Patients with sagging, deflated breasts often opt for a breast augmentation surgery combined with a lift. The combination procedure can remove any lax and hanging skin. It can also enlarge the breast size while reshaping the areola and nipple if needed. A breast lift on its own cannot create volume. In some cases, a breast lift alone may cause the breasts to become even smaller as the procedure reduces the size of the breast pocket.

Breast augmentation alone cannot help drooping breasts as it does not address overly lax skin. Some surgeons also recommend getting both procedures done in one sitting as it saves time and money. Patients will only require one application of anesthetic and one period of recovery time. However, this depends on each patient's medical history as well as the quality of breast skin, as not everyone is suitable for a single-stage approach and will require a staged lift followed by augmentation. For such patients, surgeons usually perform the breast lift first and add the implants 3-6 months later once the breasts are fully healed.

A typical breast lift and augmentation surgery can take 2-4 hours and requires general anesthetic. Surgeons use four different incision techniques depending on the individual  patient’s medical history, areas requiring change and the desired outcome. The Lollipop or Vertical Lift method uses an incision around the areola and a vertical line toward the breast base, creating a lollipop shape.

The Anchor or Inverted-T lift technique makes an incision from the areola to the breast's crease and then across the fold below the breast. This technique is best suited for patients with severe sagging.

The Periareolar or “Donut” technique creates a singular incision around the areola. This method can only mildly lift the breast and is not suitable for severe drooping.

The Crescent technique creates a crescent-shaped incision on the areola and is optimal for minor sagging.

Once surgeons make the incision, they remove any excess skin. They reshape the breast tissue and the areola and reposition the nipple. The nipple always stays intact to the breast throughout the surgery. This helps to maintain the function of the milk ducts for women who plan to breastfeed in the future and maintains blood supply to the nipple. Surgeons then insert the implant above or under the muscle. They close the site using stitches, glue or surgical tape. In some cases, surgical drains may be inserted to avoid fluid build-up during recovery.

The size of the implants is restricted in these procedures as too large implants can weigh down the skin. Combining these two procedures makes it a complex and risky surgery with a high revision and complication rate. Therefore, it should only be performed by a professional and experienced surgeon. 

Recovery takes about two weeks, and patients should avoid strenuous activity for several weeks.