The Surgeon Minute

Can I Get By With Breast Augmentation Without a Lift?

Can I Get By With Breast Augmentation Without a Lift?

Women with deflated, sagging breasts want to achieve maximum lift with minimal scars. It comes as no surprise that women would rather boost their breasts with an augmentation than with a surgical breast lift, mainly because of the scars a breast lift requires.

It’s a discussion board certified plastic surgeon Dr. Richard Baxter, a nationally recognized expert in the field of breast surgery, has on a regular basis with patients in his Washington state practice. “A patient comes in, maybe for a mommy makeover,” shares Dr. Baxter. “Her breasts are a little bit deflated, and she says, ‘Can I just have implants, and avoid the lift?’

While implants can be used to successfully replace volume lost after breastfeeding, there are limitations to what an implant alone can accomplish. Deciding whether you can achieve your breast enhancement goals with breast augmentation surgery alone, or whether you need a breast lift, is not always a clear cut choice. If you are on the fence about which breast surgery is right for you, Dr. Baxter’s advice is to schedule an in-person consultation with a board certified plastic surgeon.

The Ideal Candidate for a Breast Augmentation

During a breast augmentation, breast implants are placed within the natural breast through a very small incision. Women with good quality skin whose breasts are only slightly deflated and whose nipples do not sit not low on the breast are the best candidates for a breast augmentation alone.

When a Breast Augmentation is not Enough

Breastfeeding, weight fluctuations and aging can all lead to stretched out, excess skin in the breasts. As we age, our skin also loses collagen and elastin. Basically, the amount of skin is increasing while the quality of skin and the contents of the breasts below the skin are both decreasing.

When breasts go from slightly deflated to moderately or severely deflated, the size of implant needed to fill out the breast increases. While a larger implant may successfully fill out the excess skin, the added weight of the heavy implant will emphasize an already drooping breast, making it even more obvious that the breast would benefit from a lift. Gravity draws the heavy implant downward, filling out the bottom portion of the breast but leaving the upper portion of the breast completely flat.

The good news for women with sagging breasts is that breast augmentation and breast lift surgeries complement each other and are routinely combined to safely provide lifting and filling results to patients who are not candidates for breast augmentation alone. A breast augmentation with a lift will remove excess at the bottom of the breast while restoring upper pole fullness with an implant.

Benefits of an Augmentation with a Lift:

  • Removes excess skin
  • Restores lost volume
  • Improves nipple position
  • Enhances breast shape
  • Boosts confidence

Nipple Position

If your nipples sit low on your breast or they point downwards instead of out, breast lift surgery is the only procedure that will re-position your nipples to a more youthful position. “It’s important to recognize the patient who is going to need a lift right up front,” says Baxter. “Nipple position is one of the key features of that.”

One way Dr. Baxter determines if a patient needs a lift with their augmentation is by studying the position of the nipple in relation to the crease below the breast. The crease or fold below the breast is known as the inframammary crease or the inframammary fold. “If the nipple is at or below the level of the bottom crease of the breast, that’s a patient who is probably going to need a lift,” explains Baxter.  

Variations of sagging nipples.

To get a better idea of where your nipples are in relation to the fold beneath your breast, position a ruler flush below within the fold, resting against the bottom of the breast. If the height of your nipple on your breast is below the top of the ruler, you may be a better candidate for a combination lift/augmentation procedure than an augmentation alone.

“If a patient has that low nipple position, if they get big implants put in to try to correct that, it’s not going to look right for one thing,” says Dr. Baxter. “It’s also going to put more stress, resulting in more stretch, on that skin envelope. Those implants will continue to drop and stretch everything out even worse. You end up with an even more challenging situation that might require an even bigger lift.”

The addition of a lift may sound daunting, but Baxter finds his patients are more than happy they decided upon that strategy after recovery. For the small price of some scarring, the breasts can be completely and properly rejuvenated back to the perkiness they held in earlier life.

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