The aspect of the breasts changes in time due to different factors such as weight gain, pregnancy, and aging. Many women confronted with sagginess of the breasts look for help in plastic surgery procedures. Among the most commonly performed interventions is a breast augmentation with implants as it increases the size of the breasts while also giving them a perkier, fuller look. But is it possible to have an augmentation without the breast lift if you have breast ptosis? Breast lift or breast augmentation? Exercise and a healthy diet help maintain the same weight and improve muscle tone, but the only way to correct breast ptosis is surgery. During breast lift surgery, excess skin is removed, breast tissue is reshaped, and the areolar complex is repositioned to improve the appearance of the breasts. But the breast lift surgery also leaves behind scars, and this is a turn-off for many women. Moreover, they believe that they can choose between a breast lift and a breast augmentation as it is enough to have one procedure to correct ptosis and augment the breasts. But the indication for a certain plastic surgery procedure comes after specific measurements. This is why I always recommend my patients to come to the consultation with an open mind and not with a surgical plan ready. This is the plastic surgeon’s responsibility: to find the most suitable option that will deliver the expected results. “I don’t want a breast lift, just an augmentation with implants.” I usually hear this after examining the breasts of the patient and diagnosing breast ptosis. In many cases, performing just the augmentation with implants without correcting the breast sagginess results in even more saggy breasts, positioned low on the chest. The aesthetic result is not satisfactory and not appealing to the eye. The breasts look bigger, but like a bag filled with something. The weight of the implant is pulling them even lower on the chest wall, and the shape is not very attractive. In a vast majority of cases, there is either an upper pole emptiness or a lower pole one, depending on the placement of the implant (behind the mammary gland or the pectoral muscle). Some patients insist that they don’t want the lift because they have friends who had the augmentation without the mastopexy, even if they had sagginess as well. As I always say, there are no two patients alike, so comparing with your friend is never a good idea. The need to have mastopexy depends on the level of the ptosis. If it is just a mild sagginess of the breasts, introducing the implant will be enough to elevate the breasts so that a breast lift surgery won’t be necessary. But if the sagginess is severe, the augmentation should never be performed without the lift as the results will be disappointing. Keep in mind that it is only your plastic surgeon that can perform the exact measurements and indicate the appropriate treatment plan, and if you want impressive results, you should always follow the recommendations of the surgeon. Candidacy for breast lift with implants You may be a candidate for breast lift surgery with implants if you suffer from breast ptosis and are not satisfied with the shape and size of your breasts. Your chest may present: • A slight fall (the areolar complex is at the same level as the inframammary fold) • A moderate fall (the areolar complex is below the level of the inframammary fold) • A pronounced fall (the areolar complex points downwards) The procedure should be considered by healthy patients in a good emotional condition who don’t smoke and don’t plan a pregnancy in the future. Breast lift with implants The procedure lasts between one and three hours, depending from case to case. The patient generally receives general anesthesia. The location of the incisions of a breast lift depends on several factors, but the most common locations are around the areolar complex, vertically below the complex, and horizontally along the inframammary fold. Your surgeon will decide the shape and length of the incision, and they depend on the amount of tissue to be removed. During the intervention, the plastic surgeon will remove the excess skin, remodel the breasts, and restore the tension that will elevate it on the chest wall. The breast implants are then inserted over or under the pectoral muscle. What results should be expected after mastopexy with implants? In a vast majority of cases, the procedure leaves impressive results and the breast ptosis is corrected. Hence the breasts are higher on the chest, but also bigger, fuller and looking more youthful. The result can be appreciated immediately after the intervention. However, it can take up to one year to evaluate the final result of the intervention. The implants need time to settle, the swelling and bruising to subside, and the surgical incisions need to heal and the scars to mature. Are there any complications related to breast lift with implants? There will always be risks to any surgical procedure. After a breast lift, complications such as hematoma, infection, cutaneous necrosis, and asymmetry of results can occur. The patient can avoid several complications if she follows the recommendations of the plastic surgeon offered during the preoperative consultation. A breast lift with implants doesn’t have an increased rate of complications compared to a breast augmentation with implants. Conclusion Due to the wealth of information online about plastic surgery interventions, some patients tend to believe that it is only their decision what procedure to undergo. The reality is that the plastic surgeon’s advice is important when it comes to plastic surgery. The surgeon will perform extensive examinations and take measurements that will help him decide what treatment plan is optimal to achieve the goals of the intervention. When it comes to breast augmentation, it should never be performed without a breast lift if the patient presents severe sagginess of the breasts as the results will not be aesthetic.