Quite a number of women who present requesting a breast augmentation would actually benefit from a lift. Typically this occurs after breast feeding/ pregnancy. The volume of the breast often fluctuates dramatically during pregnancy. Drooping breasts and loss of volume can also occur with weight fluctuation.
Breast augmentation is recommended if one is seeking enlargement. It should not be seen as inducing significant lift. In other words there is only a minor element of lift in augmenting the breast.
Lifting and enlarging the breast, otherwise known as augmentation mastopexy, is recommended if there is significant droop. If a prospective patient declines a lift at the same time as an augmentation then I will usually decline to perform the augmentation alone as the end result will likely not be aesthetically pleasing.
Plastic surgeons assess droop using measurements (sternal notch to nipple) and where the nipple complex lies in relation to the breast fold. Nipple complexes below the breast fold or at the lower extent of the breast are deemed to be ptotic (significant droop).
Mastopexy involves incisions around the areola and vertically down to the fold of the breast with a horizontal extension in the fold. The augmentation is usually performed first and then the incision markings are reassessed before proceeding to the lift. The more limited round block lift is much less satisfactory and has fallen out of favour with many surgeons.