Q: I have been considering breast surgery due to sagging breast tissue and low nipple position. Over time, I’ve had children and have gained then lost weight. I had breast implants placed before my children were born, and my breasts were perky for a while, and now they are sagging. Is breast lift a good option and does the lift alter the nipple position/appearance?

A: With time, gravity, and weight changes, the breast tissue, and nipple position can sag, resulting in a shape that is more elliptical than round. If a patient has had implants in the past, the weight of the implant can also contribute to sagging. There can be a loss of volume at the upper portion of the breast, accumulation of breast tissue in the outer and lower breast quadrants, and downturning of the nipple position. A breast lift is a procedure that lifts the nipple position higher on the breast as well as lifting the sagging breast tissue, resulting in a rounder, perkier breast that sits higher on the chest wall.

A breast lift may be performed with a breast augmentation with an implant or fat transfer, or as a stand-alone procedure. In some cases, a patient wants to augment the loss of volume with an implant or fat grafting in conjunction with the lift. Women with existing implants often choose to replace their implants while some choose to remove implants entirely and opt for the lift procedure alone. Some patients also want to include some liposuction to eliminate unwanted fat around the back and underarm bra line, and this can be combined with a lift procedure.

There are three types of incisions for a breast lift, depending on the degree of lift needed. The periareolar incision is for small lifts, and the scar is at the edge of the areola. The circumvertical (“lollipop”) incision is for medium lifts, and the scar is around the areola and vertical to the bottom of the breast. The inverted T incision (“anchor”) is for larger lifts, and the scar is around the areola, vertical, and in the breast crease. With all three incision types, the nipple and areola remain attached to
the underlying breast tissue, remaining connected to the milk ducts and nerve endings. There may be a temporary loss of nipple, and areolar sensation as the small nerves around the areola are regenerating. The majority of patients can expect to maintain long-term nipple sensation and lactational ability.

In our office, we use the Vectra 3-D imaging system for our patients having breast surgery so that they can see a simulation of how their breasts can look after surgery. Imaging is very helpful in deciding whether augmentation along with a lift would be beneficial to meet the patient’s aesthetic goals.

Please schedule an individual consultation with me to discuss these issues or any other questions you may have regarding breast lift and associated procedures.

Dr. Cindy Wu

Dr. Cindy Wu discusses breast lift surgery.