Breast augmentation places a saline or silicone implant behind or within the breast tissue to increase volume and cup size, while a breast lift (mastopexy) removes excess skin and repositions sagging tissue and the nipple-areola complex higher on the chest, without adding volume.
Patients whose main concern is lost fullness typically need only augmentation. Those with nipples at or below the breast crease usually need a lift, and many need both performed together.
Dr. Joshua C. Kreithen, board-certified by the American Board of Plastic Surgery, has performed over 10,000 surgeries over more than 25 years at Holcomb - Kreithen Plastic Surgery & MedSpa in Sarasota, including thousands of breast augmentations, lifts, and combination procedures. This guide breaks down exactly how the two differ in technique, incision pattern, and results, so you can walk into your consultation with Dr. Kreithen already knowing which questions to ask.
Breast Augmentation Basics
Breast augmentation is a surgical procedure that increases the size and improves the shape of the breasts by placing an implant within each breast. Patients typically choose augmentation when they want more volume, better symmetry, or a fuller silhouette that diet and exercise cannot achieve on their own.
Two implant types are available:
- Saline implants: Filled with sterile saltwater, FDA-approved since 2000.
- Silicone gel implants: Filled with cohesive silicone gel, re-approved by the FDA in 2006 following extensive long-term safety studies.
Both implant types carry a well-documented safety profile, though patients should discuss risks such as capsular contracture and implant rupture during their consultation. Dr. Kreithen evaluates each patient's frame and has patients try on implant sizers to help identify the most natural-looking result before surgery.
What Is a Breast Lift (Mastopexy)?
A breast lift, also called mastopexy, is a surgical procedure that raises and reshapes breasts that have begun to droop, without changing their size. Excess skin is trimmed away, the areola can be resized, and the remaining tissue is repositioned higher on the chest wall.
Sagging, medically known as ptosis, develops for several common reasons:
- Pregnancy and breastfeeding: Breast tissue expands and contracts repeatedly, stretching the skin's support structure.
- Significant weight changes: Gaining or losing substantial weight alters volume faster than skin can adapt.
- Age-related loss of skin elasticity: Collagen production slows over time, reducing the skin's ability to hold breast tissue in place.
- Gravity and genetics: Some patients are simply predisposed to earlier or more pronounced sagging.
To simplify, a lift addresses the position and shape of the breast tissue itself rather than its volume.
Breast Augmentation vs. Breast Lift
- Primary goal: Augmentation increases breast volume; a lift repositions and reshapes existing tissue.
- What it addresses: Augmentation corrects lost or insufficient volume; a lift corrects sagging and downward-pointing nipples.
- Incision pattern: Augmentation typically uses smaller incisions around the areola, in the breast fold, or in the armpit; a lift generally requires longer incisions to remove excess skin.
- Size change: Augmentation increases cup size; a lift alone does not add volume and may even appear to slightly reduce fullness once sagging tissue is tightened.
- Recovery: Both involve several weeks of restricted activity, though lift recovery can take slightly longer due to more extensive incisions.
How Common Are These Procedures?
Breast augmentation remains one of the most requested cosmetic surgeries in the country. According to the American Society of Plastic Surgeons, surgeons performed 306,196 breast augmentation procedures in the United States in 2024.
Implant safety has also been under long-term scrutiny by federal regulators. The FDA notes that silicone gel implants were re-approved after an extensive long-term safety study in 2006, while saline implants have carried FDA approval since 2000. That track record gives patients considering augmentation, alone or paired with a lift, a substantial body of safety data to review with their surgeon.
How Do I Know Which Procedure Is Right for Me?
The right procedure depends on where the nipple sits relative to the breast crease and how much volume you want to gain, if any. Patients whose main concern is size, with breasts that still sit relatively high on the chest, are typically better candidates for augmentation alone.
A few anatomical signs point toward a lift, augmentation, or both:
- Nipple at or above the breast crease, volume is the main concern: Augmentation alone is often sufficient.
- Nipple pointing downward or sitting at/below the breast crease: A lift is typically needed to correct that positioning.
- Significant loose or lax skin: The excess usually needs to be trimmed away regardless of implant size.
A breast lift with implants is a common combination for patients who have both sagging and a desire for more volume. This approach repositions the breast tissue while simultaneously adding fullness with an implant, addressing both concerns in a single operation. This combination tends to suit patients after pregnancy or major weight loss, when breasts have lost both shape and volume at the same time.
Common Misconceptions About Breast Augmentation and Lifts
- "Augmentation alone can fix significant sagging." Implants add volume, but they cannot lift tissue that has already dropped below the breast crease; a lift is required for that correction.
- "A lift alone will make breasts noticeably larger." A lift reshapes and repositions tissue rather than adding to it, so volume stays roughly the same or can appear slightly reduced once loose skin is removed.
- "Either procedure will look obviously artificial." Dr. Kreithen's approach of evaluating each patient's frame and using implant sizers before surgery is designed specifically to avoid an overdone result.
- "Augmentation prevents breastfeeding." Because implants are placed behind or within existing breast tissue rather than replacing it, augmentation does not affect the ability to produce milk.
Breast Augmentation or Lift? We’re Here to Help You Decide
Choosing between augmentation, a lift, or a combination of both starts with an honest look at your anatomy and goals, and that's exactly what a consultation with Dr. Kreithen provides. He walks patients through that process personally, using implant sizers and a detailed discussion of lifestyle and aesthetic priorities to build a plan suited to their body.
That guidance is backed by real experience: board certification with the American Board of Plastic and Reconstructive Surgery, over 10,000 surgeries across 25-plus years in Sarasota, a plastic surgery fellowship at the University of Florida following a five-year general surgery residency at East Tennessee State University, and recognition as a Castle Connolly Top Doctor for breast augmentation and breast cosmetic surgery.
Every procedure takes place in the practice's AAAASF-accredited outpatient surgical facility in downtown Sarasota, an independent review standard that adds another layer of confidence beyond the surgeon's own credentials.
If you're in the Sarasota or Tampa area and ready to decide which is right for you, schedule a consultation with Dr. Kreithen at Holcomb - Kreithen Plastic Surgery & MedSpa.
Disclaimer: This information is provided for educational purposes only and does not replace a consultation with a board-certified plastic surgeon. Outcomes, risks, and suitability vary from patient to patient.