I want minimal scars - Do I have to have a typical breast lift?

Practical34341,
Thanks for your question. Based on your pictures, the location of your breast fold and the location of your nipple- yes you do require a lift. As for the type, due to the amount of lift you will need. More than 2 cm to match, you are only a candiate for a lollipop or a anchor lift. The donut lift/mastopexy will be inadequate to lift your nipple to an appropriate height without causing distortion of your breast/aerola post procedure. Sometimes the "right" anwers is not what you "want" but what you "need." Hope that helps.

Thank you for your question. Based on your photos, you seem to have severe ptosis, so a minimal-scar or concentric (periareolar) mastopexy might not provide enough lift. That’s why multiple surgeons have recommended a full lift—it’s the only dependable way to elevate the nipple, remove excess skin, and create a stable shape for an implant. If you want to keep scars on the breast mound to a minimum, you can opt to place the implant through an inframammary fold incision and use the vertical technique when anatomy permits (which results in a shorter scar than Wise) and use a small implant with absorbable internal support (such as P4HB/GalaFLEX) to enhance longevity. Additionally, planning aggressive scar treatments like taping, silicone, or laser can help. A staged approach—starting with a small implant first, followed by a limited lift if needed—can reduce visible scarring but may temporarily worsen drooping. It's best to have an in-person evaluation with a board-certified surgeon to measure nipple-to-fold distance, assess skin excess, and select the least invasive lift that still ensures a safe, durable result.

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
Thank you for your question and for sharing your photos, they provide valuable context. Based on what I can see, you do show signs of ptosis (breast drooping) with skin laxity and nipple malposition — which likely means that a breast lift (mastopexy) would be the most effective way to achieve a youthful and balanced shape.
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Your nipples are located below your breast fold therefore anything less than a full breast lift would not give you a sufficient lift. The implants would sit low on your chest for a “rocks in socks” result.

The amount that a breast is lifted with a mastopexy is directly proportional to the amount of scarring from the procedure, i.e. the greater the lift, the more scarring. It is difficult to evaluate your needs purely based on these photos, but it appears that the amount of lift required to achieve a good aesthetic outcome would require a full mastopexy.

Dear Practical34341,

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

Could you possibly upload another set of photos to be reviewed? I think the frontal view photo may not be an accurate representation of how things actually look. It may just be the angle at which the photograph was taken. Taking weight-loss into consideration is obviously an important factor as well, but based solely on viewing the lateral view photos, I would say that doing a dual plane augmentation or an augmentation with concentric mastopexy may be options if large enough implants are used.

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. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.

With regards to your specific question, As with any cosmetic/aesthetic surgery, scars are a trade off. A patient is accepting a scar in order to improve something that distresses them (cosmetically). Scars are forever but fade and improve with time. That being said, they are non-negotiable. With regards to scar options, that will be up to your surgeon to determine based on the degree of sagging/ptosis. Minimal sagging can be corrected by a limited scar approach (i.e. Benelli or circular/concentric). However, it is inadequate for more significant correction and in cases where it is inappropriately deployed the results are typically less than satisfactory. There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon (ABPS).

I completely understand how you feel. Wanting fuller, lifted breasts without visible scars is such a common and very valid wish, especially after the hard work and transformation that comes with weight loss. You’ve already come so far, and now you’re just looking for that final, beautiful finishing touch.
The challenge is that after significant weight loss, the breast skin often becomes softer and less elastic. That means a true lift, one that restores roundness and nipple position, usually requires more support than minimal-scar techniques like a concentric lift can provide. While it’s tempting to want to keep the incision just around the areola, this method often doesn’t hold up well when more than a subtle lift is needed, and it can sometimes cause flattening or stretching of the areola over time.
That doesn’t mean you’re out of options. In my practice, we focus on refined, short-scar techniques that give a beautiful lift while keeping scars delicate and easy to conceal. A vertical (lollipop) lift is often the perfect compromise, it reshapes and supports the breast beautifully, but with a fine, discreet line that fades softly with time. For some women, pairing this with a dual-plane augmentation (where the implant helps create internal lift and fullness) can minimize the need for a larger incision altogether.
Since you’re comfortable with a scar hidden underneath the breast, a modified lift or augmentation-lift hybrid could also be tailored for you, reshaping from beneath the breast for support, while keeping the surface lines clean and minimal.
There’s always a way to achieve a fuller, more lifted look that feels elegant, soft, and natural, without visible scarring taking away from your result. It’s all about designing a plan that respects both your anatomy and your aesthetic vision.
Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon & Destination Doctor

Hello, thank you for the detailed notes and photos. When the nipple sits below the inframammary fold, adding volume without tightening the skin envelope usually makes the breast look heavier rather than lifted. In this anatomic setting a lift is what changes shape, the implant only restores upper fullness.
Why concentric periareolar lift rarely fits this pattern• It offers a small vertical raise only• It can widen the areola and flatten the breast shape over time• With weight loss skin, support is limited so shape tends to settle again
What typically works with the least visible scars in daily life• Vertical lift with implant when horizontal excess is modest. The scar follows the areola then a short vertical line that hides in the shadow of the lower pole• Wise pattern lift when there is true horizontal excess. The fold scar sits in the crease you already accept and fades for most patients• Auto augmentation techniques use your own lower pole tissue to build upper fullness so the implant can be smaller• Staged plan is considered in select cases, yet be aware that implant first can stretch skin and drop the nipple further
How to keep scars discreet and the breast round• Map the fold height and nipple to fold distance on both sides• Control the pocket so the implant does not ride wide or high• Choose implant base width that matches your footprint• Scar care with silicone and sun protection as you heal
Key questions for your consultation• How many millimeters of lift are planned at the nipple and the fold on each side• Whether a vertical only pattern can achieve that amount or if fold reshaping is needed• Whether auto augmentation will be used so the implant can stay moderate• Plan for symmetry if one side needs more lift
A precise plan needs measurements and a skin quality check, yet your photos are consistent with a real lift rather than a periareolar only approach. If a more specific opinion would help standardized photos and a brief history can be gathered through a complimentary conversation with a coordinator before any medical evaluation.
Wishing you a smooth path to a rounder balanced result with scars kept quiet in everyday life.Güray Yeşiladalı, MD