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When I evaluate a patient for a breast lift at the same time as an implant, things are a little more complicated. So you've probably heard about the pencil test, and if you failed the pencil test but still want bigger breasts, then you might be a candidate for a breast augmentation at the same time. But I have to think about the texture of the skin, the quality of the breast tissue, and the degree of ptosis, because sometimes the procedure has to be staged. It's safer that way, when one is done first, followed by the other procedure. I would think that the breast augmentation is the more painful part, but the breast lift adds scars and we don't like to put scars if we can avoid it but most women feel that a better shape is justified. There are a lot of scar products. There are some silicone products, massage techniques, avoiding UV radiation. There are a lot of things that can be done to improve scars.