I see a lot of patients who come in for a consultation for breast augmentation and either know they definitely need a breast lift (mastopexy) or do not realize that they need a lift. An augmentation – mastopexy is one of the most complex surgeries that plastic surgeons perform and they carry a high complication and revision rate as a result.

When I evaluate a breast, I take measurement and analyze the breast. The shape of the breast is taken into account particularly when viewed from the side or lateral position. I am looking to see how much breast tissue is below the breast crease and where the nipple is positioned. This determines the amount of droopiness or “ptosis”.

Women should begin to consider a breast lift when the nipple is at or below the level of the breast crease. Contrary to what some surgeons tell women, a breast implant does not “lift” the breast. If the nipple position is low to begin with, it will remain low after.

If the nipple is at the lowest point on the breast (pointing down towards the floor), then you are not a good candidate for a breast implant and lift in one operation. The breast lift needed is significant and will result in complications or re-operation if done in one surgery (with rare exceptions). In these situations, it is best to do a lift first then place the implants a couple months later. The risk of incision separation and possible infection of the implant is high if done in one surgery, especially if you are a smoker or have thin tissue.

A woman with a nipple above the breast crease and not too much excess skin is a good candidate for a one – stage augmentation – mastopexy as long as the implant desired is not too large.

Do not be fooled by a plastic surgeon that will offer to do your surgery in one procedure despite these conditions being present. It will end up costing you a lot more than just money in the long run!