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5ft4, 141lbs and recently lost 25lbs: Do I Need a Breast Lift? (photo)

I am 5'4" 141 lbs. I have lost almost 25lbs so far and I am hoping to lose 10 more before surgery. My first consultation is on Monday. I am currently a 34C, however if I get down to 130lbs I am more like a 32B. I would like to be a full D to DD (what I was when I was breast feeding). I would consider a lift if I could also reduce my areola size, but I really do NOT want the lollipop scar. How much extra is usually charged to reduce areola size during augmentation/are they better done separately?

Doctor Answers (14)

TWO OPERATIONS byVillar

+2

If you are ultimately seeking a D or DD size breast, you should consider having the mastopexy performed first without implants.  Dense poorly mobile  tissue makes relocating the nipple-areola complex more difficult with a more tenuous blood supply.

A mastopexy is a tightening procedure. The skin envelope is being reduced with the same amount of tissue  being forced up into a higher location. 

An augmentation is a stretching procedure.  The two operations are enemies.  Increased pressure lowers the vascular margin of error. Though most surgeons perform both operations simultaneously, the complication rates are higher.  Doing a mastopexy and stuffing DD implants in you is asking for trouble.  Some physicians consider the loss of a nipple  or flap a normal risk and the cost of doing business, but it is a big deal to the patient.

If you want smaller, round nipple-areoar complexes with normal texture, the inverted T technique is the most reliable of all procedures in a case like yours.  You will have to accept scars or stay the way you are if scars are out of the question.  The majority of major disasters that are referred to me, are attempts at minimal scar techniques in poorly chosen  patients.

 

Patients should be carefully evaluated to weed out the higher risk  patients such as those with dense tissue and large amounts of breast tissue, smokers, diabetics and obesity. 

It is prudent to send the patients home with drains in mastopexy and reduction patients but especially in simultaneous mastopexy/augmentations.  If a hematoma develops overnight without a drain the blood supply to the nipples could be compromised resulting in partial or complete nipple-areola necrosis before the morning visit.

 

Make sure your surgeon sees you the very next day after such procedures.

We have performed 89% of our patients requesting both mastopexy and augmentation in two stages since 1982.  We have not had any partial or complete nipple areola complex losses. No flap necrosis.  One minor incision infection.

Best wishes. Knowledge is power.  Luis F. Villar MD FACS


West Palm Beach Plastic Surgeon
4.5 out of 5 stars 7 reviews

Do I Need a Breast Lift?

+2

Yes

And for the amount of lifting you will need with implants you would be far better served to consider a lollipop or a full anchor lift. The areola size would be decreased as part of any lift. It is more likely to be durable when done with something more than a peri-areolar lift. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 34 reviews

Breast lift or NO breast lift--that is the question.

+2

If you are a B cup now and want to get to a D or DD size, implants are (obviously) needed. That degree of implant volume will indeed "fill" your present skin brassiere to a fairly significant extent, but will NOT "lift" your breasts. The weight of your implants will drop behind each breast over time, and can give the appearance of some degree of nipple/areola rotation to (a perceived) higher relationship to (an actually) lower breast mound.

But then there is the issue of your large areolas. Implants (add volume) can be expected to stretch the areolas to some degree, so even if implants alone can yield a satisfactory augmentation results, you will still need incisions and scars to reduce areola diameter. And if your results would be enhanced by even a modified (lollipop or circumvertical) lift or full (Wise-pattern or "anchor") lift, there will be more scars.

No patient "wants" scars. That is why there are so many gullible patients who are lured into short-scar facelifts, crescent or periareolar breast lifts, "mini" tummy tucks, etc. Everybody wants more for less. (Whether that be more result for less cost, or more lift for less scarring, etc.) But some anatomic situations require incisions and resultant permanent scars in order to achieve appropriate results!

With your concern about scars, I would consider augmentation alone first, see how things turn out in terms of appearance (and see how the short augmentation scar heals), and then consider adding whatever lift or areolar reduction is considered worthwhile (in terms of cost and scarring). This might require two operations, but doesn't burn bridges in terms of options. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 144 reviews

Breast lift and areolas

+2

First, if you are a b cup and want to be a d cup then you need more volume ( i.e. implants). You also need a lift and your areola are large. This can only be accomplished with incision around your areola and on yoru breast skin. 

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Lift with implants

+2

hi ajaj1234

thanks for the post and the question. I think based on your desired goals and photos, your best option is to have the implants with a full lift. Yes, I understand that no one WANTS the vertical scar. However, attempting to correct this issue with JUST the around the nipple scar will simply not work well for you. The around the nipple scar is good for VERY MILD cases of areola enlargement and breast sag ONLY.

You should take the time to see several PS and determine how you want to proceed. best to you. 

Bennett Yang, MD
Rockville Plastic Surgeon
5.0 out of 5 stars 8 reviews

Do I Need a Breast Lift?

+1

In a word, yes.  Implants do not lift the breast, they fill them out where they are, and if they are too low (overhanging the crease beneath the breast) then they hang off of the implant and this is not a good result.  No one WANTS the vertical scar, but periareolar (or Benelli) lifts with a scar only around the areola are very weak lifts, the eventual size and shape and degree of reduction of a large areola is unpredictable, and the more lift you need, the worse the shape of the breast and the worse the scars.  I do periareolar lifts in patients who only need a mild lift. Those who need the least lift benefit from the periareolar lift the most.  Believe me, it is better to have a breast with a beautiful shape and the vertical scar that usually fades well than a breast of unsatisfactory shape and a worse quality and more visible periareolar scar.

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Breast lift needed...

+1

Thanks for your post and photos. I have seen other women with your anatomy, size and goals. A breast lift and implant placement has created a solid size enhancement and a good long-term result for those patients. For your case, it is best to consult with a local plastic surgeon to discuss any recommendations. Best wishes.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 140 reviews

Periareolar lift with a Gummy Bear implant would work

+1

In distinction to a few commenter, I think you can actually pull off a very effective periareolar (Benelli) purse string breast lift with an implant without a vertical scar as your areolar diameter is going to allow a fairly aggressive skin reduction to be incorporated and your nipple position is really not that low in relation to your breast crease (IMF).  For this particular operation, I'm a fan of the round-based shaped  implants from Sientra, which is a type of the "gummy bear" implant family.

I would suggest you be a little more conservative then chasing a DD result from your surgery as that will make the mastopexy much more difficult to execute. Based on your starting volume and guessing your dimensions, I would guess the 320 or 370cc Sientra round base anatomic silicone implant would be the implant I'd probably use depending on your actually breast width measurement. 

Robert Oliver Jr., MD
Birmingham Plastic Surgeon

Full breast lift with implants

+1

Looking at your pictures it appears that to achieve a D size breast you will need a full lift (anchor scar) with small implants to have upper pole fullness. The areola reduction is part of the breast lift procedure and should not have an extra charge.

Good luck!

Tal T. Roudner, MD, FACS
Coral Gables Plastic Surgeon
5.0 out of 5 stars 83 reviews

Do I Need a Breast Lift?

+1

   Your areola can be reduced at the same time that implants are placed to increase your breast size.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast lifts and augmentations each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 238 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.