i am 26 years old, 136 pounds, and 5'2" with a 450cc breast augment. my breasts just seem too saggy and i am unhappy with them. i want a lift to perk them up and would like to know what lift would be recommended.
What Breast Lift is Recommended if You Already Have an Augmentation?
Doctor Answers 16
Types of lifts
In the case of women with breast implants that need a lift, you have to first assess if a lift is, in fact, necessary. I have often seen patients with breast implants who felt their breast were low and felt a lift was either required or even recommended by other plastic surgeons. In some cases closing the implant pocket and raising the inframammary fold can raise the position of the implant and thus the breast obviating the need to perform a lift. Make sure that this is not the case with you before undergoing a breast lift.
If, however, a lift is indicated, there are basically three types. Incision just around the areola; around the areola with a vertical; and an incision around the areola, a vertical, and a horizontal. The lift with the incision around the areola along with a vertical is usually the one that works best. The lift where there is only an incision around the areola tends to flatten the breast, the scar itself may be problematic, a permanent suture underneath the skin is required that sometimes can be felt and can distort the shape of the areola, and, generally, does not lift the breast significantly. I have found that this type of lift is often overused. The lift where a horizontal incision is used as well should also be rarely performed. There are newer breast lift techniques that make that horizontal incision unnecessary.
Ary Krau MD FACS
Breast lift after augmentation?
Thank you for the question.
Specific advice will depend on your in person examination. The more breast ptosis (drooping) the more extensive the breast lift that will be required. One piece of advice I would give you: your 1st concern should be obtaining the best results possible (scarring concerns should be secondary). Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.
In other words, if you select your surgeon based on the offer of a “limited scar” procedure you may be disappointed with the results.
Please make sure you seek consultation with their well experienced board-certified plastic surgeon. Best wishes.
Breast lift after augmentation is a common procedure
Seek out a good board certified plastic surgeon with breast lift experience - without photos or an exam its impossible to give you specific recommendations - but if you perceive your entire breast to be 'saggy', you may want to consider a vertical breast lift technique. A peri-areolar breast lift tends to flatten breast projection and does not correct sagging breast tissue.
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Nipple position is not improved by breast augmentation
Sagging with low nipple position on the breast mound is not improved with breast augmentation. Depending on the degree of descent of your nipple a breast lift may offer improvement to your breast appearance.
Breast lift after augmentation
Breast lifts are the answer only if you fail "the pencil test". Put a pencil horizontally under breast fold, if your nipple/areolla is bellow the horizon of the pencil; get a lift (any kind of lift). If it is above it (like a sun rising above the horizon) don't get a lift. If it is right on the horizon you may consider a "natural breast lift" where fat is used as a graft to fill up the upper pole, not the lower pole since it has been augmented already. I hope that was helpful.
Without photos it is difficult to tell; however, a breast lift sounds as thought it is the procedure of choice for you.
Vertical mastopexy after a breast augmentation
If you have loose skin or a low nipple position after breast augmentation you may need a vertical mastopexy (lollipop incision). You may also consider decreasing the size of your breast implants at the same time as this may be contributing to the sagging shape of your breasts.
This is difficult to answer without seeing photos so I recommend consulting with a board certified plastic surgeon for a complete evaluation.
Vertical breast lift with lollipop scars best for most women.
Here is what I would tell you without seeing you:
1) Change breast implants to somewhat smaller size (maybe 350 cc's).
2) For minimal sagging, an internal scarless breast lift can work.
3) For slight sagging, a "doughtnut" breast lift, with just a circular scar around the nipples is good.
4) For a lot of sagging, the vertical breast lift is best.
5) You never need the old fashioned anchor shaped scars for a lift.
Breast lift and breast implants
There are many different ways to perform a breastlift and even more minor variations of those ways. What is effective in one patient will not be so effective in another. As you have found out if you see 10 different plastic surgeons you will get 10 different answers as to what type of breast lift should be performed.
The aesthetic goal in breast surgery (augmentation, reduction and lift) is nipples that are 20cm from the notch on top of the breast bone, 11cm from the midline and 7cm from the fold under the breast with all of the breast tissue centered under the nipple. Sometimes we go to 21 vs. 20, 8 vs. 7 etc. to end up with less skin scarring/smaller skin incisions. When you think of it this way in the realm of breast lifting the surgery involves removal of excess skin in the vertical and/or horizontal planes to achieve the lift. The type of skin excision pattern to employ (lollipop, crescent etc) is therefore predicated on which plane the skin has to be removed and if on both planes the relative amounts on each plane. If skin removal is only required on one plane and the amount is minimal a crescent pattern will do. It the nipple only needs to be lifted upward a few centimeters the lollipop will suffice. As the amount of vertically lifting required increases you need to add a horizontal skin excision at the bottom otherwise you will end up with corrigated extra skin under the breast or a scar that runs down onto the abdomen. Some surgeons take out a larger amount of skin around the nipple-areola in attempt to get rid of the horizontal excision at the bottom. Though some surgeons get good results with this I personally do not like it because tension around the areola can cause it to stretch and the horizontal scar under the breast is less visible than a bad scar around the areola or vertically between the nipple and fold under the breast.
Not knowing your specific breast measurements or the degree of skin elasticity it is impossible to say which type of breast lift would be best for you.
What TYPE of Breast Lift is Best for Sagging Augmented Breasts?
There is NO one "best" Breast Lift method which is magically applicable to every single sagging augmented breast out there. In the absence of being able to examine you or being provided your Before and After Breast photograph no ethical Plastic surgeon can really answer your question truthfully,
IN GENERAL, if you were augmented with 450cc breast implants, it would be safe to assume that these implants bear some responsibility for the sagging of the breasts and some consideration should be given to "going smaller" to prolong the "perky again" period after the lift. Generally speaking, either an inverted T or a lollipop scar are the accepted methods of breast lifting in cases such as yours while either a crescent or a periareolar lift are rather minimalist procedure intended for minimal breast sagging only.
Dr. Peter Aldea