That’s one of the most common questions that a women considering breast augmentation asks herself and her surgeon, and is particularly relevant when a woman has some degree of ptosis (droopiness) of the breasts. It is a very valid question, as not performing a lift (mastopexy) with an augmentation where it’s indicated can result in displeasing results. The flip side to doing a lift of course is the associated scarring – this is unavoidable, as a mastopexy requires removal and tightening of breast tissue and skin.
When we analyse ptosis, we must consider it in two parts: 1. nipple ptosis and 2. glandular ptosis.
Nipple ptosis refers to where the nipple lies in relation to the inframammary fold. Glandular ptosis refers to where the majority of the underlying breast tissue lies in relation to the fold. When the nipple is below the fold, it generally means that a lift is required. When the nipple is above the fold, a lift is generally not required. A more difficult decision arises when the nipple is at the fold. This is when the pros and cons of a lift versus implants alone need to be discussed. With glandular ptosis an implant of sufficient size may occasionally be used to fill and push out the breast.
With the newer generation of anatomical highly cohesive silicone implants, there are now some situations whereby a patient who has borderline ptosis may get away with having implants alone. In these situations, one would always caution the possible downsides to having implants alone, such as early recurrent ptosis and the requirement to do a secondary lift some time down the tract.