Many of the patients that I see in consultation have small breasts that they want enlarged. They also may have a problem with sagging of what little breast tissue they have. This is more common in women who have had children and in women who had had significant fluctuations in weight. Evaluation of these patients includes looking at the texture of their skin, to see if there are stretch marks, noting significant underlying damage to the skin's ability to tighten . In addition, it's important to look at the shape of the breast, the areolar size, the asymmetry of the breasts, and the age of the patient.

Plastic surgeons grade the amount of sagging, based on where the nipple is in relation to the inframammary crease (IMC). If the nipple is at or above the inframammary crease, a breast augmentation alone may give an adequate lift. If the nipple is lower, a breast lift will probably be required, especially if the implant is being placed under the muscle. When breast implants are placed submuscular, they tend to sit higher on the chest wall.

Depending on what size your breasts are to begin with, and what size you're planning to be after the augmentation, will influence the extent of mastopexy (breast lift) needed. Usually the breast lift can be done at the same time as the augmentation. Once the implants are placed in the pocket, the patient is raised to a sitting position on the operating room table and the amount of lift can be determined.