Wt 125 lbs Age 38 2 children breast fed 6 to 9 months each. Moderate sagging Current bra size 34B Desired 34 full D 3 board certified plastic surgeons gave 3 different opinions Doctor A recommended under the muscle with breast lift absolutely necessary. Doctor B recommended under the muscle and lift not necessary. Doctor C recommended over the muscle and lift not necessary. I'd like to avoid a lift but I don't want to sacrifice the shape in the long run, I want to be happy with the outcome.
I Have Seen 3 Different Board Certified Plastic Surgeons Regarding Breast Augmentation, and Gotten 3 Opinions? (photo)
Doctor Answers (34)
When is a breast lift necessary when doing a breast augmentation.
The doctor who has examined you and you have chosen to do your procedure has to have the final word, but I will explain some principles so that you understand my poin of view. There are different degrees of breast ptosis (saggy breasts) In your case, the picture shows that the nipples are above the infra-mammary fold (The fold under the breast). Therefore your condition in called pseudo-ptosis. In your case an augmentation should be enough and a lift could be avoided. As far as the position of the implant I would favor a dual plane procedure. That means the lover half of the implant is under the breast tissue but the upper part is under the muscle. This allows the implant to fill the lower redundant part of the breast.
Breast Aug With Or Without A Lift
There are a lot of different opinions - but in reality, you are the only one who can determine what's right for you based on the opinions you're getting from board certified plastic surgeons.
The decision to augment is generally easy, but "to lift, or not to lift" is not always so obvious. See my web reference below for more information on making that decision.
The surgeon you ultimately choose should understand your cosmetic goals and be able to answer all of your questions (you should be asking a lot of questions during the consultations). You should feel comfortable with the surgical plan, the surgeon, his staff, and every other aspect of your plastic surgery. If not, keep looking and asking questions!
When your body changes lead to some laxity of the breast area, the placement of implants can provide some variablility to the final outcome. You appear to be a candidate for augmentation alone, particularly since you want to avoid additional scars from a lift. This does require horever some expectation regarding the final settling of the implants to still achieve a full rounded breast with improved nipple projection. While some techniques of implant placement will enhance the ability of the implant to settle acceptably you must be open to the possibility of a future lift. I would discuss the options with your surgeon so you have a clear understanding of the possible final breast shape you could expect. In particular the expected final nipple position in regards to the breast mound itself. You can then decide if a lift is appropriate for you. I hope this information is helpful.
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Without a breast lift, overtime your breast will droop to an unsatisfactory low position. I therefore think a lift is mandatory. The implants can go either under or over the muscle. The lift will also help keep the implant up, avoiding droopiness.
Breast augmentation results
One thing I might suggest would be to look at many before and after photos. Take note of patients have a similar starting point and have a result that are pleasing to you. Without an in person consultation it is difficult to know what is best for you, but I think a lift would be best for you.
What would be the best augmentation for this patient.
Several options could be considered, depending as to what you are desiring. A breast lift combined with an augmentation may give you the best result. a subpectoral dual plane augmentation would be the more acceptable technique, in my opinion, to give you upper breast fullness,a more natural shape that allows for better quality mammograms for the future, but may give slightly less fullness along the inner aspect of the breast.
Be sure to talk to your local Plastic Surgeon about these different options.
Good luck to you.
Frank Rieger M.D. Tampa Plastic Surgeon
Breast Augmentation with Mastopexy?
You have an interesting situation. One thing you have to remember is that the plastic surgeons are offering you their opinions based on what will give you the best outcome in their hands. There is no right or wrong answer. The questions you have to ask yourself are: What size would you like to be? Are you willing to sacrifice shape and longevity of your outcome in order to avoid additional scars? I believe a submuscular implant with a limited incision mastopexy (periareolar or vertical), will yield a good result. If a slightly larger implant is utilized, then a lift can be avoided, but the breast may sit lower on your chest than desired.
Good luck, Dr. Berardi
Different Options for Different Patients
Thank you for your interesting question! I am always amazed at the various recommendations that my colleagues make to patients. We have different ideas of what is attractive, and patients have different goals and concerns which drive our recommendations.
Your photos show that your breasts have settled. If you did not want a lift, you would have to place a good sized implant over the muscle. This is the treatment that would be recommended to a nude model who cannot have visible scars on the breasts. The implant would best be textured. The problem with this approach is that the nipples would still be on the low side and the breasts would have a very natural, bottom-heavy look. The areolas also get larger as the breast tissue is stretched. Also, there are more problems with capsular contracture over the muscle and other issues to consider.
Most patients would prefer a smooth surface implant placed under the muscle with a lift. There are different lift options, depending on the shape you like the best and the scar you are willing to accept. Either a Binelli (circle) lift or vertical lift would work well for you. Feel free to look at examples of these on my practice website. Hope this helps and best wishes!
I believe that any Plastic Surgeon still advocating breast augmentations above the muscle in 2013 should be avoided!!! Because of the large amount of breast tissue you have the best answer for you is a submuscular breast augmentation with areolar repositioning (Binelli Mastopexy) to place your breast tissue directly over the implants. This approach will give you a great, long lasting result with minimal scarring...good luck!
Breast augmentation with or without lift
I can simply your situation. I see a lot of patients very similarly to your from an anatomical standpoint.
First question: how big do you want to be? what size? This can help decide about whether a lift is needed.
Second question: what are your goals for surgery...do you want to be more "uplifted" ? Does the areolar differences in the nipple concern you?
If so and you want to be 350 cc or less....then do a silicone gel implant under then muscle with lift at the same time.
If you want to be much bigger than 350 cc and you are not sure if you even want the lift then I recommend implant only and let the tissues settle and you can add a lift at a later time if you desire.
I would recommend a "dual plane" release subpectoral silicone gel augmentation and that is probably it. You can always come back and add a lift at a later time point if you are unsure about it.
I hope that helps!
James F. Boynton, M.D., F.A.C.S.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.