Should I have my Breast augmentation with or without a lift?

An inframammary fold diagram.Illustration of the inframammary fold.
Illustration of the inframammary fold.

While 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 understand the procedure and think through your options in the most informed way, I have come up with list of questions you can ask yourself as well as some of the common questions I routinely hear from patients.

Consider these questions as a guide based on the outcome you’re hoping for!

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 a 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) Do you want to 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?

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

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.

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

photo of a breast aug patient with low nipple
Pre-Op Breast Augmentation
(prior to any implants, her natural state)

This patient was initially seen by another surgeon for a breast augmentation. You can see that this patient’s nipple, or areola, is at the inframammary fold line.

The inframammary fold (IMF), also sometimes referred to as the inframammary crease or inframammary line, is the place where the breast meets the chest wall. It is the fold line under your breasts.

Surgery #1 (another surgeon) – A breast augmentation, without a lift

photo of another surgeon's breast aug patient after implant surgery with a low nipple
Post-op Surgery #1 (from a different surgeon). No lift.

The patient opted to have a Breast augmentation without a lift. You can see that with no lift, the implants caused the breast to droop even more and created a line between the upper pole and implant.

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 still sagged. We decided to do a Breast augmentation 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 pointing straight forward. You can see that including the Breast lift with her implant augmentation did wonders to make her breast look fuller and more youthful!

photo of a patient who had a breast augmentation with a lift
Post-op Surgery #2 (with me).
Lifted and corrected!

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 MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.