A breast lift (mastopexy) does not inherently require breast implants. The procedure addresses sagging by repositioning the breast tissue, skin, and nipple-areola complex to a more elevated position. The decision to include implants depends on the patient’s existing anatomy, the quality of their natural breast tissue, and their desired final outcome regarding volume and fullness.
The Primary Goal of a Breast Lift
A mastopexy without augmentation functions purely as a reshaping and repositioning procedure. The operation focuses on correcting mammary ptosis (breast sagging) caused by factors like aging, pregnancy, or weight fluctuations. It achieves this by removing the stretched, excess skin envelope and tightening the remaining tissue to create a firmer, supported shape. Crucially, the procedure involves elevating the nipple-areola complex (NAC) to a higher location, typically above the inframammary fold. The lift restores a more youthful contour using only the patient’s existing tissue, concentrating it to improve shape and projection without adding volume.
When Implants or Volume are Recommended
While a breast lift corrects position, it cannot restore volume lost due to events like breastfeeding or significant weight loss. When a patient desires a noticeable increase in breast size or enhanced upper pole fullness, a procedure to add volume becomes necessary. This combined surgery is referred to as an augmentation-mastopexy.
Breast Implants
Breast implants (silicone or saline) are typically used when a significant volume increase is desired, often exceeding one cup size, offering a predictable shape and projection. Implants are placed to fill out the upper portion of the breast, which often becomes deflated after volume loss, providing a fuller, rounder look.
Autologous Fat Grafting
Autologous fat grafting is an option for patients seeking a more subtle volume increase or refinement. This technique involves harvesting the patient’s own fat from other areas, such as the abdomen or flanks, and injecting it into the breasts. Fat grafting provides a natural feel and appearance and is typically limited to a modest increase, generally up to one cup size, as not all transferred fat cells are guaranteed to survive the process.
Determining the Best Surgical Approach
The selection of the most appropriate surgical plan (lift only, lift with implants, or lift with fat) is an individualized process determined during the surgical consultation. The surgeon assesses several anatomical factors to ensure a safe outcome. A primary consideration is the quality and volume of the existing breast tissue, which dictates how much natural fullness can be retained and whether supplemental volume is required.
The elasticity and laxity of the patient’s skin envelope are also significant factors, as the skin must securely hold the new shape, especially if an implant is introduced. Poor skin quality or severe ptosis may complicate a single-stage augmentation-mastopexy. In complex cases, the surgeon may recommend a staged procedure: performing the lift first to create a stable tissue envelope, and then inserting the implants three to six months later.
Patient goals are paramount, determining whether the priority is solely improved shape and lift, or if it includes a desire for increased size. A lift alone is suitable for patients satisfied with their current volume, while a combined approach is necessary for those seeking both elevation and increased fullness. The surgeon synthesizes these anatomical realities with the patient’s aesthetic preferences to develop a tailored surgical strategy.