Is a lollipop lift necessary to correct my sagging? (photos)

Question

Donut lift vs lollipop lift. Why don’t some surgeons like them? Is my one breast really that saggy?

Bora Ok, MD · Answer

Hello from Istanbul! Thank you for this question. For cases of sagging around 2 cm, a periareolar mastopexy, or donut lift, is typically adequate. However, for sagging exceeding 2 cm, a lollipop lift might be more suitable. Based on your images, it seems like the right side may require a lollipop lift, but an in-person consultation would be best to accurately assess and decide the most appropriate procedure for you. Wishing you the best on your journey!

Leila Kasrai, MD, FRCSC · Answer

Your nipple is located below your breast fold, which makes a more aggressive lift more suitable for you. A donut lift would most likely be insufficient.

Mohamed Elmaraghy, MD, FRCS(C) · Answer

Based on the photos provided, there is significant asymmetry between your breasts. This includes the diameter of the areola, the size of the skin envelope, volume of the breasts and height of the nipples. If you would like improved symmetry of the final breast augmentation result, it may be advisable to have a “lollipop” or vertical breast lift on the droopier side. “Dognut” lifts have become less popular due to the lack of control of areola diameter, somewhat unfavourable scarring and flattening of the breast after surgery.

William Andrade, MD · Answer

Thank you for your question.  A donut lift has the advantage of a less conspicuous but it does not the remove as much skin, so it is not as versatile as other lifts in reshaping the breast.  Also, the areola can stretch out and get large over time.  It is possible to put a permanent buried suture around the edge of the areola (Benelli mastopexy with a purse-string suture) but I've found that some patients don't like the way that suture feels.  With a lollipop lift (vertical mastopexy) it is much less common for the areola to stretch over time, but the downside is additional scars on the breast.  They also shape the breast differently so your surgeon will needs to take several factors into consideration when recommending the which lift is more suitable. Regarding your photo, the right areola looks larger but not that much lower on the chest.  However, the crease under the left breast (inframammary fold) looks higher.  If the folds are not adjusted to be at the same height on your body, breast implants will sit in different locations on the chest.  If you are considering implants as well as a lift, these are a few of the topics that will be discussed by your surgeon.  At my clinic, a thorough breast implant/lift consult with me typically takes 45 minutes because there is a lot of information to cover.

Lane Smith, MD · Answer

Depending on what look you are going for, would determine if you need a lift. If you are planning to enlarge your breast, you could absolutely choose implants that would fill in the slight ptosis you have on the one side. With the proper pocket modification & Using a Benelli technique, where an incision is made around the areola, both areolas can be made symmetrical in size, shape, and position. The shape of your breast can be changed, and voila, twins. Without implants, you would need a lift and pocket modification to make your breast look more similar. Feel free to come by Smith Plastic Surgery for an in person consultation and we can go over in more detail what we can do to reach your breast goals.

Georges J. Samaha, MD · Answer

Hi, You have grade 1 breast ptosis and assymetry. That is when your nipple and areola are around your breast fold. You do NOT need a full anchor scar lift. Depending on how big of an implant you would like you might need a vertical mastopexy to lift up your nipple and areola. I would do a dual plane submuscular breast augmentation first with an extra high profile silicone implant. I would sit you up during the surgery, and look at breast symmetry as well as nipple/areola position. If needed, only then I would do the lift through an incision around your nipple. It take a little longer to do this step wise approach, but great plastic surgeons all do it. Most skip this step. 
Hope this helps. Dr. Georges J. Samaha MD

Daniel Barrett, MD · Answer

Dear Blooming1618,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Farbod Esmailian, MD · Answer

It is difficult to assess which lift would be best for you, as an exam is really necessary in your case to see every thing, including your breast tuck. Some patients are better candidate for one type of lift vs the other, it just depends on the individual.

Hope that helps.

Hope that helps.

Connie Hiers, MD, FACS · Answer

I think the peri-areolar incision, the doughnut lift, would work well for you. Your breasts are somewhat different shapes. Doing the lift and augmentation will give you more symmetry in your breasts, especially since one does sag somewhat. However, you can just have the augmentation. A bra will correct any difference in sagging.  The choice is yours.

Alexander Slocum, MD, PhD, FACS · Answer

Before discussing a procedure we should really focus first your anatomy, and then consider your goals. In short, no your breast is not "saggy", it just looks that way because of the position of the fold.
You have breast asymmetry, which is normal. The "sagging" breast appears to have an elevated inframammary fold (IMF). The two photos you posted are mirror images, so I cannot tell if it is the left or the right breast. In my practice I check for this by asking patients to raise their arms straight up above their head, which lifts the breasts and helps to visualize the position of the fold (IMF). My guess is that the breast with the larger NAC (the "saggy" breast as you call it) has the elevated IMF, so the shape of the breast is overall different and would be unlikely to be corrected with a mastopexy only as it doesn't change the position of the fold. Also, the level of your nipples is not that far off.
I would also want to measure the distance from the nipple to the IMF and assess the compliance of the skin and breast tissue (how much this distance increases under gentle tension). More compliant tissue means that If your goal is improved breast symmetry only, then a small periareolar lift (what you refer to as a "donut", most likely) should suffice. Remember, though, it won't change the position of the fold so your "saggy" breast will still appear to be "saggy".
If you were also considering increasing the size (with an implant), then I would recommend you consider bilateral breast augmentation with adjustment of the fold on the "saggy" side, as well as a peri-areolar mastopexy to correct the assymetrical size of the nipples and also ensure they end up even. I would reposition the fold through a peri-areolar incision and reinforce this with permanent sutures.
Remember, it is totally normal to have asymmetrical breasts, and you should consider a consultation with a board certified plastic surgeon to discuss your anatomy and your goals (sometimes finding photos from other plastic surgeons websites is very helpful!). Try to avoid going into the consult with a procedure already in mind, and good luck!

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