The Art and Science of Breast Lifts

Breasts can start drooping for a variety of reasons, such as pregnancy and breast feeding, increased age or significant weight loss. One potential solution is a mastopexy, or breast lift.

Mastopexy Surgery

Mastopexy surgery rejuvenates the breasts, returning them to a more youthful position on the chest, and provides a more aesthetically pleasing look without actually increasing breast volume. The ideal breast lift result looks perfectly natural, like you were born that way, with a teardrop breast shape but without unnaturally round upper pole fullness.

Patients Seek Out Breast Lifts for Many Reasons

Some women feel their breasts have lost their formerly nice shape or they are concerned their nipples now sag downward. Moms may miss how their breasts looked before children. Other women want better symmetry of their breasts. Many patients like how their breasts look supported in a bra and simply want to have that appearance without needing to wear a bra.  

What Happens During a Breast Lift?

A mastopexy reshapes the breast tissue internally, raising where the breast sits on the chest wall, it repositions the nipple upwards, decreases areola size and removes extra baggy lower pole breast skin.  An analogy I often use with patients is to visualize rolling up a long sport sock into a small ball – although this isn’t really what happens during a breast lift, it is easy to visualize a more compact breast shape versus a longer cylinder.   


Each breast lift technique creates a circular incision around the nipple and areola, allowing the nipple to be repositioned upward and the areolar diameter reduced, as necessary. A mastopexy preserves vital nerves, blood vessels and milk ducts, thereby best preserving breast function. Some women require additional incisions under the nipple (a lollipop scar) and in the breast fold, depending on their breast shape, the amount of excess skin and their nipple location.

My Technique

As a leading Plastic Surgeon in the Bay Area, I favor a personal technique I developed several years ago called “auto-augmentation”, which fills the breasts’ upper pole with tissue from lower parts of the breast. Not only is the breast shape improved, but auto-augmentation allows tissue to sit higher up in a pocket on the chest wall, similar to where an implant would be placed, and to have a round, compact shape similar to a natural breast implant.  

Combining Mastopexy and Augmentation

Sometimes a breast implant will be added to a mastopexy to achieve more significant upper pole fullness. Breast augmentation alone can subtly lift the nipples; however combined mastopexy and augmentation is recommended when breasts droop significantly and patients want to enhance volume and projection, achieving a push-up or padded bra look, but not necessarily a natural teardrop shape. 

Is a Breast Lift is Right For Me?

Women who are healthy, in good physical shape and at their ideal body weight (or a stable weight following major weight loss) are good candidates for surgery.

During your initial mastopexy consultation, we will take a complete medical history and learn more about your specific aesthetic goals. If you are a breast lift candidate, we will describe your ideal personalized procedure in detail. As an all-women Plastic Surgery team, we intimately understand how a woman’s feelings about her breasts can influence her self-image and femininity. Our goal is to help you be happier with the way you look, considering safety our number one priority. For more information visit my website

Karen M. Horton, MD, FACS

Dr. Karen Horton is an internationally Board Certified Plastic Surgeon in San Francisco, a fitness enthusiast, proud mom to fraternal twin girls, and devoted wife of nearly 3 decades. A surgeon’s daughter, she is proud to have built a successful, women-focused boutique private practice in Pacific Heights. Featuring a brand new Quad A-certified, fully equipped operating room, Dr. Horton offers her patients the highest level of aesthetic care, both surgical and non-surgical, in a modern, bright and discrete setting. She considers it an honor and a privilege to care for her patients! To learn more about Dr. Horton, visit and follow her on social at @drkarenhorton.