This is a commonly asked question and a good one. Different surgeons have different opinions looking at the same condition. I believe that you need a lift due to the position of the nipple complex and the majority of your breast tissue. The scars do well and it is better than trying to achieve a result with a very large implant to save the scars. That does not work well. I would recommend you get a consultation from a board certified plastic surgeon in your area and start there.
Thank you very much for your enquiry and
your photograph. I think as your nipples
are in a slightly low position, particularly on the right side the best option
for you would be a breast uplift combined with an implant.
Your nipples lie slightly below the natural
fold behind your breast and there is a danger that if you just have an implant
your breasts will still look in a slightly low position. I hope this has been helpful and if you would
like more information about breast uplift surgery it would be worthwhile
discussing this with a surgeon in your area.
you are already a 32 D, how big do you want to become? If your breasts are already drooping, what do
you think will happen when you add the weight of implants? Your best choice is breast lift, not implantation. I recommend a new technique called The Mini
Ultimate Breast LiftTM. Using
only a circumareola incision it is possible to reshape your breast tissue
creating upper pole fullness, elevate them higher on the chest wall and more
medial to increase your cleavage.
Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection without the need for
implants. This technique avoids the ugly
vertical scars of the traditional technique, maintains nipple sensation and the
ability to breast feed. If you insist on
implants, this can be done simultaneously, but I would recommend very small
implants. At size 32 each 100 cc’s of
implant corresponds to 1 cup size change.
200 cc implants would take you up to a DDD. 22% of women who undergo breast augmentation
alone require revision within 2 years because they are dissatisfied with the
result. Frequent causes of
dissatisfaction are over implantation and not performing a simultaneous lift
Gary Horndeski, M.D.
The pros and cons of a lift versus implant are best sorted out in a consultation with a plastic surgeon. No doubt if you put very large implants in that your nipples would be pushed forward and up (…for a while). The weight of a large implant will eventually cause the skin to stretch and the whole breast to droop. Additionally there is the question of whether you want to have really large breasts. There are issues with that to be aware of. If your goal is to have perky breasts but not be too large then I think based on the photos that I would lean towards a mastopexy (lift). You could also do a combination. However, you look to have enough volume that repositioning it with a breast lift is probably appropriate. If you are happy with the size of your breasts when in a non-padded bra then I think the answer becomes clear.
There general rule of thumb is that if the nipples sit below the inframammary fold (the crease under the breast), then a lift is recommended. However, there are several other anatomic factors of the breast as well as the patient's desires and expectations that further determine whether a lift is performed or not with or without an implant. Thus once you are ready, consult with a board certified plastic surgeon that can then perform an in person physical exam and help you best decide on a final surgical plan.
I think a lift in combination with your implants will produce the best result.
Kenneth Hughes, MD
Los Angeles, CA
The answer all depends upon what you want your breasts to look like. If you like the shape and position of your breasts and just want more volume, then adding an implant alone will make your existing breasts look bigger. But there will be no improvement in the position of the NAC or shape of the breasts. The implants will likely sit just slightly higher than your natural breast tissue which will "slide" off of the front of the implants, especially in certain positions. For the best shape and result, you will need to have both a vertical mastopexy and augmentation. But the choice is always up to you.
Thank you for your question. The position of your nipple in relation to the crease beneath your breast is how need for a breast lift is determined. From your photograph it appears your nipple is below the inframammary crease and that you will need a breast lift in addition to the implant to avoid the snoopy deformity. 2 Larmore please read the following link:
Let's deal with several myths about this subject.
Skin showing below the nipple is not the measure for needing a lift. The proper gauge is where the nipple sits in relation to the inframammary crease of the breast behind it when you are upright with arms down. In my opinion and experience, if the nipple is no more than 2cm below the level of the inframammary crease, then an implant can be positioned behind the breast to fill it out without needing a lift procedure. It is not possible to tell from your picture, but it appears that your breasts are too low to get an implant positioned properly behind them. Also, breasts that have drooped are likely to droop in the future even without another pregnancy and lifting them now may be appropriate.
Other myths are that breast implants lift breasts. This is an illusion from filling out the lower pole as well as filling in the upper pole. Implants "lift" breasts OUT but not UP. Also larger implants do not lift breasts further. The implant should be matched to the internal width of your breast.
It's also a myth that breasts are "tightened" by a lift. This is also an illusion created by reshaping/positioning the breast.
I would give some consideration to a lift alone -- a real lift, not a crescent or periareolar approach. This can be done with a lollipop (vertical) incision and your breasts will look bigger and better without a bra as they are actually repositioned higher on your chest as a bra simulates. The minimum size increase with a sub pectoral, round breast implant is one cup size and you may not want that much in addition to the lift effect. You can also always add an implant at a later time if you feel you still need it.
Thank you for your picture. I would recommend that you get a lift in addition to your augmentation. The augmentation only will leave you with larger droopy breasts.
Earl Stephenson, Jr, MD, DDS, FACS