Breast Augmentation or Breast Lift: Which is Right for You? By Joseph M. Brown, MD, FACS on March 14, 2017

I don’t like the way my breasts look. Am I a candidate for a breast augmentation or a breast lift? What is the difference between the two?

Due to a patient’s natural morphology, or due to changes associated with pregnancy, weight fluctuation, or with natural aging in the presence of our friend, gravity, many women are unhappy with the shape or appearance of their breasts. Breast augmentation and mastopexy (or breast lift) are two distinct surgical procedures that create different changes in a breast. Breast augmentation involves placing an implant underneath the breast tissue and/or the muscle underneath the breast tissue to increase the volume of a breast. This gives the breast mound more projection and makes it appear fuller. This surgery is best suited for women who want to be bigger. In other words, even with a supportive bra the patient wishes her breasts were larger and is unhappy with her current volume. Most of my patients who have had this have felt their breasts were small their entire lives, or noticed significant deflation after childbirth.

Mastopexy, or breast lift, is a surgery that aims to decrease the amount of excess skin on the breast, while maintaining its current volume. It also places the nipple in a higher, more forward-pointing position as some patients may have noticed their nipples “moving” lower and lower on their breast mound over time.

I always ask my patients if they are happy with their current breast size when they are wearing a supportive bra. If their answer is “yes, but I would like for my nipple position to be where it was when I was younger,” then that patient would likely benefit from a mastopexy. If the answer is, “No, I would prefer to be bigger/have more volume,” then that patient would likely benefit from a breast augmentation, with or without a lift.

What if I want my breasts to be more youthful and bigger?

Some women notice both sagging and deflation of their breast tissue after weight loss or pregnancy. These patients desire a more youthful position of their breasts and are unhappy with their volume of breast tissue while wearing a supportive bra. These patients are candidates for augmentation-mastopexy, which involves placement of an implant under the breast tissue while at the same time performing a breast lift. This may be performed in a single operation safely for many patients. In some situations, it is safer to separate the two procedures by about 3 months. This is a decision that is made based on the volume of breast tissue a patient already has as well as the extent to which the breast needs to be lifted.

If my breasts appear saggy, can an implant make them look perkier?

Yes….and no. If the main cause of the sagging appearance is deflation and the breast is in a good position with respect to the rest of a woman’s body, an augmentation can restore volume in a deflated appearing breast and make it appear “perkier.” However, the amount of “lift” that comes from placing an implant on nipple position is mild. For patients who have had significant descent of their breast tissue and have significant amount of excess skin, it would take too large of an implant to create a “lifting” effect. The key to deciding between an augmentation vs. a mastopexy is an open dialogue between the patient and the plastic surgeon. Good communication will allow for a clear definition of the specific concerns a patient has regarding her breasts, which allows for an appropriately selected treatment plan.