To be very brief- the position of your nipple, in relation to your breast fold and the rest of your breast tissue, determines if you need a breast lift.
Generally, a youthful, aesthetically pleasing breast has relatively tight tissue, and the nipple is in the center of the breast. As you age and have kids, your breasts may start to sag, and you may need a breast lift.
If your nipple is at or below the breast fold, then you need a breast lift. Regardless of size or profile of your breast implant, there won’t be enough lift for your to get an attractive shape to your breast. You need a breast lift, or mastopexy, to alter the position of the nipple in relation to the rest of your breast. Of course, you would also be a candidate for a breast augmentation and lift.
If your nipple is at or above the breast fold, the you are probably a candidate for a breast augmentation to fill the loose skin. You probably do not need a breast lift, although if your nipple position is close to the breast fold, you still may want one for a better aesthetic result.
Breast lifts are usually done 2 different ways, resulting in 2 different incisions.
1- a circular incision around the areola only, which 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- a circular incision around the areola, as well as a vertical/ up and down incision underneath. In non-medical terms, this is called a lollipop incision. The advantage of this type of breast lift is that the amount of lift that I can generate is quite large. Most women need this type of incision, in my opinion, because most women need a lift of greater than about 1-2 inches/ 2.5-5.0 cms. The disadvantage of this incision is the small but additional vertical incision.
With both types of breast lift, you have the option of getting a breast implant. The incision to put the implant in is fairly simple- I just use a portion of the breast lift incision to put the implant in. I would not recommend a breast fold or underarm incision, because I might as well use a part of the breast lift incision.
To reduce pain after surgery, I would definitely recommend a pain pump as well.