Summary:
If your breasts look less full or sit lower than they once did after pregnancy, weight loss, or ageing, you might assume that breast implants are the natural next step. However, the concern is not always a lack of volume. In many cases, it is the position of the breast tissue and nipple that has changed.
That’s where a breast lift surgery (mastopexy) may be appropriate. It addresses sagging by reshaping and repositioning the existing breast tissue.
To help you understand the different factors that go into deciding between the two procedures, we’ve prepared this guide.
Sagging and volume loss can look similar at a glance, but they're different problems with different fixes.
Sagging, or ptosis, is about position rather than size. The nipple sits at or below the fold underneath the breast (the inframammary fold), even if the breast still contains a reasonable amount of tissue.
Volume loss looks different. The breast appears deflated, particularly in the upper part, while the nipple can still sit above the fold in a relatively normal position. This is what an implant is designed to correct.
Breast implants often come to mind first because they are the more familiar and widely marketed option. However, implants primarily add volume; they do not correct a descended nipple or reposition sagging breast tissue.
In some cases, adding an implant without addressing existing sagging can make the drooping appearance more noticeable rather than improve it.
After pregnancy, breastfeeding, or significant weight change, sagging and volume loss frequently occur at the same time.
This is one of the reasons a breast lift is sometimes combined with implants or other procedures as part of a holistic mummy makeover.
Before recommending a procedure, a plastic surgeon will assess a series of specific physical measurements rather than relying on appearance alone.
The starting point is comparing where the nipple currently sits relative to the inframammary fold. This single measurement does more to guide the treatment decision than almost any other factor.
Skin elasticity affects both the degree of sagging and how a lift will settle afterwards. Skin that has lost elasticity, often through pregnancy, significant weight change, or smoking, behaves differently to skin that has simply aged gradually.
Your surgeon will also assess how much natural breast tissue is present, since this affects whether a lift alone will provide an adequate result or whether added volume is needed.
Sagging is generally graded using the Regnault classification, which describes the nipple's position in three degrees of severity based on its relationship to the breast fold, from the nipple sitting at the fold through to it reaching the breast's lowest point.
This grading helps determine which lift technique is appropriate.
These factors can help determine whether a breast lift, an implant, or a combination of both may be more appropriate.
This is the clearest single indicator that sagging, not volume loss, is the primary issue. A lift repositions the nipple and reshapes the breast envelope around it.
If you're happy with your breast size and the main concern is where everything sits, a lift alone may be enough, without the added volume an implant would bring.
Some patients want a fuller look; others simply want their existing breast tissue to sit higher and look less deflated. A lift addresses shape and position specifically, not overall size.
Results are more likely to hold if your weight has been stable for some time and you aren't planning further pregnancies, since both future weight changes and pregnancy can affect your lift's results.
If a few of these apply to you, it's worth having a proper assessment. Speak to the team at Polaris Plastic & Reconstructive Surgery to find out which criteria apply to your anatomy.
These criteria play out differently depending on what caused the change in the first place.
Pregnancy and breastfeeding commonly cause both sagging and volume loss together, which is why breast concerns are so often assessed alongside abdominal changes as part of a mummy makeover rather than in isolation.
Significant weight loss can leave loose, stretched skin with comparatively little tissue underneath to fill it. In these cases, a lift is often the primary need, sometimes with added volume if enough natural tissue isn't left to work with.
Gradual sagging with age tends to develop more slowly and evenly than pregnancy-related changes, and is usually assessed on its own rather than alongside other post-pregnancy concerns.
Some patients need both a lift and added volume at the same time, an approach called augmentation-mastopexy.
Combining the two procedures can carry a higher complication rate than a lift performed on its own, which is why your surgeon will weigh this against the convenience of a single operation when discussing your options.
As with any surgery, it's worth understanding what a lift can't do and what to watch for afterwards.
A breast lift involves a trade-off between improved breast position and visible scarring.
Rather than adding volume, the procedure reshapes and repositions your existing breast tissue through incisions that vary according to the degree of lift required.
These may be placed around the areola, extend vertically down the breast, or continue along the breast fold.
As with other breast procedures, a breast lift carries a risk of temporary or, less commonly, lasting changes in nipple sensation, as the nerves supplying the nipple may be affected when the breast tissue is reshaped and repositioned.
Sensation often improves as healing progresses, although recovery varies between patients. Breastfeeding may still be possible after a breast lift, but it depends on the surgical technique used and individual circumstances. Your doctor can assess your health and any particular risks you are susceptible to and account for these in your treatment plan.
See your surgical team promptly if you notice increasing pain rather than gradual improvement, fever, spreading redness, or unusual drainage from a wound. These aren't expected parts of normal recovery.
A breast lift (mastopexy) removes excess skin and repositions the nipple and surrounding breast tissue to sit higher on the chest, without adding volume. The specific technique and scar pattern depend on how much lift is needed.
This depends on whether your main concern is position (a lift) or volume (an implant), or both. An in-person assessment of your nipple position, skin quality, and remaining breast tissue is the most reliable way to tell.
Yes. Many patients with enough remaining breast tissue only need repositioning, not added volume. Implants are only added when volume loss is a separate, additional concern.
Results are generally long-lasting, though they aren't permanent. Future pregnancy, significant weight change, and normal ageing can all affect how long a lift holds its result.
Not typically. A lift repositions existing tissue rather than removing volume, though a small amount of tissue may be removed depending on the technique. If you also want a size change, it is usually addressed alongside the lift rather than as a side effect.
If sagging, rather than volume loss, is your main concern, a breast lift may be the more appropriate procedure, whether on its own or alongside other treatment.
At Polaris Plastic & Reconstructive Surgery, our plastic surgeons assess breast lifts, augmentation, and combined mummy makeover procedures on a case-by-case basis. We will only recommend what is appropriate for your health and aesthetic needs.