IntroductionWith aging, after multiple pregnancies, or after a considerable weight loss, women become more and more concerned with the appearance of their breasts. The reality is that with time, the appearance of the body changes under the influence of gravity and other factors, and the breasts are one of the features of the body most affected by these modifications. Often, women nowadays resort to plastic surgery to enhance the appearance of their breasts by increasing their volume. The procedure is safe when performed by an experienced, board-certified plastic surgeon and can boost amazing results if the patient chooses the right type of implants for her anatomy and follows the pre- and post-operative recommendations. At the same time, many women undergo the breast lift to get breasts that are perkier and youthful looking. The recommendation for one procedure, the other or a combination of the two is made by the plastic surgeon during the pre-operative consultation.In this article, we will discuss whether it is necessary to get implants to lift the breasts and what mastopexy entails. Aesthetic imperfections of the breastsThe appearance of the breasts could be altered after multiple pregnancies and also if major weight fluctuations occurred. If the breasts get big and then small again, the skin envelope of the breasts, as well as the ligaments supporting the breasts, are overstretched and relax, being unable to hold the breasts in an elevated position on the chest wall. The breasts have an empty appearance, and the skin envelope that used to be firm is now relaxed and saggy. Sagginess is one of the imperfections of the breasts that affects all women at one point or another in their lives. As aging is impossible to avoid, so is the development of breast ptosis, but it can also occur in young women due to a combination of factors.Saggy breasts are unpleasant and can create an emotional and physical discomfort for the woman, but often it is very small breasts or overly large breasts that pose real issues for women. Having breasts that are too small or too big compared to the rest of the patient’s anatomy can be a real issue for the woman as the quality of her life can be significantly affected. Nowadays, plastic surgery offers a solution for correcting these imperfections. In some cases, combined procedures are performed such as a breast lift with implants, breast lift with breast reduction, and even a breast reduction with implants. Correcting breast sagginess with or without implantsCorrecting small breasts can be done by using implants or fat transfer. To reduce the volume of overly large breasts, we have breast reduction surgery, and to correct breast sagginess we have more options. However, the procedure that is performed to fix this imperfection of the breasts is called breast lift or mastopexy. Despite common belief, we don’t use breast augmentation to correct breast ptosis. Mastopexy is the only effective solution to elevate the breasts; any other surgical or so-called natural methods can’t provide sustainable or even visible results and can even do more harm than good. This procedure is preferred by patients with saggy breasts, whatever the volume of their breasts might be. This means that patients with overly small breasts can need the breast lift just as much as patients with overly large breasts. However, the breast lift is often performed with implants to increase the volume of the breasts.How is the breast lift performed? To bust the myth that says you need implants to lift the breasts, we will have a look at what mastopexy entails. The procedure focuses on re-centering the glandular tissue and the removal of excess skin tissue. The procedure can be performed using multiple surgical techniques, depending on the complexity of each case and the preferences of the plastic surgeon and the patient. The anatomy of the patient also plays an important role in terms of defining the surgical plan. To elevate the breasts, the plastic surgeon will make incisions around the areola and even from the areola to the inframammary fold and in the inframammary fold, if the sagginess is extreme. The number, shape, and lengths of the incisions are dependent on the plastic surgeon’s experience and the level of breast ptosis. After the incisions are made, the plastic surgeon will detach the skin from the mammary gland tissue to elevate the gland and center it. Once the glandular tissue is in a good position on the chest wall, the skin envelope of the breasts is re-draped on it and the surplus is excised. In this manner, we get perky, elevated breasts. As you can see, there is no need to use implants to elevate the breasts, and we just need to reposition the mammary gland and to eliminate the surplus of skin. However, when mastopexy is performed, the volume of the breasts will be the same after the surgery as it was before. In some cases when the breast sagginess is severe, the breasts might even look smaller after the procedure than they were before if a considerable amount of skin tissue is removed. This is the reason why some plastic surgeons would recommend patients with smaller breasts to also get implants while having the breast lift. There are multiple benefits of undergoing combined plastic surgery procedures, but the most important is that we get a considerable improvement in the appearance of the breasts and the body in just one operation. The incisions necessary for the breast lift can be used to introduce the implants as well, so it makes sense to get implants while undergoing mastopexy as there is no further scarring.Implants are used during the breast lift not to elevate the breasts, but to add more volume to underdeveloped breasts and to help patient get breasts that are more in line with the rest of her anatomy. It is important to understand this as implants are not at all necessary for the breast lift.There would be patients coming to my practice saying they have delayed the consultation because they don’t want to get implants but they really want to get rid of the breast sagginess. My recommendation is always to seek medical advice instead of making these decisions yourself. There are patients who suffered for years and dealt with the discomforts associated with breast sagginess just because they thought the breast lift entails the use of implants and they didn’t want their breasts to get any bigger.During the pre-operative consultation, the plastic surgeon will perform a medical examination on you and also extensive measurements to better understand what procedure is most suitable for your particular case. All you need to do is communicate honestly and openly with the plastic surgeon in terms of reasons for undergoing the procedure and what you want to achieve with it. If you are happy with the volume of your breasts, the breast lift will be performed to elevate them and remove the excess of skin. If you want to get bigger breasts while having the lift, the plastic surgeon might recommend implants. Keep in mind that getting implants is associated with specific complications that could occur later on in life such as the rupture of the implants, the need to replace the implants after the warranty expires, and capsular contracture, among others. Get the advice of an experienced, board-certified plastic surgeon to make sure you undergo the procedure that best serves your purposes. ConclusionThe breast lift can be performed with or without the use of implants. The elevation of the breasts is not associated with the use of implants but with the re-centering of the mammary gland and the elimination of the skin tissue that is in excess on the breasts. Implants only add volume to breasts that are too small compared to the rest of the patient’s anatomy and are recommended for patients who are not happy with the size of their breasts even before the procedure. Keep in mind that overly large breasts are more prone to breast ptosis, so choose the volume of the implants wisely. Getting implants that are overly large can cause the development of breast ptosis once again, even after the breast lift is performed. If you thought that the only method to elevate the breasts is by using implants, the reality is that the breast lift can be performed with or without implants, depending on the aesthetic goals of the patient.