I am an active 35 yr old with 2 young kids desiring pre-baby breasts. I am very concerned about the recovery time and scars on the breast lift. Can I achieve the desired results of fuller shape and size with an augmentation only or would I also require a lift? Would an augmentation only significantly worsen the sag?
Breast Augmentation Only or Would a Lift Also Be Necessary? (photo)
Doctor Answers (24)
Augmentation Only or is Lift Needed.
Any answer has to be qualified by saying that the photos don't give a surgeon the complete picture and an examimation in necessary for a more definitive answer. That said, you appear to be someone who has a borderline situation where either solution (implant alone or lift + implant) has some downsides.
My guess is that you had very nice full breasts prior to pregnancy and you really still have an overall nice breast shape but have some deflation and sagging. Your nipple appears to not be significantly below the fold under your breast, however that is not the only factor determining whether or not you need a lift. An equal, if not more important factor is whether more than half of your breast tissue lies below the fold, and in your case it appears that it does.
Doing an augmentation only with a large implant may give something of the appearance of a lift, but this will not lift your breast tissue, and the long term result will be a LARGE breast (you have a significant amount of breast tissue) positioned low on your chest wall. Likely it will only go further south with time. Would you be satisfied with this kind of result? Adding a lift secondarily is much easier said than done. It would almost certainly require some repositioning of the implant as well. Overall not a small correction.
Alternatively, doing a lift does add extra scars to your breast and no one is excited about that. I think a peri-areolar lift would be a bad choice as it only elevates the areola, does not elevate the breast tissue - which is what you need - tends to flatten the breast - which is not what you need - and the scars are often irregular and tend to stretch out the areola - especially with a large implant.
I think a better choice would be a lift (traditional or vertical/lollipop) with an implant. This would allow your breast tissue to get lifted up, you could use a more moderate size implant, and you would have more fullness in the upper part of your breast - albeit at the expense of a lift scar. So either choice has some downsides but I think a lift plus implant would serve you better over the long run. Or you could just leave things as they are.
Would I need a lift as well?
I'm often asked by patients seeking breast augmentation whether they need a lift as well. Although there are exceptions, and different plastic surgeons may disagree on occasion, the following are general guidelines. A breast lift is defined by any procedure that re-positions the breast in a higher position. I am not referring to the ”appearance” of a lift that is achieved by the actual breast augmentation itself. If a woman’s breast and nipple are above her fold [the crease below the breast where the under wire sits] then she does not need a lift. If, on the other hand, most of the woman’s breast and nipple are below the breast fold then a lift is usually indicated. Between these two extremes is where the plastic surgeon’s judgment and experience come into play. Of course, the patient’s expectations are also critical, as some patients prefer their breast and nipple to be at a higher position than others. What is clear, however, is that the woman’s breast will be higher with lift as compared to without lift. A consultation with a board certified plastic surgeon with a particular expertise in this procedure is crucial.
There are several lifts available. The most minimal one is a crescent lift where there is only a short incision at the top of the areola. I hardly ever perform this as all it does is distort the shape of the areola and does not achieve any kind of lift. Another type of lift is where there is an incision completely around the areola. This is also referred to as a “Benelli” lift. This lift can work well in some patients, but should not be over used as it tends to flatten the breast. The next lift involves an incision completely around the areola as well as one vertically from the bottom of the areola down to the breast fold in the shape of a lolli-pop. This is a very powerful lift as it gives the surgeon the ability to control the position and shape of the breast. Finally, there is the anchor lift, also known as the inverted –T, where the incisions are the same as the lolli-pop lift plus one horizontally along the breast fold. I find that this lift, with the horizontal, is usually not necessary. I strongly believe that this horizontal incision should be avoided if at all possible. It, often, does not heal well, but even if it does, it is hard to hide in a bikini or a low cut dress.
From your photos, it looks like you fall in that in between group. You can either just undergo breast augmentation or a breast augmentation with a lift. It's really up to you as to how high you want your breast to be. Again, with a lift, your breast will be higher. Also, with a lift much less of your breast will touch your chest wall (your rib cage below your breasts). If you were to undergo a breast lift, I believe the lolli-pop lift where there is no horizontal incision would be best for you, I dont think a benelli lift will do the trick and I dont believe you need the anchor lift with that long horizontal.
My feeling is, however, that you should probably undergo the lift as well.
Hope this helps,
Breast implants provide upper pole volume but do not correct lower pole sagging
Breast implants will give you the upper pole volume you want. But they will do nothing to correct the extra sagging tissue of the lower pole of your breasts. Unfortunately, sometimes women have implants alone thinking they will take up the slack and avoid the need for a breast lift, but this is not the case. If you don't mind having some lower pole slack and want to look good in a bra, implants alone will do that.
If you really want pre-baby breasts you may want to consider a vertical lift, which removes extra tissue from the lower poles, elevating the lower poles and giving you perkier breasts (you won't look saggy in a bikini or naked). You have to be willikng to accept the "lollipop" scar. On my website you can check out the scars and see what you think. I've attached a link.
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Would a Lift Also Be Necessary?
Based upon these photos and your goals, I would recommend augmentation alone. However, anyone answering this, myself included, might have a different recommendation at the time of an in person consultation.
Were you to feel after surgery that your breast contour is not what you want, a lift could be done at any time.
When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified, but also is a member in good standing of the major plastic surgery organization in the U. S.
Thank you for your question, best wishes.
A breast augmentation and lift would provide the best result.
Thank you for the question and photos. A breast augmentation adds volume while a breast lift reshapes the existing breast tissue. I think you would obtain the best result and the least chance of subsequent surgery down the road by doing a breast augmentation and breast lift. Performed properly the incision will be very inconspicuous.
All the best,
Dr Remus Repta
It really is not possible to give an opinion on whether you require a breast lift in addition to augmentation. I would suggest you be careful about the opinions you receive based on your photos alone. There is no substitute for a careful examination and discussion with a board certified plastic surgeon who has significant experience with aesthetic breast surgery. Obviously, there are different opinions about this topic so I would suggest you obtain several consultations to get the full range of your surgical options. Remember, there is no free lunch and your avoidance of more scarring may require that you accept other trade-offs that have their own downsides.
Breast Implant and Lift
A lift with implant will achieve a look more like a pre-baby breast. Find before and after photos of women with breasts with similar sag to your own, see what surgery they did, and the results. Remember larger breasts sag more than smaller breasts. Your risk for sagging after surgery will be higher as the implant size gets larger.
Breast Augmentation with or without a Lift
This is a very common question on Realself.com., because many women are afraid of potential scarring from a breast lift but know their breasts don't look like the others they've seen who've gotten just breast augmentation. I'd like to address a few misconceptions, some propagated by surgeons:
1. With a sagging breast, a breast augmentation without a lift will just make the breast look like a larger version of what it already looks like. Incorrect! If your breast is sagging enough, then just putting in an implant will make the breast look bizarre, with persistent sagging of tissue and nipple, and excessive fullness in the upper pole of the breast.
2. A large enough implant will lift a sagging breast. Incorrect! This is, unfortunately, one of the most common myths propagated by plastic surgeons!!! You will just become larger than you want to be, and still have a bizarre look to your breasts. A larger sized implant will not rotate the nipple up into it's proper position; in fact the larger the implant, the more the nipple will be hanging off the wrong side of the breast mound. Currently, although your breast have some sag, your nipples have a pleasing position on your breast mound, and they face slightly upward. This will all be ruined with a breast augmentation without a breast lift.
3. Using a special technique like a 'dual plane', or placing the implant over the muscle or under the muscle fascia will eliminate the need for a breast lift. Incorrect!! This is the most common myth propagated by plastic surgeons. This recommendation usually goes hand in hand with that for a very large implant. This will not lead to a nice result, but puts you at risk for double bubble or persistent sagging or both.
Although your breasts have a pleasing appearance now, their degree of sagging warrants a lift in addition to breast augmentation. Visit a few highly recommended breast specialists that perform all aspects of cosmetic breast surgery. These qualified surgeons will be certified by the ABPS and be members of the ASAPS. In the hands of an expert, you will get a normal and pleasing looking, enhanced breast with a high probability of inconspicuous breast lift scars.
Best of luck!
Adding breast lift to breast augmentation
The photos that you showed are inconclusive with regard to needing a breast lift. Your nipples position appear adequate unless you are specific about liking your nipples to be higher than currently seen. In that case you will need a lift and trade-off is additional scars. If you are not ready for breast lift scar then my suggestion would be to do breast augmentation alone and consider breast lift later as needed. Keep in mind breast augmentation by itself will not cause the breast to be higher or more lifted, just fuller and larger. The upper part of your breasts will be fuller due to the implant but overall breast position on the chest will not be elevated unless breast lift is performed.
Stewart Wang, MD FACS, Wang Plastic Surgery
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.