Palo Alto Breast Lift doctors

It sounds like you like the volume/cup size you currently have, but don't like the shape and droopiness.  I see a lot of patients who are in a similar situation to yours - moms who are done having babies, have seen their breasts change with pregnancies and breastfeeding, and would like to have a better shape.  If you are comfortable with your size and don't want to be bigger, I don't think you need an implant.

It would be best to be seen and evaluated by a plastic surgeon in person, but you might be able to achieve your goals of improving your shape without changing your size significantly with a breast lift.  A breast lift, or mastopexy, would help put your breast tissue back up on your chest, center your nipple on your breast, and give you a rounder, perkier shape - in exchange for either a T shaped (anchor) or lollipop scar.

There are three ways to do a lift, basically.  They are peri-areolar, vertical (lollipop), and anchor or inverted-T.

The peri-areolar technique tends to flatten the breast, not make it perky, unless an implant is used.  For someone who already has sufficient volume and does not want more, not a good choice.

That leaves the other techniques.  For a patient who does not need much nipple elevation, the vertical lift might be fine.  However, there is a scar on the front of the breast.  This scar usually heals well as a fine line over time.

Sometimes the vertical lift requires the addition of a small horizontal incision in the inframammary fold to remove excess skin in the vertical direction.

Unfortunately, when excess skin must be removed to get elevation, there will have to be a scar on the front of the breast. These trade-offs should be frankly discussed with your plastic surgeon and should be acceptable to you if you want a breast lift that has the potential to give a nice lifted shape.

A breast lift requires repositioning the nipple/areola upwards and removing some skin.

The use of an implant as opposed to only a mastopexy without implant may allow a peri-areolar scar if the implant is relatively large with respect to the breast volume. It doesn't work, for example, if you are taking a C cup and putting in a small 150-250 implant.  There is just not enough volume from the implant to make a large enough platform to tighten down a purse-string suture without flattening the breast.

On the other hand if a patient is an A cup, and had not previously been a D, implying a lot of stretched out skin excess,  an augmentation to a C would take up a lot of the slack in the skin, decreasing the amount to be removed.  If the degree of vertical lift was only 2-4 cm, then this kind of lift works well, and the scar is just around the areola. 

When can you not do this and get an acceptable cosmetic result?  When there is just too much skin to be removed. That's where your doctor's experience and judgment will guide you.

Another point is that it is easier to control areola size post-op with the standard mastopexy. With the peri-areolar mastopexy with augmentation, there is outward pressure on the closure. That can result in unpredictable widening of the areola later, even though all precautions are taken with one or more permanent purse-string sutures.

With your history of going from D to A, implying a lot of skin excess, the vertical technique sounds appropriate.