Women desiring prettier and larger breasts might decide against a breast lift even though they might need one. Patients will ask, “I want bigger breasts, but I don’t want a lift. What will I look like?” The result will be a bigger and more attractive breast, but different than if a lift is done. The result tends to be fuller breasts that are lower than the patient having implants who has no hanging. This educational writing reviews this situation in detail to help you better understand the operation and result. This educational writing was written at the request of a patient of mine from Dover, DE.
The results of breast enlargement in patients without any hanging is covered in the breast augmentation section of my web page. You can see many before and after pics of these patients now. The medical word for a breast lift is mastopexy. The results of women with implants and a lift is also covered on my web page. But the results of what you look like if you have hanging and you decide not to do a lift, is typically not reviewed. This is the topic of this writing.
Breast Hanging or Ptosis
It’s important to first understand the different degrees of breast hanging. Ptosis is the medical word for breast hanging. The normal breast has no hanging, and the breast tissue and nipple is above the crease at the bottom of the breast. Level 1 ptosis is where the nipple and breast have descended, and the nipple is at the level of the crease. We can call this minor ptosis. In level 2, the breast gland has dropped even further and it’s 1-3 cm’s below the crease. This can be called moderate ptosis. In level 3, the breast and nipple are pointing straight down, and this is the most severe droopy appearance. This is major ptosis. Finally, there is a type of hanging where just the bottom of the breast droops. This is called pseudoptosis. In the diagram below, these levels of ptosis are pictorially outlined. The dotted line is the level of the breast crease, where the wire of a bra would go.
There are no set answers to who needs a breast lift. Measurements and a thorough consultation will help me guide you. This will determine how much hanging you have and what level of ptosis you have. Many doctors, I believe, will not recommend a lift for level 1 or minor ptosis. In this situation, the hanging is minimal; and the implant will fill up the tissue, and women will usually get good results.
With level 3, the breast has severe hanging, and implants without a lift will give unattractive results most often. Sometimes this is called a “rock in a sock.” The best operation in this case is breast augmentation and lift. A mastopexy is absolutely needed.
The difficult decision is when the woman has level 2 ptosis or moderate hanging. I will measure your hanging down to the millimeter to help with the meticulous operation. As I have said, I describe this degree of hanging as moderate. Small degrees of hanging don’t need a lift usually. Large degrees of hanging definitely need one. It’s the case where there is moderate ptosis that we need to decide if a lift is best for the patient.
Patients might ask, “Why not just do the lift anyway?” This is a reasonable question. The answer is that a lift is drastically different then just an enlargement. Breast enlargement is done through small incisions in the crease. There might just be an inch long incision. They almost uniformly heal well with excellent results. The incisions are rarely a concern. In contrast, lifts have long incisions that go around the nipple and down. Sometimes a longer incision is needed in the crease, and this would be called an anchor pattern. These incisions fade typically well, but it’s way more cutting and suturing then with just augmentation. Also the expense is dramatically more! Breast lifts can double or triple the cost of breast implants alone. So the factors of a longer and more expensive operation coupled with the longer incisions will make some women not want to do a mastopexy.
The million dollar question is, “What will I look like if I have moderate hanging and I don’t do a lift?” In a consultation, I will show you a large amount of before and after photos of patients with this situation. I describe the result as being a bigger you. This means that the breast will be fuller and more attractive. It will be bigger at the top of the breast, but the breast will be bigger in the lower location it was before surgery. The operation will not magically lift it up 6 inches on your chest.
Most patients are very happy with the results. I have been extremely surprised by the high degree of satisfaction with this procedure. Many patients will say they have a mature look that is still bigger, fuller, and attractive. They can always push the breast up to a higher position with a bra if they feel it is too low.
If a woman decides not to do a lift, it’s important to understand what can go wrong and what are the risks. I review risks in extensive detail with all my patients during the consultation. Most woman are very happy with this surgery. But this is a discussion of what might go wrong. If you don’t do the lift, one of the main risks is being unhappy and wishing you had done the lift. Some people believe the operation will deliver results that are not realistic. This is described as not having realistic expectations. The implants will fill up the tissue and give you a more full and attractive result. However, it is a lower and more mature appearance compared to a 20 year old woman with no hanging. Some patients will do the operation and feel they are too low and that they now need a lift.
I often describe risks of implants as falling into 3 main risk categories. These are popping of the implants, scar tissue formation inside, and shape issues. If you need a lift and choose NOT to do the lift, you have a greater chance of being unhappy with your shape compared to woman who have no hanging. This should make sense.
As I have described above, most women are happy with the results and the operation. You just need to have realistic expectations. It doesn’t turn you into a 20 year old Instagram model. However, if a person is not happy with the results, she can always do the lift at a later stage. She hasn’t been harmed by not doing the lift. She will just have to do it at a later time. Like all cosmetic surgery, she will have to pay for this second operation, as second operations have additional expense. It’s not the doctor or me doing wrong. Most people are very happy with the results. Some patients will not get the results that are desired, and a mastopexy or lift will be the answer.
Breast augmentation gives wonderful and attractive results to most women. However, women that have significant hanging or ptosis of the breast might need a lift. Usually small degrees of hanging do NOT need one, and they will typically get excellent results. Severe degrees of hanging almost always require a lift or results will be less than desired or suboptimal. In the case of moderate hanging, most women will get results that can be described as a bigger you. This is a fuller and more attractive breast, but it is in the lower location that the breast was before surgery. Satisfaction rates tend to be very high, but risks include not being happy with the appearance. This might lead to the decision to do the lift at a later stage or time. For those interested in additional information on breast augmentation and lift, click here.