You’d think that the plastic surgeon could take the breast tissue that has fallen, stuff it into the top of the breast, tighten the bottom part, and voila, the sagging breast is now a youthful attractive one.

Problem is, it doesn’t work. Women are not surprised when I tell them that it just isn’t possible to get the breast tissue to stay in its lifted position. Breast tissue just doesn’t hold its shape well, which is why the problem happened in the first place.

Instead, we need to remove extra breast tissue from the bottom and add to the top using a breast implant. This is called the “minus plus” principle, which was coined in the 1980s by Dr. Daniel and co-authors.

The good news is that a breast implant works very well to fill out the upper breast pole. I tell patients, the worst thing about breast implants is that they are not just like natural breast tissue. The best thing about breast implants is they are not just like natural breast tissue.

When they see me in the office, women often lift their breasts in the cups of their hands and say, “this is what I want.” These women will not be satisfied with a breast lift alone. They need a lift and implants too. This combination is called augmentation/mastopexy.

Some women want the sagging corrected and are OK with not filling out the upper poles. Of course, a bra can provide this effect. But women who desire upper pole fullness naked, in a bikini, and without a bra should consider implants, even small implants.

Some women do not want implants because they just don’t like the thought of having a foreign material in their bodies. And that’s ok. However, saline implants just contain water. If they leak, it’s just water, not silicone gel. Women who do not like the thought of having implants might consider saline implants.

It’s important for women to know that a breast lift makes the breast smaller. So if they want to stay the same size, they should consider implants. A skin-only breast lift (the surgeon just tightens the skin envelope without removing breast tissue) is unlikely to provide long-term correction.

Women need to know what to expect, so they don’t undergo a procedure that is unlikely to deliver the results they want. This goes for any type of cosmetic surgery.