Introduction The appearance of the breasts is affected by all the changes that occur on the body, including hormonal ones that we don’t even notice in a vast majority of cases. Weight loss, pregnancies, hormonal changes, gravity, the natural aging process, and even things such as the bra that you wear and smoking can alter the appearance of your breasts and cause breast ptosis. Breast ptosis is defined by an abnormal position of the breasts on the chest wall. When the breasts start sagging, the ligaments that support the breasts are relaxed, the skin is in excess, and the upper pole of the breasts is often left empty while a considerable part of the mammary gland is situated under the level of the inframammary fold. The nipple and areola complex are often positioned low on the breast as well and their projection is below the level of the inframammary fold. To correct breast ptosis, we have just one solution, and this is plastic surgery. Despite what many advertisements for different products might tell you, surgery is the only solution that can be applied with success in the case of mammary ptosis. Candidacy for breast lifting The breast lift can be performed on patients of different ages, but generally, it is women over 40 that choose to undergo the procedure. Good candidates for the breast lift should have stable mental and emotional condition and no severe or chronic health conditions that are contraindications. Moreover, patients should also have a strong medical indication for the breast lift. This means that the candidacy is assessed during the pre-operative consultation that you need to have with the plastic surgeon. During this consultation, the plastic surgeon will perform a medical examination on your breasts and also diagnose the level of breast ptosis. Only after this medical examination can the surgical approach for the procedure be defined. It is often during this time that the patient will notice that an improvement in the size of the breasts could be beneficial as well, aside from the lifting effect. Lifting the breasts and adding volume When the breast lift is performed, the plastic surgeon will perform one and up to three incisions that are necessary to allow him to remove the excess skin tissue and underlying fat layer. The breasts are perkier and fuller after the surgery and higher on the chest wall. But due to the skin excision and the re-draping of skin on the mammary tissue, the patient can also notice a small decrease in the size of the breasts after the procedure. This is natural, and it really depends on the amount of tissue to be excised during the procedure. However, this means that for patients who already have breasts on the smaller side, they will look even smaller after the breast lift. For these patients, the recommendation is to have the breast lift performed with a breast augmentation using implants. At this point, it is important to understand that having just a breast augmentation with implants won’t correct your breast ptosis. In a vast majority of cases, even for patients who don’t think they suffer from breast ptosis and want to get implants, the plastic surgeon might recommend a small lift to be combined with the procedure. Breast implants can’t correct the sagginess of the skin, but they can certainly accentuate mammary ptosis, especially if they have a big volume. An experienced board-certified plastic surgeon will be able to advise you in terms of what is the most suitable procedure that you should undergo. In some cases, the recommendation might be to have a mastopexy with an adding of volume, so breast implants will be used. When the breast lift is performed with adding volume, the plastic surgeon will start with the correction of breast ptosis and only after inserting the implants that will provide the desired augmentation. This means that the incisions that will be left after the breast lift are the ones required for the lift. Some patients will have the procedure performed with just a periareolar incision. The plastic surgeon will excise the skin around the areola to perform the lift and also use the incision to insert the implants. Keep in mind that this is possible only from breast ptosis of no more than 2-3 cm and for implants that are not overly large and can fit through that incision. If the breast sagginess is more severe or the silicone implants are larger, the plastic surgeon will have to perform additional incisions during the procedure. Generally speaking, the best results of the breast lift are noticed in women with small breasts that are saggy. When the procedure is performed on them with implants, the results can be impressive. However, it is important to understand that when you have a breast lift with implants, the risks and potential complications of the procedure are increased. Aside from the risks of the breast lift, you are also confronted with the risks associated with the use of implants. Risks and complications There is no doubt that surgery in general has risks and potential complications, and the breast lift is no different. Some of the complications that can occur after the breast lift with adding volume are common for all procedures, and these are: – Complications associated with the use of general anesthesia – Infections – Seroma and hematoma – Excessive bleeding – Delayed wound healing – Skin necrosis – Unsatisfactory results. Aside from these risks that are common to many plastic surgery procedures, we have specific risks associated with breast enhancement procedures such as: – Asymmetric breasts after the surgery – Capsular contracture – Rippling of the breast implants – Visibility and palpability of the implants In other words, aside from the complications of the breast lift, we also have the issues that can occur when we use implants. To reduce the risks and potential complications associated with a lift and implants, make sure to select a board-certified plastic surgeon and follow his recommendations to the letter. Choosing the right implants is essential for the success of your procedure, and this is not something you can do on your own or by following the advice of friends. The right type of implants for your particular case will be determined after complex measurements performed on the breasts and taking into consideration your overall silhouette and aesthetic goals. In a vast majority of cases, even if the risks are increased when combining the breast lift with implants, the results achieved are spectacular and totally worth it, as most patients will declare. What we try to achieve when combining the two procedures is correcting the appearance of the breasts from two points of view: the position on the chest wall and the size of the breasts. Just like in the case of correcting breast sagginess, there are no other efficient and safe methods to increase the size of the breasts aside from undergoing plastic surgery. If you want to see how the results of this type of procedure can look like, you will find plenty before and after pictures on specialized sites. Also, keep in mind that it is only after a medical examination and a discussion with the plastic surgeon that the suitable procedure for your particular case will be determined, so schedule the pre-operative consultation as soon as possible to find out if lifting the breasts with added volume is the procedure for you. Conclusion Lifting the breasts and making them perky becomes a concern for most women after the age of 40. With the help of plastic surgery, we can correct breast ptosis that affects a vast majority of women sooner or later in their lives. In association with this procedure, many women choose to also get more volume to their breasts by having implants inserted. When the breast lift is performed with implants, the patient will enjoy not only having perky breasts but also breasts that look fuller and bigger. Breast implants are commonly used during breast lifts, because a common result of mastopexy is a slight reduction in the size of the breasts due to the elimination of the excess skin and underlying fat tissue. For patients with severe sagginess and small breasts, this can result in very small breasts after the breast lift. After the medical examination that takes place during the pre-operative consultation, your plastic surgeon might advise you to get implants as well, aside from getting the breast lift.