Your Questions

Q: Dr. Eppley, I just want breast augmentation with implants and don’t want a lift. But based on my pictures do you think I need an uplift. My sternal notch to nipple distance measures 24 cms on each side. I had one plastic suregry consultation and was told I need a lift with breast implant. I would prefer them filled out and was hoping the use of an implant would lift them up. I have lost weight and breastfed so I have lost the fullness they once had.

A: Your pictures show an undeniable need for a combined breast lift and augmentation surgery. Implants only provide some degree of a lift if the nipples are initially at or above the lower breast crease. (inframammary fold) If not, the nipples will only be driven lower as the breast volume get bigger. Having a breast lift is really about accepting the scars as a trade-off for the improvement in breast shape. This is easier for some than others but is the defining decision about whether to do anything at all. There is another option, often called the ‘minimal’ or  ‘crescent breast lift. It is not really a breast lift at all but does lift the nipple a bit by removing a small crescent of skin at the upper nipple skin edge. For those women that have a minor amount of sagging, nipple lifts with implant placement must just be enough to get them an acceptable result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast implants but don’t know if making the breast bigger will also lift may nipples up. They have a little sag but not bad. I have read about a nipple lift but am not sure what it does or how it works.

A: A nipple lift, also known as a superior crescent mastopexy (SCM), is the simple removal of a half moon-shaped piece of skin above the nipple. This allows the nipple to move up higher based on the amount of skin removed. This leaves a very fine line scar that is usually imperceptible along the upper areolar-skin margin. A nipple lift is almost always an adjunctive procedure when placing breast implants if the patient has some mild breast sagging. An extra 1/2 to 1 inch of upward nipple repositioning can be helpful. But a nipple lift is not a replacement for a formal breast lift in cases of more significant breast sagging. In breast augmentation a nipple lift is usually done for one of two reasons. First, in women with very small amounts of breast sagging, a breast implant alone may not provide enough of a lift and the nipple lift is insurance that a more centrally positioned nipple on the breast mound may occur. Secondly, in women who really need a more formal breast lift with their implants (such as a vertical breast lift) but are very apprehensive about the scars, they may initially try a nipple lift and see how much improvement they get. One can always proceed with a fuller breast lift later if enough improvement is not obtained. A nipple lift is not the same and should never be thought of as a form of a breast lift although many call it such. It is nothing more than raising up the level of the nipple on the breast mound, it does not change the shape of the breast mound.

Dr. Barry Eppley

Indianapolis, Indiana