Surgeon Differing I Need a Periareolar Lift Along with Implants? (photo)

I have had 2 consultations with highly reputable surgeons. The first recommended silicone implants under the muscle with insertion in the IMF. The second recommended the same but with a periareolar lift in addtion. I prefer the first surgeon and his practice, but now I am confused if I need the lift. I don't want to be unhappy with the results, and my husband is now worried that I will have saggy or droopy breasts if I don't get the lift. Thanks for you help!

Doctor Answers 17

The periareolar lift is usually not a good option.

The periareolar lift is not a good option.  It tends to produce a distorted areola, with very little lift effect.  I think you are fine with implants alone.  Your areola will get about a centimeter wider, just so you know.  However, I don't think you necessarily have to have an areola reduction (which would prevent this).  The inframammary approach is the most common one.  The decision regarding saline versus silicone is yours, but both will give you great results.  Under the muscle is best.  If you need a lift later on, the vertical technique is best.  I've attached a link to my website in case you wish to read more.

Kansas City Plastic Surgeon
4.7 out of 5 stars 56 reviews

Is a periareolar lift needed?

I do see a slight asymmetry.  You don't need to have  a periareolar lift.  However, an asymmetric nipple position may bother you after surgery.  A periareolar lift can address this.  

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Breast Augmentation first-lift later if you need it

Thank you for your question and photos. You do have a breast asymmetry which will require a lift of the lower breast if you hope to achieve symmetry after your breast augmentation.

Often asymmetries are magnified after a breast augmentation, you need to be aware of that.

The risk of breast augmentation in a breast that is ptotic (sagging) is that in some cases the breast implant may push the nipple down which creates what we call a "snoopy deformity" in which the breast implant creates a mound higher than the nipple areola (snoopy's for head) and the nipple and areola point down (snoopy's nose).

It sounds like your first surgeon is quite aware of these potential problems and I suggest you and your husband meet again with at surgeon to discuss your concerns about scarring and your husband's concerns about appearance with breast augmentation alone.

I would add that in my experience (31 years) after 9 months to a year, patients who have had mastopexy are not concerned about the scars and are happy with the improved shape of their breasts.

Periareolar lift?

Great question!  It really depends on what YOU want.  Implants alone will fill your breasts and give you a great, natural look. Performing a lift to one or both breasts will help to elevate the nipples and possibly make them more symmetric. So if you want a natural look, and felt more comfortable with the first surgeon, then it may be best to go with him.  And don't forget ... if you get the implants without the lift, then later decide you want a lift, you can still do the lift after getting the implants. BUT, if you get the lift now, and decide you don't like the scars, you can't get rid of the scars!  You're not burning any bridges by getting implants alone. I hope that helps and with you all the best!

James Knoetgen, III, MD
Fresno Plastic Surgeon
4.8 out of 5 stars 59 reviews

Circumareolar lift optional

Thank you for your question and the photo. From the photo and your description, it really seems as though the circumareolar lift is optional.  It would help correct the nipple asymmetry that you have and would also allow the surgeon to decrease the size of your areolae which will widen/stretch with the addition of implants.  It really boils down to how much these details bother you and if you are willing to have a scar around the circumference of the nipple to correct this. I think you will get a good result either way. It is your call whether you think it is worth it to go the extra step for the circumareolar lift.  I don't think there is a "wrond" decision.  I think you have to decide what is best for you. You may want to return to the first surgeon and discuss the possibility of the small lift with him and see what he has to say. I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Periareolar Lift with Breast Augmentation

It is impossible to know for sure from only one picture, but you appear to have good reason for the periareolar lift. Your areolae are asymmetric and the right one appears to be somewhat ptotic (droopy). The lift would correct both. Depending on the exact anatomy, you may need only a lift on the right. If you prefer the first surgeon, go back for another consultation and discuss what the other surgeon said and what you have learned here.


Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast augmenetation

 A periareola lift in your case may be used to address the asymmetry of your areolas. I will do that in patients with this problem.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Augmentation - Do I Need a Periareolar Lift Along with Implants?

Many years ago a surgeon-friend of mine said, "Want to know what's perfect?  Nothing."

Actually, some things may be perfect but your situation is one in which I don't believe there is a "perfect" answer.  You have to decide which compromise is most acceptable to you.  Implants alone will, in general, just enlarge your breasts and to the extent that you have sagging, that may be exaggerated, particularly if you go with larger implants.

For someone like you, and depending on what you're wiling to accept, you may want to consider implants alone with a small superior crescent lift on the right side.  This will actually make your right areola larger than it is (and it's already larger than your left) but it would provide reasonable symmetry without adding the increased complexity (and associated risks) of a more traditional and formal lift, even including the circumareolar.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Breast augmentation together with breast lift

Your breasts are asymmetric with the right nipple lower and further from the midline than the left. My guess is it is about 2cm lower. If you just put an implant in each breast via IMF or periareolar incisions this asymmetry will be magnified and I do not think you will be happy. You will at least need to reposition/lift the right nipple. From the single photo you submitted it is difficult to tell if the left nipple needs to be repositioned/lifted as well.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Do i need a lift

with just the one photo and not an examination it is difficult to be totally sure. I do not like to put in a larger implant to avoid the need for a lift and make the woman too large. I would recommend using the implant diameter that fits you the best and make the decision for a lift or not, on the table if it is borderline. I would use the infra-areolar approach so that if you do need a periareolar mastopexy or lift you could just continue the incision.

if you like the first surgeon better, return to see him again for another consult and look at more photos. ask to talk to a patient who looked like you did before surgery and see if you can meet with that woman if possible.


Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 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.