Hi, this is Dr. Hall again from the North Shore of Boston. I find that many women coming to see me after their pregnancy don’t like the deflated appearance of their breasts. They want to know if they need a lift or just an implant.
Let’s talk today about a simple way to find out. Put a sheet of typewriter paper under the breasts and place a dot on the skin between the breasts at the top edge of the paper. A Sharpie felt-tip marker works well for this. Or just leave the sheet of paper in place. This shows the level of the fold under the breast. Now stand in front of a mirror and look at where your nipple is in relation to the fold (get diagram).
If your nipple is a fingerbreadth or more above the fold, then you don’t need a lift. Breasts can look droopy and deflated, but if the nipple is well above the breast fold then this is called “pseudoptosis” or false drooping. A breast implant will generally fill up the missing volume of the breast and elevate the nipple.
If your nipple is a fingerbreadth or more below the breast fold, then you are going to need a lift with your breast implants to raise the nipple back up over the implants. If you only use an implant, then the breast is going to drop off of the implant and look funny.
So, it is that easy. But “wait,” you say- what if the nipple is at or just below the breast fold. Well, that is a more challenging question. The answer is: it depends.
If the breast skin has good elasticity and the distance from the nipple to the breast fold does not stretch too much on exam, then a compromise might be to place the implant above the muscle in the sub glandular position or “dual plane” position where it will drop with the breast. But, if the skin has poor elasticity and/or the distance from the nipple to the breast fold is too great, then the breast will stretch and drop like a stretchy hammock under the weight of the new implant and a breast lift will be needed very soon. I will measure the distance of the breast fold to the nipple as I manually lift and gently stretch the breast to see how it is going to respond to the weight of a new implant. If this distance is more than 9 1/2 cm or so, then a breast lift is typically needed. During our exam, I will ask a woman what cup size she was wearing when she was breastfeeding. If she was a D cup or larger when breastfeeding and/or has had significant weight loss and/ or is a smoker, then a breast lift is more likely to be needed at the time of the implant, because the skin is not as elastic from the effect of smoking or from prior stretching and will not hold its shape as well under the weight of the implant.
I’m Boston plastic surgeon, Dr. Jonathan Hall, and thanks for listening to Breast Implant University!