You would like more volume – but your breasts already sag a little after pregnancy, breastfeeding or weight loss? Then you have probably already asked yourself: Is an implant enough to address both, or do I also need a lift? This question is more justified than many people think. Because an implant adds volume – it does not automatically raise a breast that has lost firmness. In some situations, the combination of augmentation and lift is therefore the more coherent path to a harmonious shape. In this article we explain to you objectively when this may be the case, what the combination involves and how you can make the right decision for you together with us.
Volume or lift – what does your breast really need?
Two very different concerns are often lumped together, even though they call for different solutions:
- Loss of volume: The breast looks emptier, “deflated” or smaller than before – but the tissue itself still sits relatively high. Here, an implant or autologous fat can replace the missing volume.
- Sagging (ptosis): The skin has lost firmness, the nipple sits lower, often below the inframammary fold. Here it is not about volume, but about position and skin tightening.
The decisive point: If there is only a loss of volume, augmentation alone is often sufficient. If there is pronounced sagging, an implant can make the breast fuller – but the drooping shape and the excess skin remain, or may even become more apparent afterwards. It is precisely at this intersection that the combination becomes relevant.
What is an augmentation mastopexy (augmentation + lift)?
The technical term sounds cumbersome, but the principle is easy to follow: In an augmentation mastopexy, two steps are brought together in one concept – augmentation (adding volume with an implant) and mastopexy (tightening of skin and glandular tissue, raising the nipple).
The idea behind it: The implant provides fullness and upper-pole shape, while the lift adapts the skin envelope to the new volume and brings the nipple into a harmonious position. In this way, a single procedure addresses both “too little volume” and “too much skin or too low a position” at the same time. This combined approach has been described and systematically evaluated in the scientific literature for years.
Signs that an implant alone is not enough
Whether augmentation alone is sufficient or a lift sensibly belongs alongside it cannot be stated in a blanket way – it depends on your tissue. There are, however, typical signs that may speak in favour of a combination during the consultation:
- The nipple sits at the level of the inframammary fold or below it – an implant would lie behind it, but the nipple would still point downwards.
- There is noticeable excess skin, and the skin appears “empty” and stretchable.
- The breast has lost shape and firmness after pregnancy, breastfeeding or more significant weight loss.
- You would like not only more size, but above all a raised, firmer contour.
If augmentation alone were performed in such cases, the result may look fuller but still low-sitting – the desired raised shape then often does not develop. An honest assessment of the skin envelope and the nipple position is therefore at the heart of the planning. If you are interested above all in the lift itself, you will also find detailed information on this on our page about the breast lift.
Result and scars: what the combination involves
Honesty is part of good counselling – which is why we speak openly about the difference in scarring. Augmentation alone requires a smaller access point. As soon as a lift is added, additional incisions are usually necessary in order to remove skin and reposition the nipple. Depending on the initial findings, different incision patterns may be considered – for example only around the areola, an additional vertical line downwards, or a T-shaped variant.
What you can realistically expect in this respect:
- A lift means more scars than augmentation alone – however, these lie in well-plannable areas and usually fade noticeably over the months.
- In return, a raised, firmer shape can be achieved that an implant alone cannot produce when sagging is present.
- The combined operation is technically more demanding than either single procedure, because volume, skin envelope and nipple position must be coordinated with one another at the same time.
For whom this trade-off – more scars in exchange for a more harmonious overall shape – is worthwhile is a very personal consideration. This is exactly what we discuss with you at length.
One-stage or two-stage approach: possible paths
In principle, there are two ways to combine augmentation and lift:
- One-stage (a single procedure): Augmentation and lift are carried out in one operation. This means one anaesthetic, one healing phase and a single cohesive result. This approach has been widely studied in the specialist literature and is established for many initial findings.
- Two-stage (two procedures): Augmentation and lift are performed separately over time. This can be useful in very pronounced findings or with particular safety considerations, because each step can be planned separately and the interim result can be awaited.
Which path is the calmer one in an individual case depends on your tissue, the extent of the sagging and your expectations. There is no “always right” here – there is only what suits your findings. We do not make this assessment over your head, but together with you.
A shared decision in the BONITAS consultation
Whether an implant is sufficient or the combination with a lift is the more coherent path can only be assessed responsibly after a personal examination. At our practice on Kornmarkt 4, Alejandro Marti, specialist in plastic and aesthetic surgery, takes the time to look closely at your skin envelope, the nipple position and your wishes.
In this conversation we clarify with you, among other things:
- whether loss of volume, sagging or both is the predominant factor in your case,
- which approach suits your findings and your expectations,
- which incision pattern, which scars and which healing phase are realistic.
This way you make your decision informed and at your own pace – on the basis of an honest assessment rather than a promise.
A real trial instead of a 3D simulation: my personal method
Many practices advertise digital 3D simulations on a screen. I deliberately take a different path. With me, you try out different sizes directly using real trial implants (sizers) – you see and feel volume and weight immediately on your own body. This tactile, physical sense gives you a more honest idea of the result than any image on a monitor.
On this basis we then together choose the solution that suits you, one that fits optimally with your individual breast footprint, your breast base and your natural breast shape. In this way, it is not a piece of software that makes the decision, but you – together with me.
Frequently asked questions
Can an implant replace a sagging breast without a lift being performed?
With mild loss of volume and a still good skin envelope, augmentation alone can be sufficient. If there is pronounced sagging with a low-sitting nipple, an implant does add volume but does not raise the breast. In that case an additional lift can be the more coherent path. The individual assessment is made during the examination.
Does the combination leave more scars than augmentation alone?
Yes. A lift requires additional incisions in order to remove skin and reposition the nipple. These lie in plannable areas and usually fade over the months. In return, a raised shape can be achieved that an implant alone cannot produce when sagging is present.
Is everything done in one operation or in two steps?
Both are possible. The combination can often be carried out in a single procedure. In very pronounced findings, a two-stage approach can be useful. Which path suits your findings is something we discuss with you individually in the consultation.
Literature & Scientific Sources
- Khavanin N et al. “A systematic review of single-stage augmentation-mastopexy.” Plastic and Reconstructive Surgery. 2014. PubMed PMID 25347628
- Stevens WG et al. “One-Stage Augmentation Mastopexy: A Review of 1192 Simultaneous Breast Augmentation and Mastopexy Procedures in 615 Consecutive Patients.” Aesthetic Surgery Journal. 2014. PubMed PMID 24792479
- Sarosiek K et al. “Getting the Most Out of Augmentation-Mastopexy.” Plastic and Reconstructive Surgery. 2018. PubMed PMID 30511991
- Qureshi AA et al. “Mastopexy and Mastopexy-Augmentation.” Aesthetic Surgery Journal. 2018. PubMed PMID 29365038
- Pferdehirt R et al. “Finesse in Mastopexy and Augmentation Mastopexy.” Plastic and Reconstructive Surgery. 2021. PubMed PMID 34432701
- Khan UD. “Single-stage Layered versus Nonlayered Mastopexy with Augmentation in Muscle Splitting Biplane: A Comparative Analysis.” Plastic and Reconstructive Surgery. Global Open. 2022. PubMed PMID 36168613
Medically reviewed and written by Alejandro Marti – specialist in plastic and aesthetic surgery (DE & ES). Last review: May 2026.
