Breast lift or breast augmen­ta­tion: when is which procedure recommended?

Whether a breast lift or breast augmen­ta­tion is appro­priate depends on whether the main issue is a lack of volume, excess skin, or a combi­na­tion of both. After pregnancy, breast­fee­ding, weight fluctua­tions, or with advancing age, the breasts may lose fullness and sag at the same time. It is therefore often difficult for patients to assess which treatment can actually achieve the desired results. 

The key factors are skin quality, the position of the nipples, the amount of breast tissue present, and the extent of excess skin. Depending on the initial condition, adding volume may be suffi­ci­ent, while in other cases a breast lift or a combi­na­tion of both proce­du­res may be considered. 

This article explains the diffe­ren­ces between a breast lift and breast augmen­ta­tion, which procedure may be appro­priate for specific condi­ti­ons, and when a combi­na­tion of both methods is considered.

What is the diffe­rence between a breast lift and a breast augmentation?

The primary purpose of breast augmen­ta­tion is to increase breast volume. This can be achieved using implants or the patient’s own fat. As a result, the breasts may appear fuller and, depending on the initial condition, more promin­ently shaped in the upper portion. However, signi­fi­cant excess skin or severely sagging nipples usually cannot be adequa­tely corrected by added volume alone. 

In a breast lift, on the other hand, the focus is on the shape and position of the breast. Excess skin is removed, the existing breast tissue is reshaped, and the nipple is reposi­tio­ned higher if necessary. The existing volume generally remains the basis for the new breast shape. 

If there is both excess skin and signi­fi­cant loss of volume, a breast lift and breast augmen­ta­tion can be performed together. The most appro­priate option depends on the patient’s initial anato­mical condition and the desired outcome. 

When is breast augmen­ta­tion alone sufficient?

Breast augmen­ta­tion alone is primarily an option when the breasts lack volume but there is no signi­fi­cant excess skin. Typical cases include breasts that are small overall or a loss of volume following pregnancy, breast­fee­ding, or weight loss. In these cases, the nipples are usually still located above or roughly at the level of the infram­ammary fold and are predo­mi­nantly oriented forward. 

Adding volume can plump up the breasts and accen­tuate the upper breast area more promin­ently. In cases of mild sagging, this can also make the breasts appear firmer. However, a breast augmen­ta­tion procedure alone does not involve actually lifting the nipples or removing excess skin. 

Implants or the patient’s own fat can be used to increase breast volume. Implants generally allow for a more prono­un­ced and more predic­ta­ble increase in size. Breast augmen­ta­tion with autolog­ous fat is a better option when a moderate increase in size is desired and there is suffi­ci­ent fat tissue available for harve­s­t­ing. Our article “Breast Augmen­ta­tion with Autolog­ous Fat or Implants: Which Method Is Right for Me?” explains the diffe­ren­ces between the two methods. 

If there is already a signi­fi­cant amount of excess skin, or if the nipple is clearly below the infram­ammary fold, additio­nal volume is often insuf­fi­ci­ent. In this situation, an implant that is too large can put additio­nal strain on the skin without adequa­tely correc­ting the sagging breast shape. 

When is a breast lift recommended?

A breast lift is primarily conside­red when the main concern is sagging skin and breast tissue rather than a lack of volume. Typical signs include nipples that are at or below the infram­ammary fold, point downward, or are surroun­ded by notice­ably sagging tissue. A signi­fi­cant excess of skin at the lower pole of the breast may also be an indica­tion for a lift. 

However, the position of the nipples alone is not suffi­ci­ent for an assess­ment. In a condition known as pseud­op­to­sis, a signi­fi­cant portion of the breast tissue may have sagged below the infram­ammary fold, even though the nipple remains above it. Therefore, the overall distri­bu­tion of the tissue, skin elasti­city, and the shape of the lower breast area are decisive factors. 

If there is suffi­ci­ent natural breast volume and the patient does not wish to increase the size, a breast lift without implants may be suffi­ci­ent. During the procedure, the existing tissue is reshaped to be more compact and reposi­tio­ned higher. The breast usually appears more lifted and firmer afterward, but the lift alone does not increase its size. 

If you also desire prono­un­ced and, as much as possible, stable fullness in the upper breast area, this goal usually cannot be achieved to the same extent with a breast lift alone. An implant can provide more targeted fullness to the upper breast and offer more predic­ta­ble long-term results. Whether this is appro­priate depends on the quality of the skin and tissue, as well as the desired volume. 

When is a combi­na­tion of a breast lift and breast augmen­ta­tion a good option?

A combi­na­tion procedure may be conside­red if the breasts have sagged signi­fi­cantly and there is also a lack of volume. A typical candidate is a woman with excess skin, lower-set nipples, and, above all, a noticeable lack of fullness in the upper breast area. This can occur after pregnancy and breast­fee­ding, signi­fi­cant weight loss, or age-related changes in tissue. 

A breast lift corrects excess skin and lifts the breast tissue and nipples. To learn about the factors that influence long-term stability after a breast lift, see our guide “ How long do the results of a breast lift last? Factors that affect the long-term outcome “.

The additio­nal volume is created using an implant or, in select cases, the patient’s own fat. This approach allows two different goals to be achieved simul­ta­neously: a higher, more compact breast shape and greater fullness. 

However, a combi­na­tion of proce­du­res is not automa­ti­cally necessary as soon as a breast appears saggy. If there is suffi­ci­ent natural tissue and the patient does not want a larger breast, a lift without additio­nal volume augmen­ta­tion may be suffi­ci­ent. Conver­sely, breast augmen­ta­tion alone is suffi­ci­ent only if the excess skin is limited and the nipple position does not need to be raised significantly. 

Whether a lift and augmen­ta­tion are performed in a single surgery or in two separate proce­du­res is decided on an indivi­dual basis for each patient. Factors taken into account include the extent of the lift, the quality of the skin and tissue, the desired increase in volume, and the planned surgical approach. 

What factors determine the choice of procedure?

When making this decision, it is not enough to consider only your current bra size. The key factors are what is causing the shape you find bother­some and what change you hope to achieve. 

Position of the Nipples

The assess­ment focuses on the position of the nipples relative to the infram­ammary fold and the direction in which they point. If they are located signi­fi­cantly below the infram­ammary fold or point downward, this generally indicates a need for a breast lift. If they are still above the fold and the main issue is a lack of volume, breast augmen­ta­tion alone may be an option. 

Excess Skin and Skin Quality

If the skin has good elasti­city, it can usually adapt better to the new breast shape after a moderate increase in volume. If the skin is severely stretched, very thin, or already notice­ably sagging, additio­nal volume cannot eliminate the excess skin. Larger implants can also place greater strain on the weakened tissue and contri­bute to further sagging. 

Amount and Distri­bu­tion of Breast Tissue

Not only the amount but also the position of the existing breast tissue is important. If there is suffi­ci­ent natural tissue but it has predo­mi­nantly sagged into the lower part of the breast, a lift without augmen­ta­tion may be suffi­ci­ent. If, on the other hand, fullness is the main issue while the skin and nipples are still well-positio­ned, the focus is more on adding volume. 

Extent of the desired change

A patient who generally wishes to maintain her current breast size does not automa­ti­cally require additio­nal volume. If, on the other hand, the breasts are to be made signi­fi­cantly larger or given more fullness in the upper area, an implant or, in suitable cases, autolog­ous fat may be necessary in addition to a breast lift. 

Diffe­ren­ces between the two breasts

Existing asymme­tries also influence the planning process. If the breasts differ in size, shape, nipple height, or excess skin, a different approach may be necessary on each side. We explain the possible causes of breast asymmetry and the available treatment options on our page about breast asymmetry. The goal is to achieve as balanced a shape as possible; however, surgery cannot guarantee that the breasts will be comple­tely identical in shape. 

What role do scars play in the decision?

For breast augmen­ta­tion using implants alone, only a relatively small incision is usually required, often in the infram­ammary fold. For breast augmen­ta­tion using the patient’s own fat, small puncture marks also remain in the areas where fat is harvested and injected. 

A breast lift requires longer scars because excess skin is removed and the breast is reshaped. Depending on the degree of sagging, the incision may run only around the areola, extend verti­cally to the infram­ammary fold, or follow the infram­ammary fold. The type of incision required depends on the extent and distri­bu­tion of excess skin, the shape of the breast, the position of the nipples, and the surgical technique chosen. 

The desire for the shortest possible scars is under­stan­da­ble, but it should not determine the choice of procedure. If a lift is not performed solely because of signi­fi­cant excess skin, breast augmen­ta­tion often cannot suffi­ci­ently correct the sagging shape. It is therefore crucial to determine which incision is necessary to appro­pria­tely treat the actual condition. 

How is it deter­mi­ned which procedure is appropriate?

Dr. med. Peter Dietz will determine which treatment is likely to achieve the desired result during a personal exami­na­tion. During this exami­na­tion, the breasts are examined and measured while the patient is standing. In addition to size and shape, parti­cu­lar attention is paid to skin quality, the distri­bu­tion of breast tissue, the position of the nipples, and any diffe­ren­ces between the two breasts. 

Next, the desired outcome is discussed in detail: Should the current breast size be maintai­ned, is more volume desired, or is a higher, more compact breast shape the priority? This deter­mi­nes whether a breast augmen­ta­tion, a breast lift, or a combi­na­tion of both proce­du­res is appropriate. 

Body weight stability, plans to have more children, and the elasti­city of the tissue can also influence the planning and the appro­priate timing. Photos and self-adminis­te­red tests can provide initial guidance, but they are no substi­tute for a personal examination. 

Conclu­sion: Breast Lift or Breast Augmentation—Your Starting Point Is Key

Breast augmen­ta­tion is primarily an option when there is a lack of volume and the skin and nipples are still suffi­ci­ently firm and well-positio­ned. However, if there is signi­fi­cant excess skin, sagging breast tissue, or low-set nipples, a breast lift is often necessary. When volume loss and sagging occur together, a combi­na­tion of both proce­du­res may be the more appro­priate approach. 

Frequently Asked Questions About Breast Lifts and Breast Augmentation

Which treatment is right for you?

It is only possible to determine which treatment can achieve the desired breast shape after a thorough exami­na­tion. During a personal consul­ta­tion at our practice in Zurich, Dr. med. Peter Dietz will analyze your initial anato­mical condition and discuss with you what changes are reali­sti­cally possible. Based on this, a treatment plan will be developed that is tailored to your breast shape, skin quality, tissue distri­bu­tion, and the desired outcome.