Breast Lift With Implants: Why We Do It All At Once

When patients come into my office for a breast enhancement consultation, they often open their phone to Instagram, to show me what they have in mind. They may show me a picture of a girl on a yacht or on a beach, sitting up, shoulders back, and there is an impossible amount of upper pole fullness without a bra. They may tell me they want "just a little volume," but also want their breasts to sit here, high on the chest wall.

They may ask if we can do it with a "mini" lift because they don't want the scars.

Let’s step back and look at the full picture. I have been looking at breast tissue since before Instagram existed. I treat breasts like structural engineering projects. Unfortunately, what you are seeing on that screen is usually a filter, tape, or a very specific pose. But if it is surgery, it's almost certainly a breast lift with implants. An "Aug-Mast."

You are looking for a combination breast lift and augmentation. You want to defy gravity and add weight at the same time. This is one of the most technically demanding surgical procedures in aesthetic medicine. We're asking the body to do two opposing things: shrink the skin envelope while expanding the contents.

Here's the reality of the breast lift with implants, the one surgery that countless women request, but few truly understand.

The Myth of the "Filling" Implant

The Internet says: If you just get big enough breast implants, they will fill out the loose skin and lift the breasts naturally. No scars needed.

The Reality: An implant is a weight. It is not a helium balloon. It doesn't lift, it pulls.

This is the most common conversation I have during initial consultations. A patient has breast ptosis (sagging) after pregnancy or weight loss. She believes that if we just maximize the breast volume with a large silicone device, the skin will tighten, and the breasts will rise.

It won't. If I put a 400cc silicone implant behind a breast that is already drooping, I am simply creating a heavier sagging breast. You get what we call the "Snoopy nose" deformity, where the implant sits high on the chest wall, and your natural breast tissue slides off the front of it and hangs down. It looks distinctively surgical, and frankly, not good.

The Mechanism: Think of your breast skin like a customized suit. Over time, the fabric stretches. If the suit is too big, stuffing it with a pillow doesn't make it fit better; it just makes it bulky. We have to tailor the suit. We have to cut out the excess skin and tighten the envelope. Only then do we insert the implant to provide the projection.

You cannot cheat the skin envelope. If you have excess skin, you need a breast lift. If you have lost volume, you need breast implants. If you have both, you need a lift with implants. This combination procedure is the only way to truly restore the architecture of the breasts.

The Fear of the Anchor Scar

The Internet says: The "lollipop" (vertical) lift is better because there is less scarring. The anchor (inverted-T) is "old school" and ruins the aesthetic.

The Reality: The anchor incision is the most powerful tool I have. I love the anchor for a breast lift with implants.

I understand that you may be going straight to the beach as soon as you're healed, and scars don't necessarily fit into that picture. But, if you have significant drooping—if your nipple is below the breast fold—a lollipop lift is rarely enough. In fact, if we try to do too much with a vertical incision during a breast lift with implants, the breast creates a “pleat” at the bottom. It looks unfinished. It compromises the overall shape of the breasts.

The Mechanism: The anchor incision allows me to control the breast shape in three dimensions. I can narrow the base. I can lift the nipple to a higher position. I can tighten the skin horizontally and vertically. Yes, there is a scar in the crease. But in a year, that scar is a fine white line hidden in the shadow of the new breast fold.

I would rather give you a phenomenal, improved breast shape with a scar in the fold than a mediocre shape with a scar that stops an inch short. The shape is what you see across the room. The scar is what you see with a magnifying glass. When we perform a combined procedure, the goal is longevity. The anchor provides the structural support necessary to hold the weight of the implants over time.

The "High Profile" Trap

The Internet says: High-profile or ultra-high profile implants are the only way to get that "upper pole fullness" or the cleavage look.

The Reality: High-profile implants can look like two grapefruits stuck on a wall. They lack width.

In Miami, projection is a common obsession among those who want breast enhancement. They want the side profile to look aggressive. But if you ignore the base width of your chest, you end up with a gap in the middle and no "side boob." It looks distinctively like bad breast surgery.

Often, I will choose a moderate-plus profile. It gives us the width to fill out the cleavage and the side, and because we are doing a breast lift, I can tighten the skin to create that upper-pole fullness you want.

The breast lift does the heavy lifting; the implant just provides the volume. When we utilize implant sizers in the office, we are approximating, but the final decision happens in the operating room. I need to see how the breast tissue responds to the tension of the lift with implants.

Why Not Just Do It In Two Stages?

The Internet says: It's safer to perform the breast lift first, let the blood supply stabilize, and then come back for breast implants six months later.

The Reality: The textbook answer is yes. The real-world answer is no.

We can separate the procedures. We can perform the lift to address the breast ptosis, ensure the skin is healthy, and then add volume later. This is the safest route for massive weight loss patients or smokers (though I won’t operate on active smokers, since nicotine is a vasoconstrictor, and it kills skin flaps).

However, for countless women, the logistics of two surgeries are a dealbreaker. You do not want two procedures and two recovery periods. You do not want to pay the surgery center and general anesthesia fees twice. You want one surgery and overall downtime minimized. You want your breasts fixed now, not in a year. Life moves too quickly for you to wait.

My job as your surgeon is to act as the fail-safe. I have to determine if your anatomy can handle the stress of a lift with implants simultaneously. If your skin is too thin or your circulation is compromised, I will refuse to do them together. I will not risk the loss of a nipple for the sake of convenience. A breast lift with implants requires robust tissue.

The Math of Implant Selection

There's a misconception that you just pick a size from a catalog. "I want 300ccs."

That number is meaningless without context. 300cc on a woman who is 5' 10" looks completely different from 300cc on a woman who is 5' 2". We have to match the implant to your body type.

During your initial consultation, we will address implant sizes, but you need to understand the physics: because we are removing excess skin and tissue during the breast lift, the final cup size is a calculation of the implant volume minus the tissue we subtract.

We aren't just adding; we're subtracting and then adding. This is why all the sizes you see on forums are misleading. A breast lift with implants is customized. I might use a 225cc implant in your right breast and a 250cc in your left to correct asymmetry. The goal is symmetry and natural-looking results, not hitting an arbitrary number on a box. The breast lift allows us to tailor the skin so even different implant sizes look identical once the breasts heal.

The Uncomfortable Truth About Risks

Marketing brochures love to skip this part. But you are signing a consent form, and you need to know what I am focused on in the operating room when performing a breast lift with implants.

Nipple Sensation: When we lift the breast, we are moving the nipple-areolar complex to a higher position. We are stretching the nerves. Regaining feeling is unpredictable. In most cases, sensation returns, but it can take months. In some cases, nipple sensation changes permanently—it might be hypersensitive, or it might be numb. This is a risk of any breast surgery, particularly a lift.

The T-Junction: If you get an anchor lift, the point where the vertical incision meets the horizontal incision (the inverted T) is the structural weak spot. It has the poorest blood supply. In a combined procedure like a lift with implants, the pressure of the implant pushes against this exact spot. It is not uncommon to have a small delayed healing area there. It heals, but it requires patience and wound care.

Capsular Contracture: Any time we put a foreign object in the body, the body forms a shell around it. If that shell tightens, the breast feels hard. This is a risk with breast augmentation, and adding a lift doesn't change that. Implants are foreign devices, and complications can happen.

Recovery: The Logistics of One Surgery

You are booking a date. You are clearing your schedule. What does the recovery period actually look like for a breast lift with implants?

Day 1-3: You are in a surgical bra. You are on pain medication. You are sleeping on an incline to minimize swelling. You are not lifting your arms. The breasts look high, square, and tight. Do not panic. The breasts looked exactly how they are supposed to look at this stage.

Week 1-2: The pain medication stops. The itchiness starts. This is the nerves waking up. You are walking around, but you are tired. Your body is directing all its energy to the healing process. Your breasts are settling.

Week 4-6: You are usually cleared for normal activities and the gym. But no chest exercises yet. Have the implants settled? Not yet. They are dropping, but the "fluffing" process (where the lower pole rounds out) takes three to six months.

The Long Game: Your breasts looked one way at six weeks, and they will look different at six months. The breast lift with implants requires a full year for the scars to fade and the overall shape to finalize.

A Note on Financing and Value

High-quality plastic surgery is expensive. A breast lift with implants is more expensive than a standalone augmentation because it takes twice as long to perform. It requires more skill. It is a complex procedure performed by a specialist.

We offer financing options because we know this is an investment. But do not bargain hunt for this procedure. A discount breast lift with implants is usually a recipe for a revision. You are paying for the judgment of the board-certified plastic surgeon to know exactly how much skin to remove so that you are tight, but not too tight. That judgment comes from performing this procedure thousands of times.

The Bottom Line

I'll be honest with you. This is a difficult surgery. The recovery can feel long. The scar is there (but easily hidden).

But it is the only way to actually fix the problem.

You can chase the "scarless" trends on social media, but you will be back in my office in a year when gravity wins. Or, you can accept the physics of the situation. You can accept that to lift a heavy weight (the implant), you need a strong structural support system (the anchor lift).

Miami is a city that lives in high definition. From the unforgiving midday sun on the water to the social density of the Design District, this environment tests every detail, and we want you to move through the city with a polished resilience that feels like it belongs here.