When a patients plans to undergo a lifting procedure it is important to consider how that will affect the overall shape and volume of the breast. A lift is needed when the skin of the breast has stretched, resulting in sagging. This typically puts the nipple at an abnormally low position. At the same time, the fullness of the breast tissue ‘slumps down’ on the chest wall, putting it too low. A lift removes the excess skin and rearranges the breast tissue and nipple to the appropriate position. You will trade the scars of a lift for a better shape. Lifting also compacts the tissue into a tighter skin envelope. Even though we are not removing tissue, only skin, patients do feel like they are at least ¼ – ½ cup size smaller after a lift. If you want to maintain size with a lift then volume needs to be added with an implant. That implant goes under the muscle and will give back the upper pole fullness that is otherwise lost.
Some surgeons advocate fat transfer to the breast, but this really only applies to small irregularities of the shape. It is not accepted general practice to put large volumes of fat into the breast just for cosmetic purposes. Not all of the fat survives, it can take irregularly and create scar tissue and calcifications influencing appearance and cancer detection. It would be appropriate to consult with a board-certified plastic surgeon for further questions and information.