Hi, I'm 5'4" and recently won a competition to get a breast augmentation. Unfortunely I was told by the dr. that i have ptosis. I feel like my breasts definately do sag espcially after nursing 3 children. But i don't feel like they are bad enough that i wouldn't be able to get implants without a crescent lift (nipple lift). Is he just being more cautions or is my ptosis bad enough that i would be likely to get double bubble? I feel that implants would naturally correct some of this. Thanks.
Can I Get a Breast Augementation Without a Lift?
Doctor Answers (26)
I have two comments:
1. You say you won a competition to have breast augmentation. If your surgeon is a board-certified plastic surgeon, he/she should know that raffling surgical procedures is against the code of ethics of the American Board of Plastic Surgery, the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and shows poor judgment. I would be concerned that you might be going to a plastic surgeon who is either not a member of these organizations, or who does not care about these ethical concerns. I am a little surprised that I am the first to comment about that issue here.
2. As to your breast shape, from the photos alone, it seems like you need a lift, with at least a peri-areolar (circle all the way around the areola) lift, or a slight vertical lift with a lollipop-incision. I would be concerned that your implants will look to high and your nipples too low because your breast tissue will not be centered over the implant. Only an in-office exam would allow any surgeon to adequately address your options with clarity.
Be Careful When Choosing Your Breast Surgery and Breast Surgeon
I have been a plastic surgeon in Sarasota for 17 years and have heard about the contest you won on the radio. The surgeon involved is an Oral Surgeon who did one extra year of training in cosmetic surgery at a non-approved fellowship. Your surgeon is in no way, shape, or form a board certified plastic surgeon and is not certified by the American Board of Plastic Surgery. In fact, he is not board certified by any ABMS (American Board of Medical Specialties) recognized board. He calls himself a cosmetic surgeon and when others call him a plastic surgeon, I suspect he does not go out of his way to correct them. Your surgery will be not be performed at a ambulatory surgery center approved by the state or federal government, but rather at his office which only meets the guidelines for office surgery. In spite his uncertain credentials, he has been able to pose as a plastic surgeon and gain some legitimacy by a using a barrage of advertising including the contest you won. This may truly be the best example ever of how you get what you pay for. I would suggest explaining your surgeons credentials and the location you will have your surgery to your spouse, Mother, or Father and see if they agree that it sounds like a good idea.
With that said, looking at your photos, it does appear you may need some lifting of the breasts along with augmentation. The appropriate approach to determine this includes an office consultation that may last 30-60 minutes which includes a discussion of your goals and expectations and an examination of your breasts including measurements of your breasts to see exactly how much extra skin is present and where on the breast the nipple lies in relation to the crease beneath your breasts.
In our office we can explain your options, which by the way wouldn't include a crescent shaped excision of skin, and show you images of how the scars would look if you need a lift. Hopefully you would not need a lifting procedure (Mastopexy), but if you do, it is usually better to do the correct operation or no operation. This is why board certified plastic surgeons don't give away surgery as a prize in a raffle or contest. It puts the patient in the impossible position of having to decide whether to do what the free surgeon offers them, or spend the money to have the surgery suggested by another surgeon who may have more experience and better qualifications.
If you would like to have a reference to work from, we would be happy to see you in the office and after a complete consultation give you the information you need to make an informed decision.
Augmentation and lifting - are implants enough?
First of all, raffling off a breast augmentation is against the ethical code of conduct of the American Society of Plastic Surgery. Before you agree to this procedure, please check the credentials of your chosen surgeon. On the topic of breast lifting and augmentation, only minor elevation of the nipple is seen with an augmentation. If the nipple is below of level of the breast fold, or there is significant laxity in the breast skin, a lift is recommended to improve the outcome of the augmentation. An implant may allow for less incisions with the breast lift (ie. a scar only around the areola versus the "lollipop" or "anchor" incision). You can always stage the operations if you are uncertain as to whether you will be happy with an augmentation alone. Regardless, an augmentation mastopexy (breast implants with a lift) is one of the more difficult cosmetic breast surgeries you can have and the fact you have won this surgery is a serious red flag. Be certain to have your breast surgery performed by a Board Certified Plastic Surgeon!
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You do not "win" breast augmentation surgery! You need expert advice from a real plastic surgeon!
I'm not even going to answer the surgical questions first, as no reputable American Board of Plastic Surgery-certified plastic surgeon would participate in such a "raffle" or "surgery as a prize" situation, AND YOU SHOULDN'T EITHER!
Even if you were a "perfect" candidate for breast implant placement, this doctor is using you as a marketing tool, an advertisement, or self-promotion, all the while deceiving anyone within listening range of his marketing campaign that he is a "cosmetic surgeon" skilled at this procedure. Nothing could be further from the truth. BEWARE!
Add to that the fact that your anatomy presents a challenge that even properly-trained and ABPS-certified surgeons do not universally agree on a plan (as each of the on-line consultants answering here are "REAL" plastic surgeons and not the kind you have fallen prey to), and you have a situation ripe for "plastic surgery disaster!" The sad thing is that proper examination, measurement of your ptosis and exact degree of breast sagging, and listening to your goals--after which a proper surgical plan (and secondary plan, if needed) can at least offer you a chance at a good result--IF you see one or more "REAL" plastic surgeons for advice to settle on an appropriate plan!
Trust me on this--free BAD surgery requires expensive, not-free, not-easy, and less-successful revisional surgery once you find out the hard way that this is a huge mistake.
BTW, a crescent lift raises your nipple areola complexes no more than a few millimeters (less than 1/2 inch in virtually all cases), so this is not a good solution to your degree of ptosis. Any reputable plastic surgeon who performs lots of breast surgery will tell you that, but there are still good and properly-trained and certified plastic surgeons who might have differences in surgical judgment. It appears you need more skin tailoring (full or modified breast lift surgery) to properly elevate your nipple position, and implants alone (regardless of their size) will be very unlikely to solve your droop problems alone, without a "real" lift.
Please check your surgeon's credentials and get advice from several "real" plastic surgeons in your area. Then plan on paying for the expert services of your chosen surgeon, not allowing the one chosen FOR you by a raffle or competition to operate on you for "free." Also be aware that you may (and probably will be, if you haven't already) be asked to waive your rights to sue or have any redress if things don't "work out" as hoped-for. These deals usually have lots of legal "red tape" to try to limit liability for crappy advice, even worse surgery, and responsibility if there is any complication.
(And, you know what the "defense" is in these situations when lawsuits arise? You would be shocked to know that the defendant "surgeon" readily "admits" he or she is not a fully-trained and ABPS-certified plastic surgeon, so how can you or the court "hold them" to THAT standard? They are simply a non-surgeon doing cosmetic surgery, and you should have known (and agree you did in that document you will be asked to sign) that you should not expect "real" assessment and surgical expertise or any responsibility for what is done to you!)
AMAZING, isn't it?
Please, you won NOTHING but a "tease" to have you accept surgery by a charlatan at best, and a potential "butcher" at worst. Have you ever received an email from a person in Africa asking if you will "help" them invest millions of dollars for which you will be handsomely paid? This "prize"is not much better! Please read my article (on my About page of my listing on this site) titled "Why Board Certification is Critical When Choosing a Plastic Surgeon" or click on the link below.
It looks like you do need a lift-without one you will have a snoopi-looking breast which I am sure you will not be happy with.
You Can Have An Augmentation Without A Lift... But It May Not Look Great
Anyone can certainly get an augmentation without a lift, including yourself. However, your nipple position looks to be fairly low, anytime it drops below the breast fold you need to consider if a lift is an appropriate adjunct treatment option. You can go with just the implants, but it may not look great. Implants above the muscle may "correct" some of the nipple malposition better than implants under the muscle may, but you run the risk of greater capsular contracture rates and implant visibility. You can also always stage the operation, going for the implants first, then determining whether a lift is desired if you are not fully satisfied with the result.
I personally would avoid a crescent lift, you run the risk of poorly shaped areolas due to differences in tension - they inevitably become more vertically oblong. If you are going to under just a lift from around the nipple (rather than a short-scar mastopexy, or lollipop incision breast lift), I would kindly suggest a circumareolar lift as a better option than the crescent lift.
For the gold standard, best result, and properly anatomically positioned nipples, go ahead with the augmentation with a lift.
Breast lift with augmentation
It really boils down to what you want your breasts to look like. If you desire a higher, more athletic looking breast then a lift alone would partially achieve that. If you want fullness at the top part of the breast then you will need an implant with the lift. If you want a lower breast that appears heavy with the nipples still at the bottom part of the breast then implants alone. My preference with your type of breasts is to do a vertical lift with an implant but it's your chest. Have a frank discussion with your doctor- including photos of what you might want them to look like so that he/she can tell you whether it is realistic or not. Try to find photos of women with pre op pix similar to yours. Hope that helps!
Definitely need a lift
Absolutely you would need a lift if you choose to get implants as you have more then mild ptosis on your anterior and lateral view. I would suggest that you would be very unsatisfied with any result otherwise. Based on your photos, I would suggest that you actually possess a good deal of breast tissue such that a mastoepxy (breast lift) alone would give you a good result with a significant improvement in size and shape post-op.
Breast Implants - Do I Need A Lift, Too?
Hi svdk in tampa, FL,
It's hard to tell 100% from the photos and, of course, the ultimate decision has to be made by you in consultation with your surgeon.
However, increasingly, women are willing to accept the result with implants alone, or with a superior crescent lift, in order to avoid the scars and morbidity of a more traditional lift. It's often a question of which of the issues you're more comfortable with: you can get a better overall shape with a traditional lift, but you'll have scars and there are increased risks with that procedure.
So, will you be happy with a less-than-perfect contour but increased size if it means avoiding the lift? I think you will, based on what I can tell from the photos.
To be sure, though, go and visit a few more surgeons. If you visit 5 surgeons and every one tells you the same thing - whatever it is! - you may be best advised to go with it.
I hope that this helps, and good luck,
Implants can correct some breast ptosis, but sometimes you have to go to a very large implant to get the correction and then wind up with a look you did not plan on. Listen to your surgeon an if a lift is recommended by the Board Certified Plastic Surgeon, then I would follow the advice. They are giving advice based on many cases similar to yours and saving you unnecessary procedures.
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.