You’re considering a change to enhance your appearance, maybe because you’ve adopted a new, healthy lifestyle and lost a considerable amount of weight. Or maybe it’s because you are ready to celebrate a new phase of your life, and want your body to reflect the new start you want to make. To figure out whether you should get breast implants or a breast lift — or both — you need to think about precisely what it is that you’re dissatisfied with, and then have a clear picture of what your ideal breasts would be.

Option A: Altering the Size
Implants make your breasts bigger. How much larger you decide to go is a matter of personal preference, your existing body type, and what will be comfortable for you. Some women decide to have implants because they have been dissatisfied with their breast size or breast asymmetry their entire adult life and finally want to do something about it. Other times, it’s more cause-and-effect. For example, losing weight can change the shape and size of your breasts, including making them smaller and suddenly disproportional.

Implants add fullness and size to breasts, creating both shape and cleavage. However, implants do not offer any additional support to your breasts: breasts that sag before implants will sag after, possibly even more (the previous generation of surgeons were taught that placing the implant on top of the chest muscle would improve sagging, but we now know that is wrong). There is a wide range of implants — one that is just right for you. Find out about the various types of implants (and their pros and cons) here.

Key takeaway: Breast implants make your breasts larger, but don’t help with sagging.

Option B: Losing the Sag
Gravity, weight loss, nursing babies: all of these things work against your breasts’ perkiness. A breast lift (mastopexy) is when the whole breast, or the nipple/areola, or both, are moved to a higher, more youthful position on your chest. There are various kinds of breast lifts designed to address the many degrees of sagging. With the standard breast lift, your surgeon removes a good amount of skin from the lower part of your breasts while the areola around the nipple is made smaller. Then, the nipple and areola are moved to a higher position on the breast. The surgeon takes skin from the upper breast and moves it to the lower pole of the breast to provide support. If you need less of a lift (or don’t want all of the scarring involved in a traditional full breast lift), you might opt for a smaller procedure where a small crescent of skin is removed from just above the areola, which elevates just the nipple and areola two centimeters or less. There are other variations from there, which involve different degrees of both scarring and taking the sag away.

Key takeaway: A breast lift eliminates the sag, which alters the look of your breasts. But it doesn’t make them larger.

Option C: Where Sag and Size Meet
If you’re unhappy with the sagging going on at your breasts, and the size or symmetry of your breasts, you might opt for multiple procedures. You can get both a breast lift and breast implants, performed either at the same time or in two stages. If performed in one stage, the implants will be implanted during the same surgery where the breast lift is performed. The other option is to have the breast lift on one day, and implants at a later date (after a period of healing).

While it takes longer, a two-stage approach often makes sense from a health perspective. Two stages can also decrease your risk for scarring (though all procedures do come with some scarring). Your surgeon has to make a fairly large incision for a breast lift; that incision may heal better if it’s left alone. What can happen is that if the breast implant from the second part of the surgery is pushing outward against the incision and stitches, it will be more difficult for the incision to heal. Unfortunately, this can mean increased chance of scarring. Your individual circumstances will help you and your surgeon determine which approach would be best for you. You may determine that one surgery is a better option for you. In that case, make sure to emphasize to your surgeon how important minimal scarring is, and ask about ways to reduce scarring while doing both procedur