Breast Lift vs Augmentation

There are guidelines the plastic surgeon is taught regarding the amount of ptosis present which requires he or she perform a breast lift rather than a breast augmentation alone. Generally, when the nipple rests below the infra-mammary fold in the upright patient, a lift is required. Recently, I have had several patients who were “borderline” if not in slight violation of this rule and we have proceeded with augmentation alone because these patients have been adamantly opposed to the scars that are left after the classic lifting procedure. I wish to present two of these cases in which the nipples did rest below the fold to demonstrate the kind of results that can be achieved by going “against” this convention.

Patient # 1

The first is a 50 year old woman who is very attractive and has good skin elasticity for her age. She had saline implants placed years ago. One had ruptured and deflated and the other was encased in a capsular contracture and was very firm. It was a serious problem with one breast much smaller than the other after the rupture and the other one round and misshapen. We planned to remove the old implants and replace them with MENTOR Memory Gel silicone implants (along with performing the capsulectomy on the hard side). We went back and forth over the lift vs. no lift decision and finally went with the augmentation alone, understanding that we could perform a lift in the future if desired.

As you can see from the post op pictures, we achieved a very nice natural result and the patient no longer wants a lift. There is still a small amount of sagging in the erect position but it is acceptable and appropriate for her age. She and I are very pleased with the result. As long as the surgeon can shape the breasts so the lower pole (the dimension between the areola and the infra-mammary fold) is adequate enough for the nipples to point forward (not down) the breasts can maintain a beautiful tear drop shape albeit with a slight amount of ptosis; still a very attractive look. She is pictured on the following page.


My apologies: We do not have the pre-op pictures of this patient. She has a nice shape post operatively and I believe the proper decision was to forgo the lift even though we “violated” the book’s teaching. Again, if your surgeon can shape the pocket such that the nipples point in the correct direction and he chooses the proper size of implant, the results can be quite attractive and very natural. 300 cc implants were used here.


Patient #2

The next patient is 26 and has the most adorable little son and the sweetest mom in the world!

In this case, we decided on going with a larger implant size (500cc’s) due to her degree of ptosis and tall stature. Since she was flying in from the States and had limited time here, we had to order the implants in advance. She wanted the full look of a DD or DDD cup and we achieved that naturally while maintaining the proper infra-mammary dimension so her nipples would point out, not down. Again, we both feel we made the right decision in not performing a breast lift. If, in the future, she wants to have a lift performed, we can do that, keeping these implants in place or changing to any size she desires but for now both doctor and patient are very happy with the results.

2BreastLift_vs_Augmentation_05-1 2BreastLift_vs_Augmentation_05-2In the two pre op photos at left, you can see that her nipples are slightly below her infra-mammary folds, indicating-according to the book’s teachings- that a lift will be required. The post op photo says otherwise. A naturally voluptuous full-breasted shape works well in this beautiful 26 year old who is tall and curvy.