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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

Should I have my Breast Augmentation with or without a Lift?

Inframammary fold diagramWhile the decision to augment your breast is usually an easy one, the decision to have a Breast Lift with Implants is not always so obvious.

To help you better think this through, I have come up with some questions that you should think about . These questions should help you decide IF you need a lift with your Breast Augmentation.

  1. CAN A BREAST IMPLANT BY ITSELF GIVE YOU A SMALL LIFT?

    The Breast Implant does give the illusion of a lift because you get upper pole fullness. This works for women who have a nipple that is at or above the level of the skin fold beneath the breast. If the nipple is further down below the inframammary fold, it may cause the nipple to look like it is pointing south with the implant above it. If the implant is placed low to match the nipple then you defeat the purpose because you get a low hanging breast.

  2. DO YOU LIKE THE SIZE YOUR BREASTS ARE WHEN IN THE BRA?

    If so, you may only need a Breast Lift. All that would be needed is a skin tightening procedure, also known as Mastopexy. There are various types of skin tightening procedures, some with less scarring than others. We prefer the periareolar (Donut scar) scar because it is the least visible and leaves the smallest scar.

  3. DO YOU LIKE FULLNESS IN THE UPPER POLE OF THE BREAST?

    Some patients cup their hands around the breast and lift it saying “I want it to look like this” referring to the fullness in the upper part of the breast. Although in the beginning a breast lift has fullness in the upper pole, it does tend to settle after a few months. You may need an implant to give you that upper pole fullness. When an implant is placed under the muscle, it will give the lifted breast a fuller appearance in the upper pole.

  4. CAN I KEEP BREAST SIZE BUT GET FULLNESS IN UPPER POLE OF THE BREAST?

    In these cases it is possible to take some tissue off your breast and then replace it with an implant that is the same volume as the tissue that was taken off. The implant is then placed behind the muscle to give you the desired upper pole fullness.

  5. CAN YOU DO A LIFT WITHOUT A SCAR?

    Whenever you do a lift you have to change the position of the areola, or nipple. This means that at a minimum you will have a scar around the areola. When done properly, this is very well disguised as it blends with the change in color and texture between the areola and the surrounding skin. Additionally, most lifts can be done without any kind of vertical scar.

  6. IS MY NIPPLE AT OR BELOW THE INFRAMAMMARY FOLD?

    The Inframammary Fold line is the place where the breast meets the chest wall. It is the crease line under your breasts. If the nipple is below the inframammary fold you should definitely get a lift.

    implants with low nipples will cause them to point south or downward

    If the nipple is at the position of the Inframammary Fold, you should still consider a Lift. To best illustrate this very important question, I would like to show you a case study of a patient who desired Breast Augmentation. Her nipple complex was at the Inframammary Fold.

Her first surgeon elected to place an implant without a lift. Following the surgery, she was not happy and decided to redo the surgery with a Lift. Her second procedure was performed by me. The patient realized the importance of the Lift and I performed a Breast Augmentation with a Lift.

CASE STUDY – BREAST AUGMENTATION WITH & WITHOUT A LIFT

Pre Op Breast Augmentation

This patient was initially seen by another surgeon for Breast Augmentation. You can see that this patient’s nipple, or areola, is at the inframammary fold line.
The inframammary fold line is the place where the breast meets the chest wall. It is the fold line under your breasts.

Surgery #1 (another surgeon)- Breast Augmentation without a Lift

The patient opted to have a Breast Augmentation with No Lift. You can see that with no lift, the implants caused the breast to droop even more.
While the breasts were augmented to a bigger size, the whole nipple complex is low and the nipples are pointing south. The patient was not happy with the results.

Surgery #2 (with me) – Breast Augmentation with a Lift

Following her first surgery, the patient was unhappy with the way her breast sagged. We decided to do a Breast Aug with a Lift. The existing implants were removed and a Breast Augmentation with Lift was performed.
The entire nipple complex was moved up, but the scar is barely noticeable because it blends into the areola. The nipples no longer point south, as they are now pointed straight forward. You can see that the Breast Lift did wonders to make her breast look perky and youthful!

I hope the questions and answers above help you make the right decision for you. Please see my Breast Lift with Implants photo gallery for before and after pictures and, as always, feel free to ask me questions here in the comments!

By Dr. Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Posted in Breast

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7 Comments

  • wrote
    March 9, 2014 at 12:00 am

    Carol:
    The condition of hanging breasts (“ptosis”) has many causes. Some of it is plain old large breasts. Others have breasts that were larger at some point then the breast tissue atrophied (for example with loss of weight or after pregnancy). Finally we have the constricted base type of breast such as you describe.
    There are many ways to treat this constricted base, of which “Rigotomy” is but one. Rigotomies are usually performed in the context of fat grafting, and by themselves will not lower the inframammary fold.
    There are other issues to consider, such as a compact breast mass, etc. So in the end, it is as you suggest a case by case decision.
    One can do Rigotomies (basically inserting a needle under the skin and swiping it across so as to cut connective tissue bands) with fat grafting and a periareolar lift with fat graft, and indeed I have done this. The important thing is not the technique itself, but deciding which technique iOS best for each patient. For that I would need to see pictures. I’ll have Kelly at kelly@cosmeticsurg.net contact you in case thou want to set up a virtual consult or you want more info.

  • wrote
    March 8, 2014 at 11:58 pm

    Carol:
    The condition of hanging breasts (“ptosis”) has many causes. Some of it is plain old large breasts. Others have breasts that were larger at some point then the breast tissue atrophied (for example with loss of weight or after pregnancy). Finally we have the constricted base type of breast such as you describe.
    There are many ways to treat this constricted base, of which “Rigotomy” is but one. Rigotomies are usually performed in the context of fat grafting, and by themselves will not lower the inframammary fold.
    There are other issues to consider, such as a compact breast mass, etc. So in the end, it is as you suggest a case by case decision.
    One can do Rigotomies (basically inserting a needle under the skin and swiping it across so as to cut connective tissue bands) with fat grafting and a periareolar lift with fat graft, and indeed I have done this. The important thing is not the technique itself, but deciding which technique iOS best for each patient. For that I would need to see pictures. I’ll have Kelly at kelly@cosmeticsurg.net contact you in case thou want to set up a virtuyal consult or you want more info.

  • wrote
    March 2, 2014 at 5:44 pm

    Hello-I’ve read about tubular breasts, and it seems many of women who need a “lift” have some degree of tuberous/ tubular breasts, characterized by an abnormally high inframammary fold with a tight “band” underneath that constrains breast tissue, causing it to fold over and point downward. To correct this, #1: Do you first go in and snip the constrictive “band” (rigotomy) to release the breast tissue downward into a larger diameter area, thus lowering the fold? Or do you find that the height of the fold is less relevant with a good lift? (Maybe you go case by case, based on actual fold height?)
    #2: Does fat transfer work with tubular breast correction, for those who mainly want to correct the shape, with only a modest amount of added volume? If so, could all of this be done in one visit (rigotomy, lift, and fat transfer)? Thanks!!

  • wrote
    September 13, 2013 at 7:27 am

    Tina:
    You can, and it is called a virtual consult. Kelly can help you with that, you can email her at kelly@cosmeticsurg.net
    If two doctors have given you different opinions it means there are pros and cons to each choice. I may be able to give you a direct answer but most likely I will be discussing with you in detail the pros and cons of each alternative so you can then decide what suits you best.
    As far as lifts go, I tend to do more than most people because I just do a scar around the areola but we can discuss that at the time of the consult

  • wrote
    August 20, 2013 at 1:21 pm

    Chelsea:
    How did things go in your surgery?

  • wrote
    August 5, 2013 at 7:54 pm

    Can I send pictures of my breast and you tell me if I need a lift or not I have seen two doctors and they both had different opinions

  • wrote
    June 26, 2013 at 6:12 pm

    Hi Doctor Rodriguez, I’m scheduled to have my breast augmentation on July 3rd with Doctor Weiler in Louisiana. I’m 19 years old, I have had 2 children, my youngest is almost 2 month old, I weigh 120 lbs. (should drop to around 115, still loosing baby weight) I am 4’3 tall. I measured myself with a ruler from whatever its called by the throat to my nipple and if I’m doing it right it’s around 21-21 1/2 cm. From the bottom of my nipple to the bottom of my breast that is visible standing up is around an inch. All of which is my areola showing. Some skin is visible from certain angles. From top to bottom of my areola is 3 in right and 2 1/2 inches left. Before children, I was a small 34 B. With both babies my breast got up to a full 34 D. I am now a small 34 C. My doc and I have decided to go with a 600 cc saline implant under the muscle, and under the breast incision. My concerns are that I’m not going big enough or going too big, whether or not I need a lift along with my breast augmentation, and if my areolas will get any bigger (I’d prefer them to be smaller). My doc said I have big areolas, some sag, and that my breast are just naturally low and that he can’t change that and it’s just the way my body is. I’m wanting to go for a big D small DD. Basically I want them big, round, and high. Just not like balloons are sitting on my chest about to burst. mine now are like a cone shape as my doctor put it. My husband and I have looked at countless pictures and it’s confusing me and stressing me more because everyone is different and I’m worried they won’t come out the way I desire. It’s very important to me that they are perfect in every way because if I don’t like them, I don’t have the money to turn around and get them redone. Also, because I’m very self conscious about what I have now and have wanted this for as long as I can remember. I hope this is enough information for you to go off of. If you can, please get back with me asap to share your thoughts. I’d really appreciate it. Thanks, Chelsea