Women who want larger breasts may consider a breast augmentation (implant surgery), whereas, women who would like their breasts lifted may choose to have a mastopexy (breast lift). However, women in Orange County, California, who would like to improve the shape, position and size of their breasts should consider having a breast lift with an augmentation with Dr. Farbod Esmailian. Dr. Esmailian is a double board-certified plastic surgeon in Orange County who specializes in performing plastic surgery procedures to improve sagging, deflated-looking breasts.


Sometimes, it takes a combination of procedures to accomplish the look a patient desires. This is frequently the case for women who would like to address multiple issues related to their breasts.

A breast lift is designed to address drooping breasts, reduce the size of the areola and improve the shape of the breasts. A breast augmentation involves adding volume to the breasts with the insertion of saline or silicone breast implants. In addition to adding volume, breast implants will also add the “upper pole” fullness that most patients desire. A breast lift will increase the fullness in the upper portion of the breast, but not to the extent that a breast implant can.


A breast lift with implant surgery in Orange County can address a number of issues.


  • a loss of fullness in the upper portion of the breasts;
  • elongated, flat breasts;
  • nipples and areolae that point down;
  • enlarged or stretched areola;
  • pendulous breasts;
  • asymmetrical breasts (one breast is larger/longer than the other);
  • a loss of breast closeness/cleavage; as well as
  • lost volume in the breasts.


As time passes, the Earth’s constant gravitational pull causes a variety of changes throughout the body. The breasts are no exception: The skin encasing the breasts and the ligaments beneath are pulled and the breast tissues shrink, which causes the breasts to appear deflated. Due to the pulled skin, the nipples and areola fall beneath the breast crease. In addition, they no longer face forward, instead, they face down.

During a breast lift, Dr. Esmailian moves the breasts to a higher position on the patient’s chest. He also reduces the size of each areola, repositioning them on the patient’s newly shaped breasts.


While gravity causes the breasts to droop, there are life changes that can cause the size, shape and elevation of the breasts to change sooner rather than later. These changes include weight fluctuations, vigorous exercise routines, pregnancy, nursing and genetics.


It is not uncommon for women to have asymmetrical breasts. For some women, having one breast that is larger is of no concern; however, this inconsistency causes some women to feel insecure about their appearance. These women may choose to have a breast lift to help address this issue.

At his surgery center in Orange County, Dr. Esmailian frequently performs breast lifts to address uneven breasts. Once the lift is complete, the patient’s breasts will appear more symmetrical and more youthful. Furthermore, the nipple and areola will face forward once again. When breast volume is an issue, either a breast reduction or a breast augmentation can be performed on one of the breasts to attain better symmetry.


A breast augmentation is used to add volume to the breasts. During a breast augmentation, Dr. Esmailian can use silicone or saline breast implants to increase the size of the patient’s breasts.


  • saline breast implants, which are filled with sterile saline solution after insertion;
  • silicone implants, which consist of cohesive silicone gel and are inserted already filled; or
  • gummy bear implants, which are also called form-stable implants because they consist of a cohesive gel that holds its shape. Gummy bear implants are already formed when they are inserted.

A breast augmentation in and of itself may be able to address minor sagging which is called pseudoptosis; however, moderate to severe drooping will require a breast lift as well.


Dr. Esmailian and his medical staff are dedicated to providing each patient with the high-quality care and attention that they deserve. Therefore, during the initial consultation Dr. Esmailian will want to know about the patient’s medical history, including medications, lifestyle choices (smoking, drinking alcohol, recreational drug use, etc.), current medical conditions (heart disease, diabetes, etc.) as well as what she would like to accomplish with plastic surgery.

During this consultation, the patient can expect Dr. Esmailian to perform a physical evaluation of the breasts. Dr. Esmailian will take measurements and perform his assessment of the breasts in relation to the patient’s body. He will then make his recommendation based on the patient’s needs and desires. He may recommend a breast lift only, breast lift with augmentation, a breast reduction or a breast reduction with implants. Of note, is that a breast reduction does include a breast lift. Photos may be taken during the consultation or preoperative visit to help with the surgical planning. These photos may be used for reference as well as for comparison purposes once the surgery is complete.

The majority of patients will need to have pre-surgical testing performed. This testing frequently includes blood tests and at times an EKG. In addition, some patients may be required to visit their family physician to receive a surgical release prior to scheduling their surgery with Dr. Esmailian at his surgery center in Orange County.

A breast lift with an augmentation is an outpatient procedure. Patients are not permitted to drive for at least 24 hours after their surgery; therefore, a driver must be present at Dr. Esmailian’s Orange County surgery center on the day of the patient’s surgery. Arranging for a driver well in advance of the procedure is recommended.


Each patient’s anatomy and proportions are unique. Dr. Esmailian and his medical staff assist patients in determining which type of implant and what size implant will provide her with the results she desires.


Since patients must avoid heavy lifting from 4 weeks after their surgery, they need to find someone to assist them with young children and/or pets during this time.

Tops that can be put on and taken off without placing them over the head need to be readily available following a breast augmentation with a lift for at least the first week. In addition, pants that are easy to put on and remove should be used throughout the initial recovery period.

Patients will desire to remain upright for the first 48 hours following their surgery; therefore, having extra pillows on hand is essential.

Many patients find it helpful to create themselves a recovery area at home. This recovery station should have everything the patient may need for the first couple of days following surgery and have them within easy reach. Patients are encouraged to walk immediately after surgery. The procedure is not a painful procedure and most patients do well on the muscle relaxants prescribed and extra strength Tylenol.


A breast lift with an augmentation usually lasts 3 hours. Patients’ drivers may remain at the Orange County surgery center during the plastic surgery procedure or if they decide to leave, Dr. Esmailian will call them once the procedure is complete.


Patients receive anesthesia during their breast augmentation with a lift. These medications are administered to the patient by a board-certified anesthesiologist. The anesthesiologist continually monitors each patient throughout her surgery.


There is three incision options for patients who are having a breast lift. Dr. Esmailian discusses which incision he recommends with the patient prior to her procedure.

Incision options:

  • Donut/Benelli

Donut/Benelli – around the areola

  • Lollipop/Vertical

Lollipop/Vertical – around the areola and down to the breast crease (inframammary fold)

  • Anchor/T Lift

Anchor/T Lift – around the areola, down to the breast crease and horizontally along the inframammary fold

Following creation of the incision, Dr. Esmailian will begin by creating the pocket that is needed for the breast implants. This is usually a pocket that is made behind the pectoral muscle. Once the pocket is made, implant sizers are placed to determine which size works best. At this point the lift is simulated by placing staples and tucking the skin. The patient is sat up and the breasts are evaluated. If there is any adjustments needed they are performed now. The reshaping the patient’s breasts may take place now by performed the lift. If any tissue is needed to be removed, they are removed at this time. The areola are also reduced down in size, if needed. Furthermore, he may move the nipples and areola higher on the patient’s breasts. His goal is to ensure that the patient’s breasts appear natural, more youthful and no longer sag.


Before closing the incisions, Dr. Esmailian will remove the sizers and place the implants, often using the Keller funnel when placing silicone implants.


Once Dr. Esmailian is happy with the appearance of the patient’s breasts, he will close the incisions. All of the sutures that Dr. Esmailian uses during a breast lift with an augmentation are placed internally. Therefore, they are absorbable and do not require removal. Furthermore, using these internal sutures helps minimize visible scarring.


Directly following surgery, patients receive a surgical bra. The surgical bra is used to minimize swelling, help the patient remain comfortable and promote healing. This bra may be removed to shower 48 hours after surgery. However, the bra must be re-applied after the patient showers and worn at all times.


The majority of patients can resume their full activity level (including exercise) 4 weeks after their surgical procedure. Usually, at the 2-month mark, patients can begin wearing a regular bra.


While results are immediately visible, final results become apparent approximately 4 months after the breast augmentation with a lift procedure.

As a gifted breast specialist in Orange County, Dr. Esmailian consistently provides women throughout Southern California with natural-looking breast augmentation and breast lift results. His cutting-edge techniques, exceptional skills and caring manner make him one of the top plastic surgeons in the Greater Los Angeles Area. If you would like to schedule an initial consultation with Dr. Farbod Esmailian at his office in Orange County, please contact the office today at (562) 430-7373 or with our online contact form.




    Breast Lift with Augmentation FAQs

    Two weeks ago I had a lift with implants and I am still having a burning pain; how long can I expect this to last?

    Burning pain or sensation is a common part of this procedure. It is a result of the nerves that are awakening and will usually last weeks to months. The time frame is really dependent on the patient and every one varies. After the first few weeks it will begin to lessen, but I have had patients state as far a year out that they had an episode, although mild.

    How do I know if I need a breast lift when I get my implants?

    Breast implants will add volume and increase the upper pole fullness, however adding an implant, no matter how large, will not “lift” the breasts. Some patients make the mistake of going larger to avoid a lift; that is an advice that I would give. Your surgeon should be able to tell you whether you would benefit from a lift or not. Some patients are borderline for a lift and in those cases, you can have an augmentation with breast implants performed and take the wait and see approach. If things look good and you are happy with your results at 4 months, then you are good to go. If you feel that the nipple and areola are still too low in relation to your implants, then a lift would be warranted.

    I am 21 years old and I do not like the size and shape of my breasts; could a crescent mastopexy with breast implants give me more youthful-looking breasts?

    There are several different types of lifts and the crescent is the most minimal one. I just don’t consider the crescent a real lift. A crescent it good to use in certain patients like those who have one nipple/areola that is a bit lower that the opposite. In those cases, a crescent can be performed which will help with leveling the nipple/areola.

    What should I expect as I recover from a breast lift with an augmentation?

    Recovery should be pretty straightforward. There should not be significant pain, but there will be some tightness which is common. In general I allow my patients to go back to work 3-5 days after this procedure, as long as they have a desk job. If your job requires physical activity, then the recovery period may have to be extended. Usually most of my patients take the muscle relaxant and Tylenol for pain relief. At 4 weeks, full activity can be resumed and you may go back to sleeping in any position.

    I am worried about the scars on my breasts; how do I know if they are healing properly?

    All the suturing that I perform is internal and will not leave any suture marks. The incisions are dressed with a special tape that is left on for 2 weeks. After the 2 week period, we remove the tapes and scar treatment can be started at that time. As long as you are healthy (no diabetes, no smoking) and follow all the directions we provide, then the healing process should procedure very nicely.

    I have pseudo ptosis; would breast implants with a Benelli mastopexy work for me?

    Pseudo ptosis is a condition when the nipple and areola are above the fold but there is significant amount of breast tissue that is sitting below the fold. This can be addressed in several different ways. If the skin envelope is not very loose and there is not significant amount of tissue below the fold, then a breast augmentation with a dual plane technique would work well. In case where the pseudo ptosis is more severe, the more that may need to be done. In these cases the patient will benefit from a lift, even though the nipple and areola may be in a good position. This may necessitate an incision along the crease or perhaps a lift incision (donut, vertical or full).

    Will I receive pain medication after my augmentation with a lift?

    After a breast augmentation and mastopexy, I commonly prescribe muscle relaxants and narcotic pain medication. Most patients will usually the muscle relaxant only and will be comfortable with just that. Some others may need to supplement the muscle relaxant with Tylenol. In certain cases patients may need to add the narcotic pain medication that his prescribed. However, most patients (if they are taking any pain medications) will not need them after the first 48 hours.

    I am going to have silicone implants placed and a breast lift; how long does it take for the scars to diminish?

    Everyone is different as is every skin type. In general, it will take 1 year for the scar to be completely healed. During this time they will change color, going from being faint to more red or darker by 4-6 months’ time and then begin to lighten up for the remaining 6 months. The scars will never go away, but depending on the patient’s skin type, they will lighten up tremendously.

    I had a mastopexy and augmentation; my nipples seem like they are too high, what can be done to correct this issue?

    I would always recommend waiting about 4-6 months before undergoing breast revision surgery. If you fell that the nipples still too high, then this can be addressed by performing an inferior mastopexy. This is essentially removing skin along the inframammary fold (in a crescent manner) which will help bring down the nipple/areola. It is a very powerful method and works very well to help address the high nipple/areola.

    I am three weeks post op and the nipple on my left breast protrudes and is oddly shaped; do you have any advice for me?

    In general, I advise patients to wait for 4-6 months before undergoing any revision surgery. There is a healing process, swelling and settling of the lift as well as breast implants that need to happen before we can say this is your final results. If the issue persists after this period, this can easily be addressed in most cases in the office under local anesthesia.

    I underwent a lollipop lift and had implants placed sub muscularly; my skin itches and I keep having a tingling sensation; are these signs of infection?

    Itching and tingling sensation is usually a sign of the nerves that were disrupted at the time of surgery, beginning to awaken and starting to heal. During this time to help elevate the sensation and discomfort that some experience, I recommend massaging the area which will help the nerves “calm” down.

    Can I have a breast lift and augmentation at the same time?

    I almost always perform a breast lift and breast augmentation at the same time. It can be done safely, in a cosmetically appealing result if the proper steps are taken by the surgeon. In certain cases, where a patient may have significant ptosis or has a great deal of breast tissue but wants the implanted look, then in those cases I would recommend staging the procedure to get the best outcome. The breast reduction or the breast lift will be done first and then in 4-6 months, implants can be placed.

    My breasts sag, but only slightly; if I have large implants placed, would that fix the sagging or would I need to have a lift as well?

    Placing larger implants to avoid the scars that are necessary is usually not a good idea. The larger implant will not raise the breast nor will it raise the low nipple/areola complex to a higher location. But conversely the larger implant will cause premature stretch and thin out the tissues faster over time. You will have the same look that you have now but just bigger.

    I just had an augmentation with a lift and my nipples are itching really badly; is this normal after a procedure such as this?

    Commonly patients complain of burning sensation and itching of the nipple and skin. These are a result of surgery and disruption of the nerves. This is only temporary and will resolve over time. Also patients may experience excessive dry skin which is also attributed to the disruption of the nerves that help innervate the glands that moisturize our skin on a regular basis. I always recommend good moisturizing of the skin during this temporary period.

    If I have a breast lift, will my breasts look smaller?

    A breast lift will not reduce the size of the breasts but it may give the appearance of a smaller breast. This is because during a breast lift, the excess skin is removed and the breast is made tighter and more compact, therefore changing the appearance from an elongated breast to one that is more compact. Also the bra size may change, as most patients will be wearing a slightly large bra to accommodate the excess skin. A breast reduction, which commonly uses the same incisions, will reduce the breast as well as lifting them.

    I had my breast lift with augmentation at which time I lost the sensation in my left nipple; is there any chance that the feeling will come back?

    Loss of nipple sensitivity is a rare complication of any breast surgery, whether it is with an implant or a lift, this may happen. The rates are very low and are more in correlation with the size of the implant. Adding a breast lift does not increase your chance of loss of nipple sensation. Studies have shown that the large the implant, the more chance of loss of nipple sensitivity. If nipple sensitivity is lost immediately after surgery, the sensation may come back but it can take up to 1-1 ½ years to return.

    I really do not want to increase my breast size, but I would like fuller-looking breasts; to accomplish this will I need implants placed during my breast lift?

    A breast lift alone will allow you to keep the same volume but place the nipple and areola in a better location and raise the breast mound higher up in relation to the breast tuck. To achieve a fuller upper pole, an implant will be needed. However, if an implant is placed, the outcome will be a larger breast. Some patients desire to keep the same size breast but achieve the fuller upper pole. In these cases, a smaller implant can be placed with removal of equivalent breast tissue to help maintain the same volume but now have the implanted look.

    My breasts are of two different sizes, will using two different implants help getting me breasts even?

    If we are not performing a lift, then placing different size implants would be the best option. If the patient is undergoing a breast lift, then the better option would be to reduce the larger breast and then place implants that are the same size or very close. The problem with one greatly larger implant than the other is that the breasts will age differently over time.

    How long do I need to wear my surgical bra?

    Every surgeon has their own postoperative recipe and recovery schedule. I generally have my patients where a surgical bra or sports bra (something that is soft and have no wires or cups) for about 6-8 weeks. After that I allow my patients to wear a regular bra. Every patient is different and we adjust things as deemed appropriate during the follow up visits.

    Is there a mastopexy with an augmentation that has a really fast recovery?

    A breast lift with augmentation has the same recovery as a breast augmentation only. The pain or discomfort between the two is very similar and I generally require patients 3-5 days off of work after either procedure. At 4 weeks I allow my patients to resume full activity.

    I am thinking about having a breast lift with an augmentation; how can I determine the implant size that will be proportionate to my nipple-areolar complexes?

    During the breast lift procedure, it is common to reduce the size of the areola down to a size that will fit the lifted and augmented breast. Also we take into account the size of the nipple. If the patient has a smaller nipple then we would want to stay on the smaller side of the areola sizing. If the patient has a larger nipple, then we would obviously want a slightly larger areola. This is all done in conjunction to the patient’s request as well as the ultimate size of the desired breast.