This is the most common question that I answer on Realself, an online patient and physician question and answer platform. The most common complaint is from patients who have undergone a breast augmentation and are not happy with their breasts because they feel that their breasts:
1) are lateralized and falling into their armpits
2 )lack medial cleavage
3) have no upper pole fullness
4) are laying on their belly
5) breasts that look oblong, described as an “eggplant”

If you are experiencing any of these concerns, you have likely undergone a breast augmentation only when a simultaneous breast augmentation and lift procedure may have been in your best interest
In order to appreciate who needs a breast augmentation versus simultaneous breast augmentation and lift, we have to back up and discuss breast aesthetics; Frist, you have to appreciate that the inframammary fold is not only the junction of your breast and abdomen, but also that it defines the bottom of your breast. As such, your breast implant cannot be placed below the fold and ideally sits on your fold. Thus, in order to ensure that your nipples will be centered on your newly augmented breast mound, you have to make sure that the radius of the chosen implant is not longer than your nipple to fold distance. If you appreciate this explanation, you will soon realize that if your nipple is at your fold or lower, there is no way that your nipples could be centered on your newly created breast mound. In fact, the most frequently disgruntled patient I see, is one who had her nipples actually located above the fold, yet the distance from the fold to the nipple was not long enough to accommodate the chosen implant radius.

Plastic Surgeon Orange County
Plastic Surgeon Orange County

To summarize, even if your nipples are above your inframammary fold, you have to limit your implant size such that its radius is not longer than your nipple to inframammary fold; otherwise you will be risking having your nipples pointing down instead of straight ahead. When making a decision regarding whether a lift is needed or not, the first thing we do is figure out how what size implant you choose; once we commit to an implant size, then we make sure that the chosen implant’s radius will be accommodated by your nipple to fold distance; if not, you will need a lift!
Unfortunately, far too many surgeons do not feel comfortable performing implant augmentation and lift procedures simultaneously, and thus avoid recommending this procedure, even these combined procedures are in the best interest of their patients. Some may recommend a crescent or periareaolar breast lift; however, this procedure is plagued by widened areola scars and suboptimal lift. Today, the most effective simultaneous breast augmentation and lift procedure involves a customized,” tailor tack” vertical mastopexy procedure. What this means for you is that the length of incisions on your breasts are limited to only areas on the breast that need hemming.

If you are considering a breast augmentation but are not sure if a breast lift is in your best interest, a complimentary consultation with Dr. Mowlavi will help clarify the ideal procedure for you.

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