Do I Need a Breast Lift and Implants or Breast Implants Alone?

The most common question my breast augmentation patients ask me is whether they need a breast lift or mastopexy in addition to breast implants. This is especially common after patients have had children or have lost weight. The key factor in answering this question is whether you have mammary ptosis or sagging of the breast. If you have significant mammary ptosis then you will need a lift in addition to implants.

What is Mammary Ptosis or Sagging of the Breast?

The diagnosis of mammary ptosis depends on the position of the nipple relative to the inframammary fold or the fold under the breast also called the inframammary crease. If your nipple or a significant amount of breast tissue is hanging below the inframammary crease then you have mammary ptosis and will need a lift in addition to implants. Breast shape as relates to ptosis or sagging is categorized as follows:

1. Normal breast-The breast shape and position is considered normal if the nipple and breast gland is above the inframammary fold, the fold under your breast.

normal breast shape side view

Side view of normal breast shape

2. Pseudo ptosis – The breast gland is below the inframammary fold but the nipple is still above the fold.

3. Grade 1 ptosis– The nipple is at the fold under the breast but still above the breast gland.

4. Grade 2 ptosis– The nipple lies below the fold under the breast but still lies above the lowest point of the breast gland.

5. Grade 3 ptosis– The nipple lies below the fold under the breast and below the breast gland.

Different degrees of mammary ptosis or breast sagging

Different degrees of mammary ptosis or breast sagging

The Pencil Test for mammary ptosis

One test you can do at home is called the pencil test. To do the pencil test place a pencil into the fold under the breast and drop your breast. If the pencil stays in place you may have significant mammary ptosis or sagging and may need a lift in addition to implants. If the pencil drops to the floor you likely do not have mammary ptosis and will likely be able to have implants alone.

Implants alone without a breast lift for normal breast shape

If your breast and nipple is above the fold under your breast then you can have implants alone without a lift.

Implants alone without a breast lift for breast pseudo ptosis

If you have Pseudo ptosis you often can have implants alone without a lift. Often the implant can be placed under the chest muscle, called a sub muscular breast augmentation. However in some cases the implant must be placed under the breast gland, a sub glandular breast augmentation.

Implants with a breast lift for Grade 1 breast ptosis

Patients with grade 1 ptosis may be able to have implants alone if the implants are placed under the breast gland, a sub glandular breast augmentation. However if a lift is needed it is often possible to do the lift with an incision only around the areola, a Periareolar mastopexy or breast lift.

Implants with a breast lift for Grade 2 breast ptosis

When the nipple is below the fold under your breast you will need a breast lift in addition to implants. Usually a lift with a scar around the nipple and under the breast is required. This can be a Lollipop lift or and Anchor lift.

Implants with a breast lift for Grade 3 breast ptosis

Grade 3 mammary ptosis almost always requires an Anchor breast lift in addition to implants.

Why a breast lift is needed in addition to implants when you have ptosis-The Snoopy Deformity

When a breast implant is placed under the breast or chest muscle the implant is positioned above the inframammary crease or fold under the breast.

Breast implants can be placed under the breast or under the muscle

Breast implants can be placed under the breast or under the muscle

If the nipple is below the inframammary crease the implant can push the nipple further down. The result is that the implant causes a bulge or mound above the nipple and the nipple appears lower. The side view of the breast then resembles the profile of the cartoon character Snoopy as shown in the drawing below:

Snoopy deformity occurs when a breast implant is placed into a sagging breast without doing a breast lift

The Snoopy deformity can occur when a breast implant is placed under the muscle in a sagging breast without also doing a breast lift

In summary if you have significant mammary ptosis or breast sagging that causes your nipple to be below the fold under your breast you will likely need a breast lift in addition to implants. The pencil test descried above can help you determine if you may need a breast lift in addition to implants. Please consult an experienced board certified plastic surgeon with experience in breast implant surgery for an examination and consultation.