Breast Lift vs. Breast Augmentation: Which Is Right for You?

While patients can almost always identify what they don’t like about their breasts, they don’t always know which operation will best address their concerns. While a breast lift surgery (mastopexy) and breast augmentation  share many features, they are very different operations designed to accomplish very different goals.

If you’re dissatisfied with your breast size and appearance and are seeking surgical correction, understanding your options is critical. In this blog, we’ll explore the differences between a breast lift and breast augmentation and help patients understand which one best fits their needs.

What Is the Difference Between a Breast Lift and a Breast Augmentation?

As women age, their breasts tend to undergo predictable changes that may be exacerbated by pregnancy, breastfeeding, weight fluctuations, or even genetics.

These changes include:

• Loss of breast volume and youthful “perkiness”
• The development of loose, saggy, inelastic skin, often with stretch marks
• Drooping breast tissue and/or nipple and areola below the natural fold of the breast (ptosis)

Breast Lift

A breast lift, or mastopexy, is an operation designed to address these changes by tightening the skin envelope of the breast and re-positioning the nipple-areola complex to a pleasing anatomic position. While there are many variations and nuances, all mastopexy procedures address these general changes.

Determining the correct mastopexy procedure is a separate discussion, but the best treatment largely hinges on the degree of breast sagging, or “ptosis.” A detailed discussion of ptosis can be found in my previous blog on the internal bra.

While a mastopexy does a beautiful job of restoring a more youthful breast shape and better-positioned nipple-areola complex, it does not address breast volume. In fact, tightening excess skin often results in making a breast appear smaller, albeit with a more pleasing shape.

In summary, a mastopexy:

• Tightens loose breast skin
• Reshapes and rejuvenates the breast
• Repositions the nipple-areola complex to a pleasing, youthful position
• Does not address breast volume

*A mastopexy primarily improves breast shape but does not address breast volume

Breast Augmentation

Unlike a mastopexy, breast augmentation is an operation designed to increase breast volume. There are multiple approaches to augmentation, including using a patient’s own fat (known as fat grafting), using saline or silicone implants, or a combined procedure (composite augmentation).

While it is different for each patient, a breast augmentation may also have the added benefit of improving breast shape and even correcting some very mild sagging of the nipple.

In summary, a breast augmentation:

• Adds volume to the breast with fat, saline or silicone implants, or both
• Often improves the shape of the breast
• May correct very mild sagging breasts and/or drooping nipple-areola complex without a mastopexy

*Breast augmentation primarily increases breast volume but often improves breast shape

So Which Operation Is Right for Me?

My mother always told me never to answer a question with a question, but this one is crucial.

I always start by asking patients: “Do you like the volume of your breasts when they are in a bra?” If the answer is “no,” then a lift alone will not make the patient happy, and an augmentation (witht or without a lift) will be required to give them the volume they seek. If the answer is “yes,” then a breast lift procedure alone may very well give you the results you seek.

However, this isn’t always the case. To understand why, it’s necessary to understand the concept of the “upper breast pole.”

Think of the upper breast pole as the part of the breast or chest that isn’t covered by a bra, or the section that’s exposed by a low-neckline dress. The French call this the “décolleté.” In America, we call this the “Social Breast.” But I digress.

It is important to understand that a mastopexy will not improve or restore upper pole volume, which many patients often associate with youth. To do this, breast augmentation is required.

*A mastopexy alone will not enhance or restore the upper pole breast volume. This can only be accomplished with a breast augmentation

Case Study: Mastopexy With Mesh

A picture is worth a thousand words, so let’s summarize everything we’ve talked about so far with a case.

If you’ve read my other blogs, this patient will look familiar. She is a 32-year-old woman who felt as though her breasts were too “droopy” and lacked shape. As I always do, I asked her if she was happy with the volume of her breasts in a bra and noted her lack of upper pole volume. After she confirmed she was happy with her overall volume, we settled on a breast lift with a mesh.

Her 3-month post-op results are shown below on the right. Note the improved shape, restoration of her youthful form, and the surprising amount of native breast volume. The patient was thrilled with her beautiful results.

Two years after her initial operation, the patient returned to me. She had lost around 15 lbs, which resulted in a significant loss of breast volume.

At this point, she was interested in adding volume. Since she had no fat for grafting, we settled on silicone breast augmentation to improve overall volume and shape. Her two-week post-operative results are shown below. Note the dramatic improvement in upper pole volume.

This case beautifully illustrates how a breast lift differs from a breast augmentation. In the first operation, the patient was seeking improved shape, but she was happy with her native volume. A mastopexy alone provided her with exactly the results she sought. As she lost weight, however, she desired more volume. A second operation in the form of a breast augmentation restored her lost volume and shaped her upper pole.

What Is Augmentation-Mastopexy?

The example above involved two operations because the patient’s goals changed as her weight fluctuated. However, is there a scenario where both a mastopexy and a breast augmentation are required and can be accomplished in a single operation? As you may have guessed, the answer is yes, and the procedure is called an augmentation-mastopexy.

An augmentation-mastopexy:

• Improves or restores breast shape by tightening loose breast skin and reshaping the natural breast tissue
• Increases breast volume with fat grafting and/or breast implants
• Is required for patients with more advanced ptosis seeking increased breast volume
• Is often performed as a single operation

*Patients who desire more volume and have an advanced degree of breast sagging (ptosis) will require an augmentation mastopexy to achieve the results they seek

Case Study #2: Augmentation-Mastopexy

The case below illustrates such a scenario. This patient is a 33-year-old primarily seeking more breast volume. As can be seen from her pre-operative photos, she has a significant degree of breast sagging, with the nipple-areola complex pointing downwards.

Given this degree of ptosis, an augmentation alone would not have given the patient a satisfactory result because the nipple-areola complex would sit well below the implant. As a result, the patient underwent an augmentation-mastopexy to reposition the nipple higher, allowing it to sit in a more pleasing position above the implant.

Key Points to Take Away

A breast lift, or mastopexy, may be right for you if you:

• Are happy with your breast volume in a bra but are otherwise dissatisfied with their appearance when braless
• Feel as though your breasts have drooped over time
• Feel as though your breasts have lost their youthful shape and contours

A breast augmentation may be right for you if:

• You are dissatisfied with your breast volume, even when wearing a bra
• Your breasts have experienced minimal signs of natural aging including extra skin and/or nipple-areola descent
• Are looking for additional upper pole breast volume specifically
• Are looking for breast enhancement that helps you fit clothes better
• Are looking for a rounder breast appearance

An augmentation-mastopexy may be right for you if:

• Are dissatisfied with the shape and volume of your breasts even when wearing a bra
• Have more advanced signs of breast aging including loss of volume, extra, loose skin and descent of the nipple-areola complex
• Are looking to enhance the way your breasts fill out cloths
• Are looking for a rounder appearance to the breasts

Breast Lift and Breast Augmentation FAQs

Do a mastopexy and an augmentation leave the same scars?

No. A breast augmentation is typically performed through a small incision within the natural breast fold or around the lower half of the areola. Breast lift scars can vary, but they typically require an incision around the areola. In more advanced signs of breast aging, additional scars down the front of the breast and within the breast fold may also be required to shape the breast in multiple dimensions.

When are two separate operations required for augmentation-mastopexy?

In patients who struggle with severe signs of breast aging or have undergone massive weight loss, it’s recommended to perform a breast lift followed by a breast augmentation three months later. This approach gives Dr. Gougoutas much more control over the final breast position and shape. It also allows patients to have more say in their implant sizing once the breast has been restored to a more youthful contour and position on the chest wall. Finally, it’s beneficial for patients who are unsure if they want more volume but know they are dissatisfied with their breast shape, as it allows them to get used to their new breast shape and position before committing to an implant.

If I’ve had a previous breast augmentation but my breasts have aged around the implant, can I get a breast lift without replacing my implants?

Technically, yes. However, in almost all scenarios, aging of the breasts takes many years to happen. If you feel as though your breasts need rejuvenation in the form of a lift, it may be time to replace your implants, which can easily be performed in the same operation.

Will either a breast lift or breast augmentation decrease my nipple sensation?

Because a mastopexy requires more incisions to shape the breast, there is a greater chance that you may experience some loss of breast or nipple sensation. However, this is generally minimal or short-lived. A breast augmentation alone rarely results in a change of nipple sensation.

I’m interested in implants, but I’ve heard they need to be replaced every ten years. Is this true?

In general, implants may need to be replaced every 10 to 15 years. This is, however, a rule of thumb and not a firm guideline. For further discussion of implant replacement, please see my blog: When Do I Need To Get My Breast Implants Replaced?

Learn More About Breast Mastopexy and Augmentation in Seattle

Deciding between a breast lift, breast augmentation, or both can be a complicated and anxiety-provoking decision. Being educated on the many options open to you and having transparent, honest communication with the right surgeon about your breast anatomy is critical in helping you reach your specific goals.

To learn more about a breast lift and a breast augmentation in Seattle, schedule a consultation with board-certified plastic surgeon Dr. Alexander Gougoutas today by calling (206) 320-6138 or completing the online contact form.