Breast solution? Can I get implants without a lift? (Photos)

Im 34 yrs with 3 kids and breastfeed for 2 yrs one of them, just wondering what would be the best solution to get a nice firm and bigger breast. I'm scared of lifting but not sure if I can put implant only without lifting or if there is any new technique used for my case and if the lifting is a must is the fat transfer will be a solution instead of implant or no. Appreciate your help

Doctor Answers 12

Post Baby Breast Options

A breast augmentation is often performed in patients looking to replace volume lost from breast-feeding. The ideal patient for an augmentation alone is a young woman with good skin quality, that has breasts that do not sag and has nipples positioned at or above the fold.

Patients, like yourself, with both a lack of volume and sagging breasts are most often offered a combination of a breast lift and augmentation (mastopexy augmentation) to address both issues. The trade off is a scar on the breast around the nipple with a possible extension down towards the breast crease creating a lollipop or inverted “T” pattern. The size and location of the scar depends on the amount of lift needed, the patient’s anatomy, and surgeon preference.

The decision to do an augmentation by itself versus an augmentation with a lift is less based on patient preference and more dictated by the nipple position and the ratio between the post-augmented breast volume and the amount of excess skin you have. The less volume, the lower the nipples, and the more excess skin you have the greater the chance you will need a lift and the more of a lift you will need.

Implants are most often used to augment the breast because of their ease of use and the predictability of the result.  For patients looking for a more "natural" approach to breast augmentation, fat transfer is an option in the right patient. Unfortunately, the results of fat grafting to the breast are often disappointing, unpredictable, and can lead to difficulties with cancer surveillance down the road. Becasue of these shortcomings, I steer most young patients towards impant-based surgery.

For more information on breast surgery after beast feeding see the link below.

A detailed examination will help delineate the best surgical option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

No, you need a lift for sure

You would look like a rock in a sock if implants and no lift. Not what you want. A lift while creating scars is what you need to position the nipple higher and remove some of the lower stretched skin. Please see a board certified plastic surgeon.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 53 reviews

Breast solution? Can I get implants without a lift

I do not think an implant alone will make you look lifted. It will only be larger. I think an implant with a lift would be required to give you a nice cosmetic result

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Breast solution? Can I get implants without a lift?

You are correct that the best cosmetic result in a person with your particular anatomy would be with implants and a breast lift. Implants alone do not adequately lift the breast when there is significant sagging, no matter the size or type of implant, and will not produce a good aesthetic result in a patient who also needs some variation of a lift.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. If you live outside of the United States, the surgeon should ideally be a member of the International Society of Aesthetic Plastic Surgery (ISAPS). You should discuss your concerns with that surgeon in person and be very realistic about your potential cosmetic result.

Robert Singer, MD FACS

 La Jolla, California




Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Breast lift

You have significant drooping, ptosis, of her breasts.  You would require a breast lift, mastopexy.  Fat transfer will not drooping that you have.

Steven S. Carp, MD
Akron Plastic Surgeon
4.5 out of 5 stars 28 reviews

Breast lift with implant

Hello and thank you for your question. You are a great candidate for a breast lift with implants.  The lift is necessary because your nipples are below the inframammary fold.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

Breast lift vs implants

Hello and thank you for the question and the photos. 

Based on the photos, I would suggest a full lift with implants. The degree of loose skin you have will not be corrected with implants alone. A lift will be needed to help remove the excess skin and reshape the breast. This can be done at the same time of the augmentation. You should expect to take 1-2 weeks off of work for recovery depending on the type of work you do.  It will be about a month out of the gym. 

You should have several consultations with board certified plastic surgeons before making any decision. 

As always, it is best to be healthy, no smoking, and make sure any health conditions you have are managed by your primary care md.  

Best to you. 

Bennett Yang, MD
Rockville Plastic Surgeon
4.9 out of 5 stars 10 reviews

Breast lift with Augmentation?

Thank you for your question. Judging by the photos you provided I would indeed recommend a breast lift in addition to your breast augmentation surgery. A breast lift is performed to reposition and raise the breast higher on the chest by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Then, the implant is used to give, or restore, upper pole fullness at the top of the breast. I encourage you to discuss these options with your board certified plastic surgeon. Good luck! 

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 41 reviews

Breast augmentation/lift

Thank you for your question and photographs.

I would recommend that you schedule a consultation with a board certified plastic surgeon to have an examination of your breasts done. At that point, the surgeon can recommend whether you need a breast lift, breast augmentation or both. From the photos you have posted, it definitely looks as though you would need a breast lift as well as a breast augmentation to correct the sagging and add projection and volume. At my office, we use Crisalix which is a virtual reality device that will allow you to view what your breasts would look like after a lift, or view different sizes of implants and pick which best suits your desires.  As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate.  Crisalix  is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants.  Thus, our patients leave the consultation feeling confident with the size of the implant they chose.  
Best of luck in your endeavors!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 64 reviews

Can I get implants without a lift?

Thank you for the question and pictures.

 After review of your pictures, it is clear that you WILL benefit from breast lifting surgery. You will not end up with an aesthetically pleasing results if you undergo breast augmentation surgery only.

 If you were to undergo breast augmentation surgery only  I think that 2 types of “results” would be predictable:

1. You will end up with “big and low” breasts and unhappy with the aesthetic outcome etc.

2. You will end up with the breast implants sitting high on your chest wall with the breast tissue lower down,  again creating an aesthetically unpleasant outcome. You will find that you will continue to have breast skin sitting on top of upper abdominal wall skin, unless you lift the breasts.

For some patients the necessity of additional scars is a “dealbreaker” ; for these patients it is better to avoid breast surgery altogether.   

On the other hand, many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.    

Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities,  anesthesia and surgery facility fees (minimally) are patient responsibility,  when returning to the operating room for revisionary breast surgery.  

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift.. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation. To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer.  The use of the tailor tacking technique is very helpful. 

 Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.  Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. 

 Patients should be aware of the complexity of this combination procedure and achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc). 

 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved. 

Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer). 

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery. Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. 

 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful.  Best wishes.

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.