Breast Lift and Augmentation Surgery

What Is Breast Lift with Implants (Augmentation Mastopexy)?

Breast lift and augmentation surgery is a combined aesthetic operation that reshapes sagging breast tissue while restoring lost volume with an implant in the same operation. It is also described as a breast lift with implants, an implant-assisted breast lift, or augmentation mastopexy.

This surgery is a method that yields successful results, especially in:

• after childbirth and breastfeeding,
• in those who have experienced significant weight loss,
• in individuals with age-related breast volume loss,
• in patients with naturally small and sagging breasts,

The goal is not only to enlarge the breasts. At the same time, the goal is to raise the nipple to the ideal level, reshape the lower pole of the breast, and give the breast a younger, firmer, and more balanced shape.

Why Does an Implant Alone Not Correct Every Sagging Breast?

This is one of the points I most frequently discuss during examinations.

Many patients think that sagging breasts can be corrected simply by using a larger implant. However, this is not always true.

An implant can add volume to the breast; however, it cannot lift the downwardly displaced nipple upwards and cannot eliminate excess skin.

Therefore, in patients with significant sagging, using only an implant is not always the answer;

• This can cause the nipple to remain low,
• the lower part of the breast to look heavy,
• and the implant to shift downwards over time.

This can cause the implant to shift downwards over time.

In these cases, breast lift surgery becomes a complement to implant surgery.

&#1f449; If you are wondering in which patients breast augmentation surgery alone is sufficient, you can also check our Breast Augmentation Surgery page.

When Is a Breast Lift Alone Sufficient?

Yes.

It is not correct to place implants in every sagging breast.

If breast volume is sufficient and the patient’s primary expectation is only to achieve a more upright appearance, breast lift surgery alone may be sufficient.
However, if there is significant volume loss in the breast tissue, even if the lift procedure alone tightens the breast, it may not provide the full upper pole appearance the patient desires.
Therefore, the surgical plan should be made according to the patient’s anatomy, not according to ready-made templates.

Who Is a Good Candidate for Breast Lift and Augmentation?

Breast lift and augmentation surgery is not a standard procedure applied to every patient. While some patients only require breast augmentation, others may only need a lift to achieve the desired result.

Combined surgery may be considered when the breasts have become both empty and sagging after pregnancy, breastfeeding or weight loss, particularly when upper-breast fullness has been lost. The aim is not simply to enlarge an empty breast, but to lift and reshape the tissues while restoring volume in proportion to the body.

Here are the most common patient profiles we encounter:

—Patients Experiencing Volume Loss After Childbirth and Breastfeeding

Significant changes can occur in breast tissue after pregnancy and breastfeeding.

In many women;

• breast volume decreases,
• the upper pole empties,
• the nipple shifts downwards,
• the skin loosens.

In this case, using only silicone implants may not be enough to correct the sagging. Similarly, a lift surgery alone cannot restore the lost volume.

Therefore, if both a full and lifted breast appearance is desired after childbirth, combined surgery may be the most suitable option.

Patients Whose Breasts Have Emptied After Weight Loss

After losing a large amount of weight in a short time, while the fat content in the breast tissue decreases, the skin may not recover at the same rate.

As a result;

• the breasts appear empty,
• excess skin occurs,
• the nipple descends.

In these patients, using only a large-volume implant is often insufficient. Because even if the implant adds volume, it cannot correct the sagging skin and nipple position alone.

Patients with Loss of Upper Pole Fullness

In some women, even if the breasts do not sag significantly, volume loss is observed, especially in the upper pole area, known as the décolleté region.

This situation may occur especially;

• after breastfeeding,
• with age,
• after weight changes

If this is accompanied by mild or moderate sagging, combined surgery can provide a more balanced and natural result.

How Does the Degree of Sagging Affect Combined Surgery Planning?

One of the most important assessments in breast lift and augmentation surgery is the degree of sagging. Because not all sagging is the same, and the same incision or implant plan is not applied to every patient.

The position of the nipple relative to the inframammary fold, excess skin, and the amount of downward displacement of the breast tissue are evaluated together.

Mild Sagging

The nipple may be at or slightly below the inframammary fold.

In this group, implants alone may be sufficient for some patients. However, if the upper pole gap is prominent and skin quality is poor, a limited lift procedure may also be necessary.

Here, the decision is made not only by considering the position of the nipple, but also by the overall shape of the breast and the desired fullness of the patient.

Moderate Sagging

The nipple is significantly below the inframammary fold but not at the lowest point of the breast.

In this group, using implants alone is often insufficient. The nipple needs to be lifted and excess skin removed.

If there is also volume loss, adding implants to the lift procedure may provide a more balanced result.

Severe Sagging

The nipple is located well below the inframammary fold and is often displaced downwards.

A breast lift is unavoidable in these patients. Whether or not an implant will be used is determined according to the existing breast volume and the patient’s expectations.

If there is significant volume loss, a combined surgery is preferred. If there is sufficient breast tissue, a lift alone may also be appropriate.

Why Does a Large Implant Not Correct Breast Sagging?

It is common to think that a large implant will lift the breast; however, this approach is not correct in most patients.

The function of the implant is to add volume. It does not remove excess skin and does not lift a displaced nipple upwards.

Using an excessively large implant:

• can increase the load on the skin and breast tissue,
• can predispose to downward displacement of the implant,
• can create a weighted appearance in the lower part of the breast,
• can increase the risk of sagging again in the long term.

Therefore, implant volume should be chosen not to conceal sagging, but in accordance with the base width of the breast, tissue thickness, and the desired appearance.

How Is Implant Selection Planned in a Sagging Breast?

In breast lift and augmentation surgery, implant selection is not simply about deciding how many cc to use.

The main features evaluated are:

• breast base width,
• Thickness of existing breast tissue,
• Upper pole space,
• Ribcage structure,
• Skin elasticity,
• Desired projection,
• Targeted postoperative appearance.

In some patients, a smaller volume implant with high projection may be sufficient. In some patients, a wider base implant is preferred.

The choice between a round or anatomical implant is not determined solely by the question of “which one looks more natural?”. The effect the implant will create in the breast, the placement plan, and the patient’s existing tissue are evaluated together.

If you would like to examine the advantages and limitations of breast implants in more detail, You can also check out our page on the Pros and Cons of Breast Implant Surgery.

In Which Plane Is the Implant Placed in a Sagging Breast?

The implant can be placed supramuscularly, submuscularly, or in a dual plane. In combined surgeries, the choice of plane depends on the tissue thickness, the degree of sagging, and the characteristics of the implant to be used.

In patients with thin tissue coverage, submuscular or dual plane placement may better cover the upper part of the implant.

In some patients with sufficient breast tissue, supramuscular placement may be considered.

There is no single correct plan that applies to everyone. The goal is to choose a placement where the implant will remain stable in the long term and will appear harmonious with the breast tissue.

What Is the Internal Bra Technique?

An intrabreast bra is the reconstruction of tissues within the breast using sutures to support the breast tissue and implant.

Although this term is sometimes used as if it were a single technique, it is actually a general definition encompassing different tissue support methods.

During surgery:

• the inframammary fold can be recreated,
• the implant pocket can be narrowed,
• lateral opening can be limited,
• the breast tissue can be fixed higher,
• the lower pole support can be strengthened.

An internal bra is not necessary for every patient. It becomes even more important, especially in patients with significant tissue laxity, those who have previously experienced implant displacement, or those with weak lower pole support.

In my approach, an internal bra is not a marketing phrase applied to everyone as a standard; it is a surgical support method used if needed.