Dear Dr. Kim,

A good friend of mine just got her breasts done by you and your team. She is super happy with her results and referred me to you enthusiastically for my potential surgery.

However, I do have a question about what type of surgery I may need. I have had a couple of kids and my breasts are not as “perky” as they used to be. Can this be fixed with only breast implants, or might I need a breast lift, as well? How do you determine what would work for me?


CKL in San Francisco

Dear CKL,

Thanks for contacting me with your with your questions! Of course, every patient is unique and an in-person consultation is the only way to truly determine the best course of action for your desired results, but I can certainly share with you the general guidelines regarding breast augmentation and breast lift.

In short, it’s all about the nipple. The position of your nipple is really the determining factor as to whether or not you need a breast lift.

Your nipple should be above the breast fold. The breast fold is the crease created where the bottom of your breast meets your body. If your nipple is even with or below the breast fold, then you need a breast lift to achieve what is generally considered a youthful and aesthetically pleasing breast.

When your nipple is at or below the breast fold, even a large implant with a high profile won’t create enough lift to get the desired shape for your breast. To alter the position of your nipple in relation to the rest of your breast, you’ll need a mastopexy (that’s the fancy medical term for breast lift).

Now, if your nipple is at or above the breast fold, then you probably don’t need a breast lift and are a good candidate for a breast augmentation to simply fill the sagging skin, although if your nipple position is close to the breast fold, you still may want one for a better aesthetic result.

You didn’t say if sagging was your only concern or if you also want to increase the volume. If you are happy with your size, then a breast lift may be all you need. But if you wanted to go larger, you would also be a candidate for a breast augmentation with lift.

There are basically two ways to do a breast lift. Both methods result in different incisions, and therefore, different scars.

1. Benelli Mastopexy
A circular incision around the areola only is called a Benelli mastopexy. This method has the advantage of a smaller scar. The disadvantage is that the amount of breast lift generated is small, and most women are not a candidate for this procedure.

2. Lollipop Incision
The more common type of breast lift incision involves a circular incision around the areola, as well as a vertical, up and down incision that runs from the aerola to the bottom of the breast. In non-medical terms, this is called a lollipop incision. I can generate a lot of lift with this type of incision, usually greater than one to two inches. The disadvantage of this incision is the small but additional vertical incision.

Both types of lifts and incisions allow me to insert breast implants using the same opening. Therefore, you would not need an additional incision at the breast fold or underarm to place the implant.

You probably already know from your friend that I send all of my breast augmentation and breast lift patients home with a pain pump that delivers pain medication directly to the area of surgery for a few days following your procedure. This greatly reduces pain and discomfort and helps my patients recover faster.

I look forward to meeting you at my plastic surgery office in San Francisco’s financial district. Please contact my friendly staff at or 415-362-1846 to schedule your consultation.


Roy Kim M.D.


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