Breast Lift (With Implants?)

My ultimate goal is to reduce excess & improve posture/reshape to a more youthful/sexy look. I find while breast lifts offer a huge improvement the before and afer photos that really jump out to me as being perfect are the ones with small implants. a nice mix between natural and fake. Would going from my current size to a large c or small d offer the ease on the posture and lower back I'm looking for? Are implants lighter or heavier than breast tissue? If these were yours what would you do?

Doctor Answers (12)

You need a reduction (remove tissue from lower poles)+ implants

+2

You are correct.  The best option is a combination of a small reduction (same as a lift really) and implants.  The reduction removes excess tissue from the lower pole and the implants restore upper pole fullness.  You cannot get upper pole fullness without implants.  That is why the combination photos you have seen look better.  Depending on how much extra tissue is removed from the lower poles, you may have some relief of you back pain.  Implants weigh about the same as breast tissue.  I've had plenty of patients just like you, in whom a small reduction not only makes them look better, but they are more comfortable and have less upper back pain too.  The vertical technique is superior to the obsolete inverted-T - better shape, less scarring.  Works well with implants.  There is a big difference between surgeons; be sure to insist on seeing plenty of before and after photos.  If you're like them, there is a good chance you will be satisfied and the reverse is true too.


Kansas City Plastic Surgeon
4.5 out of 5 stars 34 reviews

Breast Lift or Breast Lift with implants?

+2

It is difficult to comment specifically with only a single picture and no opportunity to do a proper consultation. However, you do have heavy looking breasts with ptosis (sagging below the fold) and a nipple and areola that is also low. Recommendations will be based on your goals and you do give a little info about these. To achieve less stress on your lower back and improve your posture - do not have breast surgery!. It may be hard to hear but your best solution will be to improve your level of fitness, improve your core strength and lower your body fat. Your breast size and weight is likely not contributing significantly to your back problems. As you succeed with weight loss you likely will lose volume in your breasts with the shape staying about the same.  Then you can decide if the cosmetic shape and size improvements you are considering make sense.

A breast lift with a modest sized implant looks like it will achieve the best breast shape improvement but understand that a heavy breast, with or without an implant will still sag more quickly than a smaller breast. Implants add weight to your breast so forget about the idea that an implant will solve future gravity related problems. In the short term, an implant combined with a lift and reduction of some breast tissue can create a fuller and rounder looking breast than a lift alone.

The right solution for you,  can only be determined with a thorough consultation by a Plastic Surgeon and a careful discussion about the pros and cons of each approach. Think about long term strategies solutions and you will likely be happier with your decision.

Dr. Mosher

Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.5 out of 5 stars 9 reviews

Breast lift for you

+2

You would be well served by a breast lift because of the ptosis you have.  I would advise you to lose some weight first in order to get the best result.  At your current weight, adding implants will potentially make you look heavier.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

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Breast lift with implants?

+1

Thank you for the question and picture. I think the answer is somewhat complicated.

The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 
Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

You should also be aware that the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.

In my opinion, the decision  to do the operation in a single or two  staged fashion becomes a judgment call made by a surgeon after direct examination of the patient.  For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 707 reviews

Breast Lift Options

+1

This is a very common situation after pregnancy, and also is seen in many patients who naturally have full and somewhat droopy breasts but who have never been pregnant.  As you obviously are aware, a number of surgical options are available.  A breast lift (mastopexy) will remove some skin and in most cases some breast tissue as well (in order to tighten and re-shape the breasts internally), so your lifted breasts will most likely seem somewhat smaller, even if you still fit a D cup bra.  A reduction can be performed if you would like to transition from a D to a smaller C-cup (or even a full B-cup) breast profile; it is essentially a breast lift plus more extensive removal of breast tissue.  Both procedures relocate the nipple/areola complex to a youthful position at the top of the breast mound.

In either case you may or may not end up with upper pole breast fullness, which is something most patients want from their breast rejuvenation surgery.  If you pinch the breast above the nipple/areola complex and  there appears to be a fair amount of breast tissue there, then you may be fine with a lift or reduction alone.  If there is not much breast tissue there, then in most cases a lift or reduction will not improve that situation in a lasting way, and you'll have to think about whether or not to have an implant placed to create that aesthetically ideal upper pole fullness.

Mastopexy (breast lift) and augmentation can frequently be performed simultaneously, but in some patients with larger breasts it is best to perform the mastopexy first and then several months later perform the augmentation.  Reduction and augmentation, as odd as it may sound, are sometimes performed simultaneously as well.  It sounds counterintuitive, but what is being accomplished (ideally, if the appropriate surgical technique is used) is removal of excess lower pole and lateral breast tissue, and simultaneous augmentation of the upper / medial aspect of the breast by means of implant placement.  It is critical in these surgeries to be very conservative with the size of the implant, as too large an implant will quickly stretch out the lower poles and produce a 'bottomed out' appearance.  Which generally results in another trip to the operating room to tighten the lower poles, usually by the removal of additional lower pole skin.

So the most important consideration in planning the surgical rejuvenation of your breasts is determining: (1) whether or not you will have upper pole breast fullness (above the nipple/areola complex, especially the upper cleavage area) with a lift or reduction alone, and (2) whether or not you are willing to consider the placement of modest-sized breast implants for the purpose of creating upper pole fullness if it is determined that there is not enough natural breast tissue to create an ideal, youthful shape without implants.  This assessment can be reliably made by a board-certified plastic surgeon who has plenty of experience with cosmetic breast surgery.  As your doctor examines you he or she will take a number of measurements, simulate a breast lift or reduction, and assess whether or not you need an implant to provide you with lasting upper pole breast fullness.

Make no mistake about it: this is a complex surgical issue, both in the planning and in the performance.  Make sure that your board-certified plastic surgeon shares your aesthetic vision for the result you have in mind, and that he or she is able to show you numerous photographic examples of the surgery you are considering.
 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 38 reviews

Breast alone can give a nice shape

+1

Based on your photos I would recommend only a breast lift (vertical mastopexy) without implants. You appear to have the necessary volume already with your own breast tissue. I would use this to reshape your breasts, giving more fullness and elevating the level of your nipple position. If you add breast implants to your already ample size, this may only worsen the degree of sagging and make you look too large.

You could also have the breast lift first, then, about 6 months later have an implant inserted if you really want more size. This approach usually gives a nice outcome than performing the surgeries at the same time.

Consult with a few board certified plastic surgeons before making your decision.

Best wishes,

Dr.Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 141 reviews

Lejour Breast Reduction is best!

+1

Never put an implant where your own breast tissue will do!

You have enough tissue to yield a great shape. Technique will determine the ultimate perky shape of your breast. 

 

Robert M. Freund, MD
New York Plastic Surgeon
4.5 out of 5 stars 18 reviews

Breast reduction with implants to reduce the sagging and weight of the breast

+1

In this situation, I have had the best results with a combination of breast reduction along with placement of modestly sized breast implants.  Although it may seem like a contradiction, that is a great combination.  The breast reduction will reduce the weight of the breast, and help your back and posture.  Adding breast implants will fill out the upper portion of the breast and give you the "nice mix between natural and fake", and more importantly, produce the shape and perkiness that you are looking for.

Breast implants weigh about the same as the same amount of breast tissue, but the difference is that (at least the way I do this procedure), the implants can go under the muscle, which holds them up against your chest, so they are not weighing on your bra straps.  This is similar to the difference between a backpack worn on your shoulders, and a backpack with a belt that supports it around your waist.  Note that not every surgeon puts the implants under the muscle (some worry that it holds the implants too high), so be sure to ask about this.

You can have a final result with breasts larger than they currently are, the same size as they currently are, or smaller than they currently are, depending on whether the implants are bigger than, the same size as, or smaller than the tissue removed in surgery.

As to the width of your breasts, it is certainly true that they are wide, and will likely still be wide after surgery.  That can produce some boxiness at the sides of the breast, depending on the technique used.  Be sure to discuss this issue with your surgeon before surgery.

While I agree that it would be ideal if you could lose some weight before surgery, I don't think it is realistic to expect that weight loss alone will reduce the breasts to the point where they are not too heavy for you.

So that is what I would do if I were you!  Good luck!

James Nachbar, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 10 reviews

Breast Lift and Breast Implants

+1

Hello Rtdm,

I respectfully disaggree whole heartedly with my fellow surgeons.  Based on the photograph I see, you have very large and very heavy breasts.  The result of breast lift on your type of breast would yield a less than desirable appearance, with persistant sagging and a square shape to the bottom of the breast.  The only thing that would change for the positive would be nipple position.  The addition of an implant would only give you upper pole fulness but not improve much else.

You are an ideal candidate for a formal breast reduction (which includes a breast lift) and breast implants simultaneously.  Removal of the hanging breast tissue and extra skin together with implant placement for both volume replacement and shape enhancement will give you an ideal result.  This is a surgery that should be performed by a breast specialist who is certified by the American Board of Plastic Surgery and is a member of the American Society for Aesthetic Plastic Surgery. 

Best of luck!

 

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

Breast lift and implants

+1

If you are looking to improve back pain symptoms and posture your best option would be a small to moderate breast reduction. This will provide both a lift, which will improve shape and a reduction in excess breast volume which will improve your overall symptoms. This could be accomplished with a vertical reduction avoiding a long horizontal scar. Although the addition of an implant would produce more upper breast fullness, it adds another element of potential complications if performed in conjunction with a breast  reduction/lift.

David A. Bottger, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 26 reviews

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.