I've had consultations with 2 surgeons so far. One said I'd achieve a good result w/ just implants. The 2nd one measured me & said that to achieve my desired result, I need a circum-areolar lift w/ implants to fix my nipple position & reduce the size of my areola. I'm looking to restore upper pole fullness & desire the round, perky look. I want the best result possible, but I also wasn't anticipating the extra scars. Could this be achieved with implants alone or is a lift really necessary?
Breast Augmentation with or Without Mastopexy? (photo)
Doctor Answers (19)
Just implants if you size it right
I think if you pick a good size implant you can avoid a lift. I have seen many patients in my practice such as yourself and have avoided a lift. It can easily be performed at a later date under local anesthesia with no down time if needed.
A lift can improve but may not be necessary results with an augmentation
Looking at your photos, you are really on the borderline of whether a lift would be better or not. I have a patient posted on my web with the same level of ptosis (sag & nipple position) so you can see what it will look like with just an implant. In general, to get an aesthetic result, the nipple areolar complex should be between 18-22cm from the notch in the chest bone; there should be normal skin visible below the areola; and the size of the areola should match your desired size, (the ideal size is 3.8-4.2 cm). You have show of skin below the areola, but a little less than ideal. You can not count on the implant to lift the areola, with time the pocket will fill and the implant will settle and the areola will be minimally elevated. Your areola are not too large, but if you would like a smaller areola, then you could consider having them reduced. I am not a fan of the periareolar lift in general because the eye follows the circle around the areola and becomes the focus of the onlooking eye, so if you like the size of the areola, I would prefer a crescent above the areola to be removed that does not go all the way around. The crescent excision can also be positioned obliquely to center the position of the areola on the breast if necessary, (your right areola is slightly more medial than the left) . If you do not mind the size of the areola and are happy with the position of the nipple areola on the breast then I do a transareolar incision which is the most hidden scar of all and becomes barely visible with time. My recommendation is to look at MANY photos of before and after with breast like yours and decide what look you like best. I do not believe a lift is necessary in your case, but a slight elevation of the areola will likely give a slightly more aesthetic result. Check you before and after photos. Good luck!
Considerations for Breast Augmentation vs. Breast Augmentation with a Lift
Your pictures show that your breast shape, volume, and nipple position are such that you fall in between those patients that don’t need a lift, and those that obviously do. In this situation you certainly will receive various opinions from different surgeons. Different recommendations are related to varying experience and preferences among physicians. With respect to breast lift (and without being judgmental), I believe there are a number of surgeons who try to avoid doing a lift in combination with an augmentation for two reasons -- because they think the woman won’t accept additional scarring, or because it’s a more technically difficult operation and therefore requires more time / effort and expense.
"Ptosis" defines the amount of sagging a breast demonstrates, and it is often graded based upon the position of the nipple in relation to the inframammary fold. As ptosis develops, the nipple moves inferiorly and the breast tissue overhangs the inframammary fold. The amount of ptosis will determine if a woman should consider a breast lift and this will directly affect the type of lift performed. To get a better idea of the position of the inframammary fold, and whether any ptosis is present, tuck a pencil horizontally under the fold of each breast. A horizontal line through each pencil marks the position of each inframammary fold; it is not uncommon for there to be some small discrepancies in position when comparing the two sides. If one or both nipples sag below the line of the inframammary fold, you are a candidate for a breast lift. (Depending upon breast shape and volume, even if the nipple is at the level of the fold or just slightly above, there are still situations where a small lift may enhance the result.)
I can’t tell where your inframammary fold lies in these pictures, but I suspect your nipple position is close the level of the fold. Your breasts lack volume and your nipple position is low on the breast (the right nipple is lower than the left).
Breast augmentation and lift can be performed as separate procedures or at the same operation. In questionable or borderline cases, it may be appropriate to perform the dual plane augmentation first, wait to see how much settling occurs, and then perform the lift if it is needed. Breast augmentation and lift can also be performed together at the same operation. This is technically more difficult, and these cases have a higher revision rate, but I would not say that the complication rate is necessarily higher. And, if performed properly, the risk of areola or scar widening is very low. Combined augmentation and lift is more demanding when there is more breast ptosis. In your case, you do not require as significant a lift, so it is more straightforward.
Photographs of the breast size and shape that appeal to you will help communicate your desires to your surgeon. This will be helpful in avoiding miscommunication, which may otherwise ultimately lead to your dissatisfaction.
You would probably have a satisfactory result with a dual plane augmentation, but the position of your breast and nipples will not change significantly; your breasts will still lack some upper pole fullness, and your nipple position will be lower on the breast.
The key to your question lies in your statement “I'm looking to restore upper pole fullness & desire the round, perky look.” I don’t think you will be able to achieve this with an augmentation alone. The addition of a circumareolar lift will position the nipple over the central breast mound and produce a result that better fits your description. I’m sure your surgeon can show you pictures of patients who have had breast augmentation with a lift so you can see the change in nipple position and the appearance of the scars.
My goal is to produce the best breast shape possible, and so I don’t hesitate to recommend a lift if I feel it is necessary. It is then up to the patient to decide if she wants to accept my recommendation. Although some women may not want to add additional scars to their breasts by having a lift, it is my opinion that in many instances the improved contour outweighs the presence of the scar. A thoughtful and caring surgeon should be able to help you understand the differences in breast shape and nipple-areolar complex position with or without a breast lift, and should be able to guide you during your decision making.
I hope this is helpful. Best wishes. Ken Dembny
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Breast Augmentation +/- Lift
I think if you desire perkiness and the most upper pole fullness, a donut breast lift should be performed. Otherwise, you will be fine with a primary dual plane breast augmentation. Candidates for a Breast Lift (Primary Breast Shape Concern):
1. Patient is happy with breast size in a bra, but desires improvement in shape.
2. Nipple position sits at or below the level of the breast crease (inframammary fold)
3. Significant amount of loose skin and breast tissue, which hangs over the crease leading to a hollow appearance in the upper pole of the breast.
Candidates for Breast Augmentation (Primary Breast Size Concern):
1. Patient is happy with nipple position and amount of skin in relation to crease.
2. Desires increase in volume of breast to increase bra cup size and provide more cleavage and fullness to upper and lower pole of breast.
In many cases, patients have concerns of both size and shape, therefore requiring a breast augmentation with a breast lift to achieve desired results. I hope this helps.
Avoiding a breast lift
If you select the right implant with enough volume and projection you should be able to get the uplift without a breast lift. You always run the risk of needing a lift in the future if the shape does not turn out the way you expected. If your nipple pointed down then a lift would definitely be needed.
Mastopexy and scarring
You could go either way.
A purist would say that you need the circumareolar lift with implants to get the result you desire. Yes, this would help bring the nipple slightly up and make your breasts perkier if that is what you desire.
But, you can also get a good result with implants alone. When the implants settle, they may not be as high as you want them but the result would still look good with no scar around the nipple. Most women only get the high, pushed-up look with a push up bra.
What you decide is up to you. You have to ask yourself the question...is it worth a scar 360 degrees around the nipple to have your breasts a little higher and a little perkier. Scars fade in time and the contour needs to be good.
There are many factors that weig on the decision as to whether an augmentation alone
will achieve the best possible result, or whehter combining the augmentation with a mastopexy or breast lift will achieve the best possible results. As one of the most important factors in this decision ios the desire of the individual patient, it really isn't appropriate to gneralize the answer to your particular patients to all women in your situation. The short answer is that augmentation may acgieve the results you desire with less scarring, and if the scar is critically important to you that is probably the best decision you can make. If you want the "best possible result" and additional scars would not bother you, than you might be better served with the combination surgery, particualrly if you believe that the size of your areola should be reduced. If you are unsure, remember that in the end you can add a breast lift down the road to an augmentation performed today, but you cannot undo a breast lift that has already been done. For better or worse, once you have educated yourself about the benefits and risks of each procedure, the decision rests in your hands. Good luck...
To Lift or Not to Lift- Should depend on your goal, and your surgeon's skill
Your question is very difficult to answer, because to answer in any particular way (yes, have a lift, or no, don't) would require me to have an understanding of the quality of the results your surgeon produces with each technique.... As this is impossible (it is a mistake to believe that all surgeon's outcomes with any particular procedure are equal), the only responsible way to answer your question is to help you understand what I think would be possible in my hands...
Further, it is important to realize that as one of the primary variables in the decision making process for breasts that are a bit droopy is the elasticity or stretchiness of the skin, and this is something that could only be appreciated on physical exam (in other words, I would need to see you in person to be confident in my recommendation), your best recommendation is going to come from an experienced surgeon Certified by The aMerican Board of Plastic Surgery who has actually had the benefit of examining you and understanding your goals.
In my practice, I would show you photos of lots of patients that started out with an appearance similar to yours, some of whom chose to undergo a breast augmentation alone, and some who had a lift with an implant. I would point out the differences in the patient's experiences, scars, recovery periods, and short-term and long-term outcomes- helping you make the choice that is best for you.
The surgeons on this site (although all of us mean well and are trying to help) who have NOT examined you can only describe what they think would turn out well IN THEIR HANDS... and of course, you should remember that what they think is attractive may not be the same as what you think is attractive.
These are all reasons that the ENTIRE process is so important. Getting information and advice from surgeon A, then admiring photos of surgeon B's work, then visiting surgeons C and D for consultations is a recipe for unhappiness!
Find a good surgeon that you like and feel you can trust- one whose photos are uniformly beautiful to you. Visit with them for a good talk about your goals and his recommendations. You'll know when you're in good hands.
A breast lift or implant and lift
From your photos, it is clear that you are somewhere in between the lift and the implant alone. However, you do have some existing breast asymmetry that can only be improved by lifting of the breast itself. One of the best options is for you to communicate with your surgeon and especially with your request for "the round, perky look. I want the best result possible" be open to a lift to help restore a more youthful position of the breast. Relying on a heavier breast (if your surgeon tries to use a larger implant trying to achieve a lifting effect), will only take away from the "perky" aspect of your breasts. You can ask your surgeon to make the decision for you once the implants are in place. This isn't perfect, but is the most realistic approach. As long as you trust your surgeon and communicate, you will likely be happy - and you can avoid the cost and recovery of a second "planned" procedure to tighten the breast later.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
Breast Augmentation with or Without Mastopexy?
I know why you are getting so many different opinions. You have what I call “In-between Breast” & you have a bit too much droop for just implants & not enough droop for a full lift. I think if you do just implants, in 6 mos- year you will be complaining of your breasts being too low..But then a donut lift is really a compromise operation that gives some lift but not a lot..and then there is the scarring..This is a very difficult decision but you can always add the lift later. But at more cost!
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