A lift and an implant aren’t alternatives to each other. They are two different answers to two different problems. If the breast has dropped, we talk about a lift. If it has lost volume, we talk about an implant. And a lot of the time, both are needed in the same operation.
Who is a breast lift (mastopexy) suitable for?
We perform breast lift surgery most often after childbirth, after significant weight loss, or where the sagging has been there from the start. The goal is to bring a breast that has dropped into a better shape and a better position.
The operation itself is easy to describe. We reshape your own sagging tissue and lift it upward. We remove the excess skin and move the nipple to a higher position, and the breast takes on a rounder form. What a lift doesn’t do is add volume. It won’t increase your cup size. If you are happy with your size and sagging is your only complaint, a lift is what you need.
What problem do breast implants solve?
An implant gives the breast volume and fullness. Fullness in the upper part of the breast, the upper pole, is something a lift alone can’t produce. In the early period after a lift the breast does look round, almost as though an implant had been placed, but over time it softens and takes on a normal breast shape. If you want lasting fullness in the upper pole, that is where an implant comes in.
If pregnancy, breastfeeding or weight loss has emptied your breasts and you want your old fullness back, an implant is the answer.
Is an implant alone enough when the breast has sagged?
That depends on how much sagging there is. Where the need for a lift is small, an implant on its own can be enough, because it stretches the tissue. In a woman who has given birth, reaching her pre-pregnancy volume can bring the shape back on its own.
Where there is more sagging, an implant isn’t enough by itself. Then we need to lift and place an implant in the same operation.
When are a breast lift and implants done together?
If you want more volume as well, we place an implant inside the breast and lift your own tissue on top of that. So one operation gives you both the lift and the augmentation.
If your tissue is sufficient, meaning you are happy with your volume or you would even like it smaller, we do the lift alone.
Lift, implant, or both? That is a decision we can only make at a consultation.
How do we decide between a breast lift and implants?
At the consultation the first thing we look at is where your nipple sits. We take the measurement from the crease under the breast. If the nipple is level with that line the sagging is mild, if it is below the line it is moderate, and if it is at the lowest point it is advanced. This is the Regnault classification. There is also the situation where the nipple stays high but the tissue underneath has slid down, and we call that pseudoptosis.
So, briefly: sagging alone means a lift, lost volume alone means an implant, and the two together mean both.
How large an implant is used in a breast lift with implants?
Here we lean toward natural, and toward implants that aren’t very large. The reason is straightforward. A breast that has sagged before has reduced skin quality. Putting a very large implant inside it adds weight that gravity works on, and that can create a tendency to sag again in the future.
For everyday comfort and to keep the risk of future sagging as low as possible, we choose a lower-volume implant in patients having a lift with an implant.
Do a lift alone and a lift with an implant differ in scarring or breastfeeding?
They don’t. In both operations there is usually a scar around the nipple and an inverted T shaped scar running down from it. We hide the horizontal arm of that T in the crease under the breast. So what you see from the front is the scar around the nipple and the vertical line running down.
Breastfeeding is the same in both as well. Wherever we work on the nipple there is a risk to breastfeeding, and that risk runs between 10 and 20 percent. Having this operation doesn’t stop you breastfeeding, it raises the risk somewhat.
What else do we talk about when making the decision?
Your pregnancy and breastfeeding plans are an important part of it. If you are thinking about having children soon, we plan the timing together, taking into account that pregnancy and breastfeeding will change the shape of the breast again.
The same goes for your weight. If you are in the middle of losing a significant amount, a plan made before your breast volume has settled may not satisfy you later.
Frequently Asked Questions
Will my breasts get bigger if I only have a lift?
No. A lift gathers and repositions the tissue you already have, it doesn’t add volume. If you want lasting fullness in the upper pole, you need an implant.
Is an implant enough on its own if I have sagging?
If the sagging is mild it can be, because the implant stretches the tissue and gathers the breast. If there is more sagging, we need to add the lift.
Can I have a breast lift and implants in the same operation?
Yes. If you want volume and you also have sagging, we place the implant and lift your own tissue in the same session.
How do I know whether I need a lift, implants, or both?
Your nipple position, the degree of sagging, your current volume and what you want from the result all decide it. We see all of that at the consultation and give you a clear plan.
Alongside this decision, our articles on scarring after a breast lift, its effect on breastfeeding and, on the implant side, round or teardrop implants are worth a look as well.
Dr. Alper Eskalen assesses breast lift and augmentation for each patient, with all of these details in mind.
