All breasts that are large enough to require reduction, also require a "lift." On the other hand, there are many patients who desire a breast lift (known as a mastopexy) without a reduction. Finally, there are patients who desire a lift plus enlargement of the breasts (a so-called augmentation/mastopexy).
Sagging or droopy breasts can occur in a number of circumstances. Some patients develop breasts with imperfect shape during puberty, for no known reason. Other patients start with breasts of "normal" shape but then develop ptosis of the breasts related to pregnancies, weight loss or aging. The mastopexy procedure is designed to move the nipple/areola complex higher on the breast, and to reshape the breast to varying degrees depending on the extent of the ptosis. In milder cases this can be accomplished with an incision around the areola. In moderate cases mastopexy requires an incision around the areola and a vertical incision from the areola down to the inframammary fold. Finally, the droopiest breasts require the incisions described above for moderate ptosis, plus a horizontal incision in the fold under the breasts. As a general rule, mastopexy alone is the procedure that patients are the least happy with of all breast procedures because gravity tends to make the breasts sag again over time. See Augmentation/mastopexy below.
Breasts requiring reduction vary tremendously in size. The amount removed from an enlarged breast can vary from half a pound to four pounds per breast. Unlike most other types of surgery that fit into the category of cosmetic surgery, breast reduction is sometimes "covered" by insurance. This does not mean that the insurance will pay every penny, but that insurance reimbursement may cover some of the patients' expenses. Most breasts can be reduced with an incision around the areola plus a vertical incision from the areola to the fold. Larger or droopier breasts also require the horizontal incision in the fold under the breast.
Some patients, as stated above, desire both a lift of the breast plus an enlargement of the breasts. This is usually, but not always, related to deflation of the breasts after breast-feeding. This procedure involves everything that is mentioned under "Breast Augmentation" plus everything mentioned above under "Mastopexy." Many patients come in requesting mastopexy alone but agree to the combination of augmentation/mastopexy, often with a very small implant, because of the fullness in the upper part of the breast that such an implant can provide. Mastopexy alone will not replace the fullness in the upper portion of the breast that so many patients are seeking.
To see before and after images, please click Breast Reduction.