Breast Lift vs. Augmentation: How to Choose the Right Procedure for Your Goals
As a plastic surgeon, I approach breast surgery with a focus on preservation. When performing a breast augmentation, I work to preserve as many of the muscular attachments as possible, helping maintain the position of the implants over time. I focus on your long-term result, not just what the result looks like on the operating room table. With breast lifts, I try to optimally utilize your body’s natural tissue to achieve the desired outcome. While I don't typically use mesh or scaffolding in primary surgeries, I find these tools valuable in revision procedures.
Breast Augmentation: Procedure Overview
Incision & Implant Placement
For breast augmentation alone, I create a small incision (about 3.5-4 cm long) in the natural fold underneath the breast (the inframammary fold). I typically place the implant in the submuscular plane, as this approach holds up better over time, has less risk of capsular contracture, and makes mammograms easier. While I rarely place implants in the subglandular plane, the subfascial plane can be an excellent option for certain patients. We'll discuss these options in detail during your consultation to determine the best approach for you!
Image Source: Paul Harris Plastic Surgeon | Breast Implant Placement
Different Types of Breast Implants
I offer both silicone and saline breast implants. Most patients prefer silicone (gel) implants because they feel more natural. For silicone implants, I recommend routine ultrasound examinations to check for rupture, which I provide in-office beginning five years after surgery. Saline implants, while also having a silicone shell, don't require ultrasound monitoring since ruptures are immediately noticeable.
Breast Lift: Procedure Overview
A breast lift involves lifting the nipple and removing some of the inferior breast gland that can sag with aging, gravity, and body changes such as pregnancy or weight fluctuations. A breast lift alone will not give you additional volume. If you are looking to increase the overall size of your breast, or want more upper pole fullness, these things are accomplished by adding a breast implant to the breast lift operation.
The combination of a breast lift and a breast augmentation is a complex procedure that requires careful planning, as it involves adding volume while at the same time removing skin. This can lead to complications if not performed by a well-trained plastic surgeon. Having trained with renowned breast surgeons Dr. Holly Wall and Dr. Simeon Wall, Jr., I utilize specialized techniques to achieve predictable, safe results when combining these two procedures.
Patient Examples
Example 1
Do you think this patient needs a breast lift, breast implants, or a breast lift + implants?
This is somewhat of a trick question - she is “borderline”! She could get by with either a lift and implants, or just implants alone. However, when we discussed her goals during her consultation - she wanted to be higher and perkier than just implants would have allowed. She did not like her 3D computer-generated imaging, which showed implants alone, and we elected to also do a lift in conjunction with implants for her.
Below: Patient age - 48yo, shown at 2 mo post op; implants used: SSM-275cc.
Example 2
This patient is 26-year-old, and wanted more volume. She does not need a lift!
Below: Implant: SSLP-235cc, 11 weeks post op.
Example 3
If your breasts look like this, I would recommend a lift!
Which is Best: Breast Augmentation, Lift or Both?
The best choice depends on your unique anatomy, examination findings, and personal goals. During your consultation, we will discuss these factors to determine the optimal approach for you.
Breast Surgery FAQ
“Does insurance cover breast augmentation?”
No, insurance does not cover any aesthetic surgery including breast augmentation.“What’s the cost difference between a breast lift vs augmentation? Or both?”
An augmentation costs ~$8k
A lift costs ~$12-17k
An augmentation + lift costs ~18k
“Is the recovery time different for a lift vs. augmentation?”
The recovery is similar between the two. For two weeks after surgery, avoid strenuous physical activity that increases your heart rate or blood pressure. Walking around and moving your arms and doing gentle arm stretches is encouraged (we will show you how to do these!). If your surgery involves an implant, your chest will feel sore, as if you have done tons of push ups!!
If you include liposuction with your breast procedure, such as liposuction of the lateral chest and armpits, this area is often the most sore after surgery.
“How does scarring compare between the two procedures? What if they’re combined?”
A breast lift includes an incision around the areola, a vertical incision extending down from the areola, and sometimes a horizontal incision hidden in the breast fold. If a breast lift and breast augmentation are combined, the incisions are that of the breast lift. A breast augmentation involves a small incision in the fold underneath the breast.
With proper scar care and the use of Brijjits (for breast lift scars), these scars typically heal exceptionally well.
“What makes your approach different from other plastic surgeons?”
I focus on preserving your natural anatomy and tissue. I use a “short-scar” technique to minimize the horizontal scar as much as possible.
“How do I make sure my surgeon has the right experience for my breast surgery?”
You should see a surgeon who has extensive experience in breast surgery and is a trained plastic surgeon.
Some cosmetic surgeons train in another surgery subspecialty (such as general surgery or OBGYN), and then they complete a one-year cosmetic fellowship. Plastic surgeons complete 6-7 years of dedicated plastic surgery residency and training. I completed a comprehensive six-year plastic surgery residency, followed by an additional year of specialized aesthetic fellowship training. This aesthetic fellowship—which differs from a cosmetic fellowship—allowed me to train directly under two world-renowned plastic surgeons who specialize in breast surgery. It is important to understand this distinction: while some doctors complete a one-year cosmetic fellowship after training in other fields, my background includes both complete plastic surgery training and advanced aesthetic specialization.
TL;DR
Breast Augmentation: Ideal for patients with well-positioned nipples and minimal sagging.
Breast Lift: Recommended when nipples fall below the breast fold or fail the "pencil test" (when a pencil stays in place when placed under the breast).
Breast Lift + Augmentation: great for a patient with sagging breasts who also wants more volume
I love breast surgery! They are some of my favorite surgeries to perform.
Liposuction is often a great option to combine with breast procedures to target stubborn fat at the lateral chest and armpits.
To learn more about personalized options for your aesthetic goals, book your consultation with Dr. Meredith Kugar, today.
