Breast Augmentation Q&A
92%
WORTH IT RATING
"Worth It Rating" shows the % of consumer reviewers that stated the procedure was "Worth It" or not. See more RealSelf Worth It Ratings or Add Your Review
774 Reviews
Breast Augmentationbefore & after photos
View Before and Afters

Average Breast Augmentation Cost: $6,200

Learn about Breast Augmentation

3,419 people and 890 doctors are talking about Breast Augmentation

Get Free Email Updates

Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)

asked 3 months ago by MF35 in New York
Latest answer by Brooke R. Seckel, MD
Question viewed 579 times
Tags: silicone implant, over muscle, upper pole, without lift

I've had consults with 3 PS's and am considering around 450cc silicone implants placed over the muscle. I don't want a lift at this time and one PS told me this would be my best option for a lifting effect without a lift. I don't have kids yet and would be open to a full lift in the future, instead of just having a circumareolar mastopexy now. Would HP or mod profile implants be best for upper-pole fullness? And would 450cc silicone in the subglandular position be appropriate for me?

29 answers to Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)

+2

Submuscular Implants placed into a Ptotic Drooping Breast risks Double Bubble or Snoopy Deformity

Submuscular Breast Augmentation even with dual plane dissection often leaves the Breast Implant in a higher position than a Subglandular Breast Implant. Your Breast are Ptotic (sagging) and Submuscular Implantation risks a Snoopy Deformity in which the implant rides higher than your natural Breast tissue. For this reason I would use the Subglandular Breast Augmentation approach unless you are willing to have a Breast Lift at this time. A Breast Lift can always, many say preferrably, done... more
Brooke R. Seckel, MD

Boston Plastic Surgeon

www.drseckel.com

+2

Do I need a lift?

Thank you for the photographs and for your question. You have a very slight degree of droop. In your situation I generally recommend placing the implants, allowing them to settle and consider a lift or tightening of the breast only if necessary after about six months. While implants above the muscle would give more lift I generally favor implants below the muscle because they tend to look more natural and mammography is better. In someone like yourself I... more
Adam Tattelbaum, MD

Washington DC Plastic Surgeon
+1

Borderline needing a lift

You are indeed borderline needing a lift but it appears that you can avoid it at least for now. It is important to understand that implants do not lift the breast and larger implants do not lift the breast more. The issue of above or below the pectoralis muscle is a separate one with a properly released (dual plane) muscle and I would agree that you need the implant under the muscle for a natural looking result for the upper pole of the breast. A 450 cc implant is almost certainly too big... more
Scott L. Replogle, MD

Denver Plastic Surgeon
+1

Whether or not to have a lift.

Based on your photos, you would be better served with a submuscular implant in a dual-plane. You have very little breast tissue in the upper poles of the breast and the implant will be very obvious without much soft tissue to cover it. Rippling and ridging may become a problem for you in the upper pole. As for the lift, if you have adequate stretch of the lower pole skin, the implant can allow for some upper rotation of the nipples as this skin is filled out by the implant. A... more
David Bogue, MD

Boca Raton Plastic Surgeon
+1

Breast Implants and Breast Lifts

Hello MF35, Subglandular implant placement in a ptotic breast, especially with a large implant, will quickly lead to a large ptotic breast. I specialize in implant revision and see this all the time. No matter how large an implant is, it will never allow the ptotic nipple areolar complex to rotate up into a better position on the breast mound, yet some surgeons do it all the time. Another concern I have is that your inframammary folds sits high on the chest (hence the... more
Gerald Minniti, MD, FACS

Beverly Hills Plastic Surgeon
+1

Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis?

Breast implants do not lift breasts, lifts lift breasts. Implants fill breasts out where they are. It is difficult to tell from your photos whether you are borderline (nipple at level of inframammary crease but not significantly below; some overhang of breast but little enough that an implant, whose bottom lies at the level of the fold, will fill out the lower pole of the breast adequately so that the breast does not "hang" off of the implant), or whether you are worse... more
Robert M. Grenley, MD

Seattle Plastic Surgeon

www.seattleplasticsurgery.com

+1

Lift with implants

With a dual plane technique (partially separating the breast tissue from the muscle) there is no reason to have the implants placed over the muscle. I would recommend that you consider a possible peri-areolar mastopexy at this time. My approach is to have a detailed discussion about this possibility at the consultation. Then at surgery I place the implants through a lower areolar incision. If the breasts look nice, then the operation is over. If the nipples... more
Bruce Genter, MD

Abington Plastic Surgeon

www.drgenter.com

+1

Be informed if you are going to get large subglandular implants at a young age

Thank you for your question and the photos. First, let me point out....implants do not cause lift. They add volume to your breasts. There is a limit to how much volume can be added. Here are some things to consider: 1. As you get older, your breast skin will age, stretch and become thinner even without an implant. The larger any breast, augmented or not, the worse it will look over time due to skin stretching. 2. Adding any implant to your breast adds weight and will... more
J. Jason Wendel, MD

Nashville Plastic Surgeon

www.mc.vanderbilt.edu

+1

Choosing the right breast surgery

Your dilemma is a very common one and one that you need to discuss at length with your surgeon to make sure that you are making the best decision for you. There are many factors to consider. Perhaps most important is deciding what your goals are. Your breasts are lacking in tissue which makes them look deflated and more droopy than they probably are. Placing an implant will increase the volume and fill out the skin. It will not lift the nipple much if any. However, with fuller breasts, they... more
Margaret Skiles, MD

Sacramento Plastic Surgeon

www.featherriverplasticsurgery.com

+1

If you want a lift - get a lift!

I understand all of your concerns but a few rules of thumb; 1- Implant lift breast poorly. Although large subglandular implants may give the appearance of a lift, but then you are stuck with a large implant - is that what you want? the trade-off may be unacceptable. 2-Breast lifts look great and many techniques allow you to breast feed after the procedure. 3- In the end- breast lifts for saggy breasts - Implants for small breasts
Robert M. Freund, MD

New York Plastic Surgeon
+1

Breast lift or not

You are definitely a bit low in the photos and solely based on the photos I would probably consider a circumareola lift to adjust the areola size and lift them a bit. An exam may suggest differently. I prefer under the muscle for thin patients. As for the implant size, I would have got evaluate you in person.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)

Great photo but in person always better. In that regard my recommendation is donut lift + under muscle implants. Follow up of results please.
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Breast implants and ptosis

I hear what you are saying, but like many of my colleagues feel that large subglandular implants will eventually sag due to the implant weight and skin laxity. Subpectoral placement tends to be better for upper pole fullness and may be combined with a periareolar mastopexy if necessary. For narrow breast width, I frequently use moderate plus implants, rarely HP. Yes, after pregnancy a breast lift may be beneficial.
Michelle Zweifler, MD

New York Plastic Surgeon
+1

Augments alone should be good

As you can see from the other answers, there is more than one way to do this and get a good result. if you have a surgeon you like and you have checked out their credentials and reputation, then follow their advice and i bet you get a great result! that said, unless you are a bigger person than your photos would suggest, you may want to consider a slightly smaller implant....perhaps around 400cc at most....so as to lessen the chance of problems/deterioration/sagging... more
Bruce K. Barach, MD

Schenectady Plastic Surgeon

drbarach.com

+1

Breast implants alone probably a good option for you

You do have a mild ptosis or slight droopiness to your breasts. However, if you want to go with 450 cc implants, you will probably get enough of the lift from the implants to satisfy you without a breast lift at this time. With time, you can expect to have more drooping and may need a lift later on.
James Tang, MD

Houston Plastic Surgeon
+1

The borderline lift

Actually your nipple is at the fold and at the mid-humeral line, and the lift is probably not needed. The breast tissue is thin above and a subglandular implant is likely to cause further thinning over time, so unless there are other issues pointing to a subglandular implant, under the muscle will look better over the years. The HP is rather round, and the moderate profile is likely to be better. Best of luck, peterejohnsonmd.com
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+1

I agree with implants

I agree with implants over the muscle, but unless you want to be large, I think that 450 is on the big size for you. Perhaps you are 6" tall and then I will change my mind. Best to be seen and evaluated. I am just guessing but do have over 30 years of experience behind me.
William B. Rosenblatt, MD

New York Plastic Surgeon
+1

Subglandular silicone breast implants work well for mild ptosis.

Hi. 1) So many different opinions. You must be so confused. We are quick to recommend a lift in borderline situations, but judging by your pictures, you will do fine just with implants. 2) We don't know your dimensions, but in general 450 cc's is quite large. The best thing to do is to use sterile implant sizers during surgery to see exactly (without guess work) which implants give you the best result. My guess would be ?400 cc's... more
George J. Beraka, MD

Manhattan Plastic Surgeon
+1

Lift v augment

I do not think that you are a candidate for augmentation alone from your photos and suspect that you will not be happy with the result. I certainly would not recommend placement above the muscle as you have very little breast mass and this will only speed up the sagging. The larger the implant, the more likely the sagging so I think you have to consider the potential complications and need for revision. Paitents do very well with augment/pexy and I am always baffled as to why they think... more
Robert L. Kraft, MD

New York Plastic Surgeon
+1

Breast Implant Positioning

I believe that you could have implants placed in a subectoral dual-plane or a subglandular pocket. While some subglandular augmentation patients have no problems, if you do have some of the problems stated below, these problems can be extremely difficult to correct later due to thinning out of your tissues.
Donald Griffin, MD

Nashville Plastic Surgeon
+1

Large Subglandular Implants May Be Visible

First of all, I do feel that you can have a nice result with implants alone in the right hands. Your nipples appear to be above the inframammary fold. I would caution you, however, that a 450cc implant placed above your muscle may well become visible at its edges. (you do not seem to have much upper pole breast tissue).
John Whitt, MD

Louisville Plastic Surgeon
+1

You DO NOT need a lift. Cold subfascial augmentation allows a supported natural tear drop appearance.

From your pictures it appears that you absolutely DO NOT need a lift. Your nipples are very close to the midhumeral point of your arm where they should be. You have a very high inframammary fold which can cause some confusion in this regard. I treat patients such as you with a technique that I call 'cold-subfascial.' I use a transaxillary approach so there are no scars on the breast nd because this technique actually supports the implant into a tear drop shape... more
Rian Maercks, MD

Miami Plastic Surgeon
+1

Subglandular implants to avoid a lift

First off, your "ptosis" is mild and glandular (nipples look to be above the crease) so an extended dual plane augmentation should give you a nice result without a lift. Subglandular implants often accelerate breast sagging and can lead to a "rock in a sock" look.
Marcel Daniels, MD

Long Beach Plastic Surgeon
+1

Borderline Needing a Lift

When you're in your spot, it is a tough call. You may find it helpful to look at before and after photos of patients with a similar breast shape after augmentation with and without a lift. Once you see what you can reasonably expect, you can make a more informed decision.
Nia Banks, MD, PhD

Washington DC Plastic Surgeon

www.drbanksplasticsurgery.com

+1

Avoiding a Breast Lift via Larger Implants over the Muscle is not a good long term plan

Hi there- While I realize that some of my colleagues do recommend placing implants over the muscle for women with slight to moderate sagging of the breasts when they don't want a lift, I could not agree more with my colleagues from Seattle and Memphis. I think this would be a short term fix with long term unhappiness for you, and would make future procedures much more complicated and expensive as well. I think your best bet is a dual plane augmentation, and I personally would not... more
Armando Soto, MD

Orlando Plastic Surgeon
+1

To lift or not

Please re-read Dr. Aldea's answer several times as he is speaking the truth to you. The best plan right now if you don't want a lift is to go submuscular and keep the size and profile as conservative as possible. Folks like you who try to fake a lift with big above the muscle implants wind up with some of the worst results after 10 years and the revisions are much more difficult because of the stretched out tissue.
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Submuscular implant only and no lifting required

The submuscular position will look much more natural, less palpable, and decrease the chance of implant migration and malposition in the feature when compared with the implant on top of the muscle. Futher, lookin at you profile pic, the nipple-areaola is in a perfect location (one centimeter above the fold under the breast), and thus no lifting required. This is indeed very good news, in that it avoids unnecessary scars on your breast. I definitly agree with your decision... more
Robert Morgan Davoudi, MD

Atlanta Plastic Surgeon
+1

Breast Augmentation/Lift: subglandular or submuscular

Many women struggle with the decision of whether or not to incorporate a breast lift (mastopexy) with their breast augmentation, in addition to the choice between under or over the muscle. The concern of scarring and the ability to breast feed in the future are both legitimate concerns. I can assure you that when performed by a board certified plastic surgeon, the scars of a breast lift will heal very well, and are minimal the majority of the time. Additionally the... more
John G. Apostolides, MD

La Jolla Plastic Surgeon
+1

Subglandular Breast Implants VS Breast Lift

To answer your question, let me present you with a few concepts 1. Everything sags with age and weight. Few things sag faster than heavy breasts. 2. If you want the breasts lifted, then you need to have a Breast Lift (Mastopexy). Adding volume (Breast Implant) to the breasts will result in MINIMAL lifting of the nipple complex followed by rapid sagging of the breast since breast implants add weight to the already sagging breasts and additional weight = heavier breasts= faster... more
Peter A. Aldea, MD

Memphis Plastic Surgeon

Ask a question