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.

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.