Kirkland Plastic Surgeons

Do I Really Need Mastopexy on Top of Different Size Implants For Asymmetry? (photo)

Hello, i have been to one surgeon who has suggested me to have a breast augmentation with mastopexy on my right breast, because of the position of my nipple, She says if i don't get it done, the assymetry will still be there with two different size implants, and it won't look nice and i won't like the result. i was against the mastopexy (which she plans to do around the aerola) because i am scared of having scars...she suggested 150-200cc but i think i am going for 200-300cc would it be too big?

The volume asymmetry can be lessened by bilateral breast augmentation with, of course, a larger implant placed in your left breast.  Placing implants only on one side does not, in my opinion, work very well, as the implanted breast feels different and has more upper pole fullness than the non-implanted breast.

If volume symmetry by implant augmentation is performed, your right nipple will still be lower and I believe the right breast will have more overhang.  The best option for obtaining better symmetry of nipple/areolar size and position and breast shape would be to lift the right nipple/areola, and I believe that this amount of lift could be accomplished with a periareolar (Benelli) lift without a vertical scar, but an examination would be helpful in order to confirm this.  The breast lift does NOT have to be performed at the time of the augmentation, and if you are unsure about having the lift, you can see what results you achieve over several months from the augmentation alone as things settle out and then undergo a lift later if desired. The lift is not that major a procedure, is not particularly painful, and if the implants are fine there is no need to re-operate on them.

Robert M. Grenley, M.D.

Seattle Plastic Surgeon

How Do I Know Which CC's Will Look Ok On My Body? (photo)

I am 5'7 1/2 and weigh 180 pounds. I currently wear a 36B and recently went to a consultation. I tried on 375cc's and thought it may be too big. My doctor said no, and encouraged me to go bigger. I'm unsure what will look good? I ultimately want to be a D but I don't want it to look too extreme. But I also don't want to go through with getting 375 or 400cc's and it turn out to be too small. What do you recommend? Help! I have attached my pic along with two pictures I would like to look like.

I do have my patients try silicone gel sizers on in a stretch cup bra. Although not a perfect method, I think it gives us some idea of how much volume a patient wants to add to her own breast volume in order to obtain the desired breast mound size.  I also think that bringing in photos can help communicate to a surgeon what size and shape (eg: how much upper pole fullness) a patient is hoping for.  The first set of photos you show are very full breasts, with a pretty significant of upper pole fullness...an "implanted" rather than a natural look, but a nice "implanted" look.  Although it is difficult to tell without examining you, I would guess that you would need at least 400cc to obtain this look, and maybe closer to 450-475cc or so.

Robert M. Grenley, M.D.

Seattle Plastic Surgeon

Which Breast Lifting Technique Would Be Most Suitable? (photo)

I have consulted a board certified PS & am in process of scheduling the surgery. Dr. has said for perkiest look go for a full lift w/ augmentation, and for a more natural look go with a donut lift w/ augmentation. Below are photos of the look I'm after & my own breasts. I know "perky" and "natural" have different definitions depending on each person. Which lifting would bring mine to the same position and shape? I know all breasts are different, I am simply going for that "style" in the pics

You are looking for a very natural look with less breast overhang and a somewhat higher nipple position and smaller and less stretched areola.  Judging by the photo example of what you are looking for, you are not concerned about having more upper pole fullness or even a "natural" implanted look.  There are two reasons to use implants...if patients are looking for larger breasts, or if they are looking for more upper pole fullness. I would therefore suggest a breast lift, perhaps a "lollipop" or vertical technique, versus a circumvertical or anchor lift depending on physical exam in terms of how much overhang you have and how low your nipple position is.  Periareolar or Benelli lifts, in my opinion, only work well with implants, as otherwise they result in a persistent flat breast, and if this mild lift is overused (used in a patient who needs a stronger and better shaping variation of a vertical scar lift), then the resulting breast shape and scar quality suffers. If you have a lift to obtain a better breast shape, and later decide that you want more upper fullness from a small and natural-looking implant, this can be easily done.

Robert M. Grenley, M.D.

Seattle Plastic Surgeon