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I would very much like to enhance my breasts now that the bikini season is here! A few doctors I've seen have recommended an uplift along with implants but I was not happy with the pictures of the scars that they showed me. I am not sure what to do.

Sara P, Newport Beach CA

Breast enhancement surgery is an elective procedure that we do frequently here at Orange County Plastic Surgery and should be designed to meet each patient’s expectations! The first question you should answer is regarding your expectations! Breast enhancement can be accomplished via a breast reduction or a breast augmentation, with or without an uplift, or with an isolated uplift – depending on each patient’s anatomy and desires or expectations. An enlarged breast almost always has some drooping of the nipple and the nipple is raised in most breast reduction procedures. Breast reduction is a separate subject – this article will focus on breast enlargement, with or without an uplift, and isolated breast uplifts without the use of an implant.

A breast augmentation by itself rarely leaves significant scars. The tiny incisions can be placed in the fold under the breast, around the areolus or in the arm pit area. Breast uplifts, on the other hand, can never be done without leaving a scar that will be visible forever – a surgeon has to make sure that the degree of improvement warrants the resultant scaring. If an uplift is attempted for a very minor degree of breast ptosis (drooping), it is unlikely that the patient will be thrilled with the trade off. On the other hand, if the nipples are hanging half way down to the navel, the minor scaring visible with uplifts will not be much concern to the patient. The trick is to make the right decision for the patient who falls in the grey zone in between the two mentioned extremes. You are correct in saying that the traditional uplift procedures do leave visible scars when naked. But newer techniques today allow a surgeon to obtain similar results with minimal incisions, sometimes limited to a circle around the areolus. Incision patterns chosen by the surgeon will be dictated by the surgeon’s experience, the patient’s anatomy and each patient’s expectations. Basically, the droopier a patient is to begin with, the more skin will have to be resected and the more scaring can be expected.

A key anatomical factor in deciding whether or not an uplift is recommended is based on the position of the nipple in relation to the inframammary fold (the fold that runs under the breast). With the patient standing, if the nipple sits above the level of the inframammary fold, a breast uplift can be avoided. If the nipple is an inch or more below the fold, an uplift will be necessary to achieve normal breast shape. In borderline cases, we help the patient to make an informed decision by showing examples of various breast configurations, with or without uplifts, and showing each patient examples of expected scars. If a patient is happy with their volume and only wants to be uplifted, an uplift by itself should be recommended, whereas a patient who puts her bra on and still feels that her breasts are not full enough would be better off having an uplift with implants. Here are a few examples to illustrate the above fact.

You can obtain more information on our web site: You may also wish to view some of these procedure specific videos:

As you can see, this is a complicated topic. A decision regarding which technique will be most desirable can only be made after a thorough consultation and a discussion of the options and each patient’s expectations. The important part is to find a surgeon who is well versed in all of these techniques, and to choose the procedure which will give you the result you expect with the least amount of scarring possible. Please feel free to call Dr. Bunkis at Orange County Plastic Surgery in Newport Beach, CA (949-997-0796) to discuss your options.