idea. Just keep the scar around the areola. However, it does not provide much lift and the scar can heal badly because of excess tension. Your best option is a vertical lift with removal of some tissue from the lower pole. You have to accept a vertical scar. Implants work best for upper pole volume. Better than fat. It's a plus/minus concept. Add volume on top and subtract on the bottom.

Unfortunately, a peri-areolar breast lift will be of no help and will likely have a bad result. To properly life the breast, a lollipop scar (+/- anchor aspect) will be necessary. No implant is needed, but some removal of the heavier breast tissue will be needed. I hope this helps.

Hi! Great questions.

You’re right that a breast lift without implants is a good option if you’re happy with your size and just want a more lifted shape—even if they get slightly smaller in the process.

The donut lift (which uses an incision just around the areola) is usually only effective when paired with implants, because the implant helps provide structure and support. On its own, the donut lift often doesn’t offer enough lift or reshaping—especially if the nipple sits below the breast fold. Even with fat grafting, it likely wouldn’t give you the result you’re looking for.

In your case, a vertical (lollipop) or anchor lift would be a better option. These techniques allow for more complete reshaping, and scars tend to fade well with time. Fat grafting can also be added to enhance upper volume naturally, but it works best when combined with a proper lift.

— Dr. B

The donut lift would give you minimal lift and the areola may stretch with tension. A vertical lift would give you overall better shape. You could add an implant for more volume and upper pole fullness if desired.

The doughnut lift might work, but the vertical lift would work better. You could also place a small implant behind the muscle for better upper breast fullness.