Getting cosmetic work done on your body is a big decision, especially when it comes to your breasts. Deciding on what breast enhancement is best for you can be a long process. One of the first aspects of the decision is determining whether you want a breast augmentation, a breast lift or a combination of the two, or something else entirely. Sure, you know you want to improve the appearance of your breasts, but which parts of them? While it may seem as simple as whether you want your breasts bigger or higher, it’s a bit more nuanced than that. Here, plastic surgeons help pinpoint how to decide if a breast augmentation, breast lift or combination is right for you.
First, consider your anatomy
The biggest factor when it comes to considering cosmetic breastwork is your own anatomy and your doctor’s take on what might suit you. “During the consultation, it is crucial that you discuss with your patient not only their goals, but their natural anatomy and how this will play into their result,” say Houston plastic surgeon Henry Mentz, MD and physician assistant Nadia Hafeez, PA-C. “Anatomy is key in determining whether your patient requires a breast augmentation alone versus a breast lift versus a combination of both.”
If you’re looking for volume, you’ll need a breast augmentation
“When do you need an augmentation? Easy. When you want to be larger. That is the easiest one,” say Tucson, AZ plastic surgeon Raman C. Mahabir, MD and Silvia Kurtovic, MD. New York plastic surgeon B. Aviva Preminger, MD notes that many women experience a loss of breast volume, as well as sagging, after pregnancy, breastfeeding or weight loss which may lead them to seek a breast augmentation.
“Breast augmentation increases the volume and projection of breasts to create a fuller, more enhanced appearance,” Dr. Mentz and Hafeez say. While an augmentation is great for adding volume, there are some aspects it can’t adjust. “Breast implants alone do not change the shape or position of your breasts on the chest wall nor do they change the size of the areola or the position of the areola-nipple complex. Think of it as adding air into a balloon—the balloon already has its shape,” they explain. If breasts are sagging, an augmentation will not help much to lift them, which is what might lead people to choose to combine a breast augmentation and a breast lift.
Consider nipple placement
While deciding whether one may benefit from a breast augmentation is a bit more clear cut, Drs. Mahabir and Kurtovic say deciding when someone could use a lift can be a bit more challenging. The key to deciphering who is a good candidate for a lift is “the position of the nipple when you are standing.” If the nipple is a certain distance below the breast fold, Dr. Pregminger says a lift may then be required.
“Sometimes adding volume achieves enough lifting without a formal lift,” says Dr. Preminger. “In other cases, implants can be combined with a surgical lift, or a lift alone can be used to reposition volume to the upper medial pole of the breasts where most women want it.”
Drs. Mahabir and Kurtovic note that you may need to get a second lift down the road if you do a lift without an augmentation. Additionally, they point out that some surgeons offer patients “mesh” or internal support, but none of these options are FDA-approved and warrant a longer conversation about risks versus benefits.
If you’re a candidate, you can get both procedures at once for a total breast makeover
Many patients opt to get both at once to have fuller and perkier breasts. “The addition of breast implants to a lift will help improve the overall shape and fullness, especially at the upper poles,” say Dr. Mentz and Hafeez. However, those with a significant amount of their own breast tissue often don’t need the addition of an implant on top of a lift to achieve shape and volume.
Fat grafting may come into play
Fat grafting, which uses a patient’s own fat to add volume, can be used during a breast lift or augmentation. “In some cases where an implant is not needed or wanted, I will do a breast lift with fat grafting to improve the overall appearance of the breasts,” say Dr. Mentz and Hafeez. “Fat grafting is an excellent way to provide volume and has become extremely popular with patients who desire a more natural appearance.”
Dr. Preminger says sometimes she combines implants with fat for a “composite breast augmentation” to achieve a natural result. “These days, this can also be accomplished with fat or with rearranging your own breast tissue,” she adds.
