is the pencil test always a clear indication of whether or not a breast lift is needed?

Thank you for your question. There are some women who will benefit from adding a breast lift to a breast augmentation. In general, if your nipple is located at or above the crease below your breast then a lift is typically not needed. In addition to nipple position, measurements are also used to determine when to add a lift. It's important to know the breast implants do not lift the nipple to any significant degree, so you can't escape the lift by using a breast implant. Breast sagging is a spectrum and women with mild/moderate sagging can sometimes go either way. In this situation, I typically recommend breast augmentation as an initial procedure, waiting six months, and then only performing a breast lift if it is truly needed. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide which procedures are right for you. 

No, the pencil test is not the only indication for lift. Breasts descend in 2 ways. One, the breast weight stretches the skin
envelope creating a fold and a positive pencil test. Two, the breast weight causes the entire
breast to slide down the chest wall. This
will not create a positive pencil test. I
recommend a new technique called The Mini Ultimate Breast Lift™. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Aligning the areola and breast tissue over
the bony prominence of the chest wall maximizes anterior projection without
implants. This technique avoids the ugly
vertical scars of the traditional technique, maintains nipple sensation and the
ability to breast feed. Best Wishes,Gary Horndeski, M.D.

Pictures or an exam will be necessary to answer this question.  A breast with a deflated upper pole that may look droopy may respond well to an implant alone.Select a plastic surgeon who performs hundreds of breast augmentations
and lifts each year, has great reviews, and has great before and after
pictures.Kenneth Hughes, MDLos Angeles, CA

Hello!  Thank you for your question!  This so-called "test" is not a medically described, or accurate, method of diagnosis for breast ptosis, or sagging.  However, it may give some insight into the possible need for a breast lift.  The position of your nipple-areolar complex makes a big determination into the need for lifting of the breast as well as the deficiency of the upper pole, as you describe.  It sounds as if you are deficient in the upper pole, which is your main concern - possibly more of a "deflated" appearance either from age, pregnancy, weight loss, etc?  Augmentation with a breast prosthetic and/or breast lift may meet your expectations.  Consult with a plastic surgeon who can examine you and discuss the various procedure(s) and assist you in determining which, if any, of the procedures would be the right one for you to meet your goals and desires.  Bet wishes!

Dear Mariie, thank you for your question. Although the pencil test helps in understanding the amount of laxity of the skin sitting on the lower part of the breast, it is not a infallible way to determine the best surgical treatment for the breast. If you could post a photo of your breast from the front and the side, with your arms along the body, I will be able to assess your concerns more appropriately and give you an honest advice.Hope this helps.Kind RegardsAndrea Marando

and gives most an idea of whether a lift is needed.  That being said, everyone has different ideas of where a nipple should be in relation to the mound.  If you want very perky, you could still have a lift when your nipple lays above the level of the pencil.  If you're okay with 'natural', you could be happy with the results from an augmentation alone when your nipple is just below the pencil.  The test works but it really depends on what your expectations are that will ultimately determine whether a lift is needed.

If your breasts are not sagging and you do not have upper pole fullness, then an implant may be a good choice. Best to be seen in person to determine this.

No the pencil test doesn't take into account the location of your nipple, which is one of the most important factors. Sometimes you need a lift, sometimes an implant, sometimes both.