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Posted April 07, 2019 in Breast Lift

So you’ve had a couple of kids and your breasts just don’t look the same anymore. They’ve lost fullness, especially up top, and they’ve gotten smaller and saggier. Can you get away with just a breast augmentation (Fig. 1), or would you benefit from a breast lift too (Fig. 2)?

Figure 1: Breast Augmentation

Before and After Breast Augmentation

Before and After Breast Augmentation Front View

Figure 2: Breast Augmentation with Lift

Breast Lift Before and After Side View

Before and After Breast Lift Side View

According to Dr. Friedman, a board-certified plastic surgeon specializing in breast and body contouring surgery, the answer depends upon these factors:

How Much Do Your Breasts Sag?

Very simply, the more your breasts sag, the more likely you are to benefit from a breast lift, also known as a mastopexy. If only a small amount of tissue droops below the breast crease (inframammary fold), then you will probably do fine with breast implants alone. On the other hand, if your nipples are located below the folds (on profile view), then a breast lift is usually helpful.

Are You Happy With Your Breast Shape?

Breast augmentation is a great procedure for resizing the breasts, but it is not very good at reshaping them. Yes, it’s true that saline and silicone breast implants will increase cleavage, fullness of the upper breasts, and breast projection. If that’s all you desire, then breast enlargement alone may be sufficient. However, if you are dissatisfied with the shape of your breasts prior to surgery, implants will not lift sagging tissues. If you have small, sagging breasts prior to surgery, implants alone will simply give you large, sagging breasts.

Are the Tradeoffs Worthwhile?

Positives of a Breast Lift:

  • Improved Breast Shape: Your breasts will be perkier and sagging will be reduced or even eliminated.
  • Improved Nipple-areolar Size and Position: Stretched-out areolae (the pigmented area around the nipple) can be reduced in size. The nipples will be higher and will generally point forward, rather than down.
  • Improved Breast Symmetry: Mastopexies can be tailored to lift one breast more than the other, obtaining better-matching breasts.

Negatives of a Breast Lift:

  • Additional Scarring: Depending upon the degree of drooping of the breasts, incisions will be made around the nipple-areola, vertically along the lower breast, and/or within the crease below the breast.
  • Additional Cost: Breast lift with augmentation is a longer, more complicated procedure than breast augmentation alone. Accordingly, it is more expensive.
  • Additional Risks: Breast lift surgery carries its own risks separate from those of breast enhancement.

According to Dr. Friedman, “Bottom line: if you are happy with your breast shape, position, and symmetry, then implants alone may give you the increased breast size, fullness, and cleavage that you are seeking. If you are unhappy with your breast shape, breast position on the chest wall, or have significant shape asymmetry, then an augmentation mastopexy (breast implants with a breast lift) may be worth consideration.”

Incision Options

In an ideal world, breast augmentation alone would lift sagging breasts. In the real world, it doesn’t. Assuming that you are interested in a breast lift in conjunction with breast enlargement, there are four potential incision choices:

Crescent Mastopexy

Crescent Mastopexy Incision Illustration

  • 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: Dr. Friedman rarely, if ever, recommends this technique.

Periareolar (Donut) Mastopexy

Periareolar Mastopexy with Breast Implants

Before

Before Breast Lift

After

After Breast Lift with 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.

Vertical (Lollipop) Mastopexy

Vertical mastopexy with Breast implants

Before

Before Breast Lift

After

After Breast Lift

  • 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: Dr. Friedman uses this technique for most augmentation mastopexies. For most women, the advantage of improved breast contour outweighs the disadvantage of a vertical scar.

Inverted-T (anchor) mastopexy

Inverted-T mastopexy (without implants)

Before

Before Breast Lift

After

After Breast Lift

  • 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: Dr. Friedman uses this technique for some breast lifts (without implants) and most breast reductions. Unlike many surgeons, he does not typically use the full anchor incision for simultaneous augmentation and mastopexy.

Here is a brief summary of Dr. Friedman’s usual recommendations:

Degree of SaggingRecommendation
MinimalBreast implants alone
MildPeriareolar (donut) mastopexy or breast implants alone
ModerateVertical (lollipop) mastopexy
SevereInverted-T (anchor) mastopexy


There is no technique that perfectly suits all women or 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.

Before and After Breast Augmentation with Lift Photos

Breast augmentation with a simultaneous breast lift is a technically challenging procedure. This is due to the fact that we are simultaneously expanding the breast size with a saline or silicone implant while contracting the amount of skin via mastopexy (breast lift). Despite these challenges, for a woman who desires larger and perkier breasts, this combination of procedures achieves what neither procedure can do alone.

As you view the photos below, look for:

  • Increased breast size proportionate to the patient.
  • Improved nipple-areolar position.
  • Improved fullness of the upper and inner breasts.
  • Improvement or resolution of  “sagging.”

Breast Augmentation with Lift, Saline Implants (Patient also had Full Tummy Tuck)

Implant size: 300cc implants Incision: Vertical mastopexy
Estimated size change: 38D to 38 Full D Height and Weight: 5’4″, 175 lbs

Before

Before Breast Lift Front ViewBefore Breast Lift Side View

After
After Breast Lift Front View
After Breast Lift Side View

Breast Augmentation with Lift, Saline Implants

Implant size: 420cc implants Incision: Vertical mastopexy
Estimated size change: 36C to 36D Height and Weight: 5’6″, 136 lbs

BeforeBefore Breast Lift Front ViewBefore Breast Lift Side View

AfterAfter Breast Lift Front ViewAfter Breast Lift Side View


Breast Augmentation with Lift, Saline Implants

Implant size: 330cc  implants Incision: Periareolar mastopexy
Estimated size change: 34A to Full C Height and Weight: 5’4″, 125 lbs

BeforeBefore Breast Lift Front ViewBefore Breast Lift Side View

AfterAfter Breast Lift Front View

After Breast Lift Side View

Breast Augmentation with Lift, Silicone Gel Implants (Patient also had Full Tummy Tuck)

Implant size: 421cc implants Incision: Vertical mastopexy
Estimated size change: 34 small C to 34 Full C Height and Weight: 5’3″, 106 lbs

BeforeBefore Breast Lift Front ViewBefore Breast Lift Side View

AfterAfter Breast Lift Front ViewAfter Breast Lift Side View


Breast Augmentation with Silicone gel implants

Implant size: 360cc implants Incision: Vertical mastopexy
Estimated size change: 34B to 34 Full C Height and Weight: 5’4″, 135 lbs

Before

Before Breast Lift Front View

Before Breast Lift Side VIew

After

After Breast Lift Front View

After Breast Lift Side View

Dr. Friedman can help you decide what the perfect solution is for your breast concerns. To schedule a consultation call us at (469) 467-0100 or fill out our online contact form today.