Breast Lift, Breast Lift with Implants & Autologous Fat Grafting in Beverly Hills | Dr. Daniel Golshani

The breast is not a static structure. It is a collection of glandular tissue, fat, connective tissue, and skin that sits in a dynamic relationship with gravity, the chest wall, and the hormonal and physical changes that women experience throughout their lives. When that relationship is disrupted, by pregnancy, breastfeeding, weight fluctuation, or the natural progress of aging, the breast changes in ways that are structural, not superficial.

Breast ptosis develops through a specific anatomical sequence. The skin envelope stretches. The Cooper’s ligaments, the internal fibrous supports that connect the breast tissue to the overlying skin and the underlying chest wall, weaken and elongate under the sustained weight and hormonal influence. The breast tissue and fat that were once distributed across the upper and lower pole shift downward. The nipple-areola complex, which should sit at or above the level of the inframammary crease, descends toward or past it. The upper pole, which in a youthful breast is full and gently rounded, becomes flat and empty as the tissue has migrated south.

This is why non-surgical interventions do not correct ptosis. Devices, creams, and radiofrequency treatments address the skin surface. They do not address the stretched skin envelope, the descended breast parenchyma, or the displaced nipple-areola complex. The correction is surgical, and it requires a surgeon who understands the anatomy of the ptotic breast well enough to correct it at every level simultaneously.

Breast ptosis is classified by degree, and the degree determines both the technique and the extent of the surgery required:

Grade 1 (Minor ptosis): The nipple sits at the level of the inframammary crease. The breast is beginning to lose upper pole fullness but the ptosis is relatively mild.

Grade 2 (Moderate ptosis): The nipple sits below the inframammary crease but remains above the lower contour of the breast. Upper pole deflation is more pronounced.

Grade 3 (Severe ptosis): The nipple has descended significantly below the inframammary crease and points downward. The breast tissue hangs below the nipple. Correction requires the most extensive skin resection and reshaping.

Pseudoptosis: The nipple sits at or above the inframammary crease, but the majority of breast tissue has dropped below it. The upper pole is significantly deflated. This presentation is common in patients after significant weight loss or following breastfeeding, and it frequently responds better to augmentation than to a full lift.

Dr. Golshani determines the degree of ptosis and the correct surgical approach during a detailed examination at consultation.

The Breast Lift Alone: Mastopexy as a Structural Correction

A mastopexy, the surgical breast lift, repositions the breast on the chest wall, reshapes the breast parenchyma into a more projecting, rounder form, removes the excess skin envelope that the descent has produced, and elevates the nipple-areola complex to its anatomically correct position.

It does not add volume. This is the single most important thing for patients considering a breast lift to understand. The size of the breast after a mastopexy is the same as or smaller than before, because skin removal necessarily reduces the circumference of the breast envelope. If the patient’s concern is position and shape, and their existing breast volume is adequate for their frame, a mastopexy alone produces a complete and satisfying result. If volume is also a concern, the mastopexy must be combined with augmentation.

Incision patterns in mastopexy are chosen based on the degree of ptosis and the amount of skin excess that needs to be removed. Each pattern produces a different scar distribution, and Dr. Golshani selects the approach that achieves the necessary correction with the minimum scar burden:

The crescent lift removes a small crescent of skin above the areola. It produces only a half-circle periareolar scar and is appropriate for the mildest cases of nipple elevation, typically one centimeter or less.

The periareolar lift (donut or Benelli lift) removes skin in a full circle around the areola. It is appropriate for mild ptosis with modest nipple elevation required. The scar encircles the entire areola and is typically well-concealed at the junction between the areola and the surrounding breast skin.

The vertical lift (lollipop lift) adds a vertical scar from the lower edge of the areola to the inframammary crease. It is the workhorse approach for moderate ptosis, providing more skin removal and reshaping capability than periareolar techniques alone while avoiding the horizontal inframammary scar.

The inverted T lift (anchor lift) adds a horizontal incision along the inframammary crease to the vertical and periareolar components. It is appropriate for significant ptosis with substantial skin excess. It produces the most extensive scar pattern but also the most powerful reshaping and skin removal capability, and it is the approach most suited to the most ptotic presentations.

The scar concern is real and Dr. Golshani addresses it directly during every consultation. The scars of a well-performed mastopexy are placed in the least visible positions, closed with meticulous technique, and supported during healing to minimize their final appearance. Most patients find that the improvement in breast position and shape makes the scars an entirely acceptable trade-off. What they find unacceptable is a breast that continues to look the way it looked before surgery.

Breast Lift with Implants: Addressing Both Position and Volume

The breast lift with implants, formally called augmentation-mastopexy, is one of the most technically complex procedures in breast surgery. It asks the surgeon to achieve two goals simultaneously that have competing anatomical requirements: adding volume through an implant while removing skin and reshaping the breast envelope through the mastopexy.

The tension between these two goals is the central challenge of the combined procedure. A mastopexy works by removing skin and tightening the breast envelope. An implant works by filling that envelope from within. When performed together, the implant exerts outward pressure on the closure that the mastopexy is trying to hold inward. This tension, if not correctly managed, is one of the principal causes of the complications associated with combined augmentation-mastopexy: wound dehiscence at the closure site, early recurrence of ptosis, implant malposition, and nipple-areola complex compromise.

Dr. Golshani addresses this through meticulous surgical planning: selecting an implant size that the reshaped breast envelope can accommodate without excess tension, choosing the correct incision pattern for the degree of ptosis, and executing the mastopexy component with the precision that a simultaneously placed implant demands. The goal is a result where the lift holds over the long term, the implant sits in its intended position, and the combined breast looks natural rather than a combination of two competing surgical interventions imposed on the same anatomy.

Staging the procedure is an option Dr. Golshani discusses honestly with patients whose anatomy presents with very significant ptosis alongside a desire for significant augmentation. In some cases, performing the mastopexy first and the augmentation in a second stage, after the mastopexy has fully healed and the new breast envelope dimensions are established, produces a more reliable and more precisely calibrated result than attempting both simultaneously. This is not a universal recommendation, and most patients with moderate ptosis and moderate augmentation goals are appropriate combined procedure candidates. But for patients at the more extreme end of the combined presentation, the staged approach is the correct surgical decision, and Dr. Golshani makes that recommendation when the anatomy calls for it.

Breast Lift with Autologous Fat Grafting: The Third Dimension

The breast lift alone and the breast lift with implants address position, shape, and volume. What they do not address is the subtle three-dimensional quality of the breast that makes it look naturally soft, proportionate, and genuinely youthful rather than surgically corrected.

This is where autologous fat grafting using the G-Stem technique adds a meaningful dimension to breast lift surgery.

In patients undergoing a breast lift alone, fat grafting can be used to restore upper pole volume without an implant, add subtle fullness to the medial breast and cleavage zone, and correct residual volume asymmetry between the two sides that the mastopexy reshaping cannot fully eliminate. For patients who want the position and shape improvement of a lift but do not want an implant, and whose volume concern is modest rather than significant, fat grafting to the breast as an adjunct to the mastopexy frequently provides enough volumetric improvement to make a separate implant unnecessary.

In patients undergoing a breast lift with implants, fat grafting addresses the zones where the implant produces a less-than-ideal result even within the lifted breast: the upper pole transition where the implant edge can be visible in thin-tissue patients, the medial cleavage zone, the lateral implant border, and any zones of residual asymmetry between the two sides. The same principles that apply in the hybrid breast augmentation context apply here, with the additional consideration that the breast envelope has been restructured by the mastopexy and the fat must be placed within that newly defined anatomical space.

The fat used in both applications is processed using Dr. Golshani’s proprietary G-Stem technique, which concentrates the regenerative adipose-derived stem cells within the harvested fat before transfer. The result is not simply volume replacement but tissue regeneration: improved skin quality over the graft sites, enhanced integration of the transferred fat with the surrounding breast tissue, and a softness and natural quality to the result that standard augmentation alone does not reliably produce.

The Nipple-Areola Complex: Position, Size, and What Changes With a Lift

One of the most visible and most meaningful elements of breast lift surgery is what happens to the nipple-areola complex, and it is worth understanding clearly before surgery.

In a ptotic breast, the nipple-areola complex descends along with the breast tissue. Repositioning the nipple-areola complex upward to its anatomically correct position, at or just above the level of the inframammary crease and centered on the breast mound, is one of the primary goals of the mastopexy.

The areola, which is the pigmented circular zone surrounding the nipple, frequently enlarges as the skin stretches with ptosis and pregnancy. Most mastopexy techniques allow the surgeon to reduce the areola circumference at the same time as repositioning the nipple-areola complex, producing a more proportionate and youthful nipple-areola size alongside the lifted breast position.

In patients with more significant nipple-areola concerns, or where the nipple requires specific reconstruction, Dr. Golshani may recommend nipple and areolar reduction and reconstruction as a component of the surgical plan.

The Multiplanar Mastopexy: Dr. Golshani’s Proprietary Approach

For patients requiring the most technically demanding level of breast lift, Dr. Golshani performs the Multiplanar Mastopexy, his proprietary approach to breast lift surgery that addresses the breast tissue and the breast envelope in multiple anatomical planes simultaneously, rather than simply removing skin and repositioning the nipple from a single plane.

The Multiplanar Mastopexy provides greater reshaping capability, more durable long-term positioning, and a more natural breast contour than standard single-plane mastopexy techniques, particularly in patients with significant ptosis, significant skin excess, or presentations where the breast parenchyma requires internal reshaping alongside the external skin correction.

Patients presenting with complex mastopexy needs are evaluated for the Multiplanar approach during consultation, and Dr. Golshani explains the distinction between the standard and multiplanar techniques clearly so that the patient understands what their anatomy requires and why.

When a Breast Lift Is Part of a Larger Plan

Breast lift surgery is frequently the primary procedure patients present for, and it is equally frequently performed as a component of a broader body rejuvenation plan:

• Breast Augmentation with Implants and Fat Grafting when the volume and hybrid augmentation goals extend beyond what the mastopexy component alone can address
• Mommy Makeover combining breast lift, with or without augmentation, with abdominoplasty and liposuction to address the full spectrum of post-pregnancy body changes in a single surgical plan
• Liposuction as the donor site procedure for the fat grafting component, producing a body contouring benefit alongside the breast lift and fat transfer
• Tummy Tuck when abdominal skin laxity and muscle separation accompany the breast changes, most commonly in patients following pregnancy or significant weight loss
• Nipple and Areolar Reduction and Reconstruction when the nipple-areola complex requires specific attention beyond what the standard mastopexy repositioning addresses
• Breast Revision for patients who have had prior breast surgery and present with ptosis developing over the implant, requiring a combined revision and mastopexy approach

The philosophy that guides every combined plan is consistent with what guides every individual procedure: a result where each component complements the others and the whole looks proportionate, natural, and entirely like the patient’s own body.

The Standard: What a Well-Done Breast Lift Looks Like

The most reliable indicator of a technically excellent breast lift is a breast that looks like it has always sat in this position.

Not a breast that looks operated on. Not a breast where the scars are the first thing noticed. Not a breast that sits too high or too round or in a shape that reads as artificial. A breast that is lifted, shaped, proportionate, and entirely consistent with the rest of the body it belongs to.

That standard is the same whether the procedure is a mastopexy alone, a combined augmentation-mastopexy, or a breast lift with autologous fat grafting. The technique varies. The goal does not.