Breast lift alone or with breast enlargement? What to do.

As a cosmetic plastic surgeon, breast surgery is a large part of my practice. Breast augmentation with implants is common among my younger patients, breast lifts are common among those a little older and breast reductions are common in those a little older still!

I have written in the past about breast lifts and augmentations:

Breast lift mastopexy with or without augmentation

Cosmetic Breast lift surgery

Saline breast implants or silicone implants

Breast lift photo

Yesterday, though, I saw two women in succession who needed both a breast lift and a breast enlargement with silicone or saline implants. That made me think about the decision process a plastic surgeon makes to recommend the right cosmetic plastic surgery for patients with small, droopy breasts.

Breast enlargement

Breast augmentation is performed by placing a saline or silicone implant under or over the muscles of the chest. The surgery is performed through small incisions in the areola or under the breast. Implants are foreign materials, and the body will form scar tissue around them to wall them off. Also, they can rupture and need replacement. But they do make your breasts larger!

Breast lift

A “mastopexy,” or breast lift, is a surgery in which the plastic surgeon will shape your breast tissue into a more pleasing shape (round rather than flat) and a higher position on your chest (closer to your neck rather than your belly). This is the plastic surgery for droopy breasts, which are defined as breasts on which the nipple is below a point 21 cm from the neck base with a majority of breast tissue below the nipple/areola.

I perform my breast lift surgery with a “lollipop” incision: an incision around the areola and then downward. Other plastic surgeons may use an “anchor incision”: the lollipop but with a horizontal cut along the width of the breasts.

The nipple/areola is elevated to its “normal” point 21 cm from the  neck base, the breast tissue secure on the chest.

Breast lift and Breast Augmentation

Some women need to have both a mastopexy and a breast augmentation performed at the same time.

A breast enlargement is needed because the breast tissue is too small for their frame, either from genetics, weight loss or, commonly, breast feeding. Breast feeding can lead to the involution of breast tissue (a decrease in breast glands).

A breast lift is needed because the breast became or always was droopy due to:

  • genetics
  • weight loss
  • pregnancy

Breast lifts and breast augmentations can be performed at the same time. The surgery is more difficult than either surgery alone, and some plastic surgeons report a higher complication rate when doing the two procedures together, yet I know of no one who does them in two separate appointments!

The weight of breast implants needs extra attention in cases of lift and augmentation because the skin of droopy breasts tends to be thinner; a reinforcement with dermal tissue may be necessary. On the other hand, the risk of capsular contracture (scar tissue around the breast implant) is much less, in my experience.

The danger of not having a breast lift when you need one

There is really no danger.

Just accept that if you have a breast enlargement performed with droopy breasts, you will have large droopy breasts—or, to use a euphemism, “mature breasts.”

Morad Tavallali, M.D., FACS