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Posted September 27, 2011 in Body, Home

In an ideal world, breast augmentation alone would lift sagging breasts.  In the real world, it doesn’t.  For a discussion of whether you would be better off with implants alone versus implants with a lift, please see  our article.

Assuming that you are interested in mastopexy(breast lift) in conjunction with breast enlargement, there are four potential incision choices:

1.   Crescent mastopexy

Advantages: Small scar along the upper half of the areola (pigmented tissue surrounding the nipple).

Disadvantages: Minimal degree of lift, may stretch and distort the areola.

Bottom line: I rarely, if ever, recommend this technique.

2.   Periareolar (donut) mastopexy

  • Before
  • After

Periareolar mastopexy with breast implants

Advantages: Small scar around the entire areolar border, may reduce areolar size.

Disadvantages: Mild degree of lift, long-term risk of areolar stretching (especially if an aggressive degree of lifting is attempted).

Bottom line: Useful in carefully selected patients who are interested in lifting the nipple areolae while reducing areolar size.

3.   Vertical (lollipop) mastopexy

  • Before
  • After

Vertical mastopexy with Breast implants

Advantages: reliably lifts most breasts and nipple-areolae, helpful in lifting asymmetric breasts, reliably reduces areolar diameter

Disadvantages: Larger scar (vertical lower breast scar in addition to periareolar scar).

Bottom line: I use this technique for most augmentation mastopexies.  In most women, the advantage of improved breast contour outweighs the disadvantage of a vertical scar.

4.   Inverted-T (anchor) mastopexy

  • Before
  • After

Inverted-T mastopexy (without implants)

Advantages: reliably lifts even the saggiest breasts

Disadvantages: Largest scar (horizontal scar in breast crease, vertical lower breast scar, and periareolar scar).  Larger risk of delayed wound healing, which can endanger underlying implants.

Bottom line: I use this technique for some breast lifts (without implants) and most breast reductions.  Unlike many surgeons, I do not typically use the full anchor incision for simulataneous augmentation and mastopexy.

Here’s a brief summary of my usual recommendations: 

Degree of sagging                                Recommendation

Minimal                                                   Breast implants alone

Mild                                                         Periareolar  (donut)mastopexy or breast implants alone

Moderate                                                Vertical (lollipop) mastopexy

Severe                                                      Inverted-T (anchor) mastopexy

There is no perfect technique that suits all women and all breasts. In carefully selected patients, however, the combination of breast augmentation and breast lift may lead to a far better result than either operation performed alone.