There are a myriad of different techniques for a breast lift. However, I think it is best to think of them as two broad categories.
The first type of breast lift, focusing on raising the nipple. No one takes the nipple off and replaces it as a free graft (except for some very unusual circumstance such as a massive breast reduction – I once removed 26 lbs of breast tissue from a woman – 13 lbs per side and I did free nipple grafts then). Most techniques in this scenario involve raising the nipple areolar complex (NAC) and there is only a skin excision above the nipple areolar complex. This allows the NAC to slide up and can give a much better balance to the breast appearance. In general it works best, when not too much advancement is needed and also can be more dramatic if the woman is small breasted. I do these procedures very easily in the office under local anesthetic and you can return to work the next day. It takes about 90 minutes or less.
The other main type of breast lift, involves not only elevating the NAC, but involves elevating the actual breast tissue. This is done under general anesthesia in the Operating Room. This requires a “lollipop” incision or “key hole” incision and sometimes an extended incision in the lower aspect of the breast. This gives a more dramatic change and can significantly reshape the breast. It is important to remember that ultimately we are fighting gravity and the longevity of the results depend on the quality of your breast tissue. Some patients will get fantastic results that will last many, many years and for others, there can be an improvement but it may be much more short lived. Also the more ptotic (saggy) your breasts, the more dramatic and long lasting the results, usually. It can be quite difficult to give a full lift to someone who has full breasts but only a small amount of saggy-ness but who wants them very, very perky.
Often times, an implant will be used with the lift. Sometimes the breasts are made smaller. Sometimes it is just a lift alone. Everyone is different. I encourage everyone to get a consultation to fully understand their options.