One doctor will do implants with no mention of breast lift and another won't touch me without one...very confused! Your thoughts? Thank you!
2 Different Responses, Confused? Do I Need a Lift? (photo)
Doctor Answers (23)
Do I need a lift?
That is a great question, lifts are dependent on a patients desired outcome and current anatomy. I am very hesitant to recommend lifts in women that are borderline in their anatomy. There is a tremendous amount of scarring associate with true lifts and if the patient truly does not need one she will be very disappointed with the results. I recommend to patients to proceed with a augmentation first and if unhappy with the results then proceed with a lift that can be performed under a local anesthesia. Good luck.
Breast implants with our without lift?
Dear Bellagal. If your nipples are above the breast fold and pointing horizontally, you could just get implants. If you decided you wanted the nipple higher, then a "donut mastopexy" would probably be enough (round scar around the nipple). I would recommend you get the implants alone; wait 3-6 months; and if you want the nipples higher, it can be done later. The donut lift can even be done awake with just local anesthesia and you could go back to work that day. I have pictures of women similar to you on my website so you can see what it may look like. Hope it goes well!
Breast Lift or Just Enlargement
A physical examination should determine whether you have true sagging of the breasts or whether they have just loosened a little and drifted downward slightly. Typically after pregnancy, the breast atrophies (gets smaller) and loosens because of the deflation, thus losing shape. Adding volume with a breast implant can often fill out the loose skin and lift the breast nicely, creating a youthful shape and increased fullness. However, if your nipples are below the fold under your breasts (where the bottom of the breast attaches to the chest), than you might have too much loose skin for an implant to fill out enough to lift the breast adequately. Then you would need a lift to correct the sagging. The choice may also depend on just how much of a lift will create a shape that will please you. Basically, there is a limit to the degree of lifting that can be achieved from just enlarging the breast with an implant. From the photo, I think you should do nicely with just an implant, but a thorough examination should tell the tale.
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Mastopexy lift or just augmentation
your nipple is below your fold and most doctors would suggest a lift and implant
no lift has a high risk of a larger sagging breast. some doctors are afraid to suggest the lift for fear of losing their patient
2 Different Responses, Confused? Do I Need a Lift? (photo)
Plastic surgery is a specialty where patients often receive different opinions from different surgeons, because there is usually more than one way to tackle the problem. This can be very confusing.
I generally try to avoid a breast lift if I think I can deliver a good result without one. Once you take the time to explain to your patient that a breast lift involves a great deal of scarring and expense, not to mention many ways to go off the rails, she will usually be very happy with an implant alone. The lift can then be achieved with the right bra.
Of course there are some patients with severe ptosis (droop) who must have a lift in addition to an implant.
Judging from your single photo, I would guess that you would do well with an implant alone.
All the best.
Do I Need a Lift?
There are two common methods of evaluating nipple/areolar position. A simple measurement from the top of the breast bone to the nipple should be about 20-22 cm, or 8-9 inches.
Better, since the breast position on the chest may vary, is the position of the nipple and areola to the breast fold, and the bottom of the areola should be above or even with the fold.
It is tough to tell on this single photo, but the areola looks low.,My hunch is that if your breasts were suitable size to you, you might not be asking for info about a breast lift. The problem is that if you do elect to get implants, the likelihood of an unsatisfying result, with the appearance of your natural breast tissue hanging off your implants, is rather high.
Options include doing a lift at the time of implants, or just starting with implants and seeing if the outcome satisfies you. Neither option seems unacceptable to me, although doing the procedures separately will probably cost more and involve two periods of recovery.
Thanks for your question,, best wishes.
Augmentation Or Lift
It is difficult to see the exact location of your nipple in the photo. The key is the its relationship to the breast fold. If lower, it is not likely that you will be pleased with an implant alone. If not, you can always have implants and then have a little vertical lift if you choose.
Uplift or not? Scarless!
Scar less surgery is currently not a possibility. There is only limited opinion that can be given to you based on the single picture you have provided, however the picture does show droopiness in the breast shape. If you require fuller breasts with upper pole fullness, and wish to look fuller in clothing then a "simple" breast augmentation will give you this. If you wish to look fuller and perkier, with your nipples point straight forwards and not downwards then you would almost certainly benefit from an uplift although this decision could be delayed for 3-6 months to allow your breast to settle. Both procedures ie augmentation and uplift can be combined in a single operation but there is a slightly higher risk of complications.
For your type of breasts I would suggest augmentation to restore volume and a circumareolar mastopexy i.e. donut uplift to restore 'naked perkiness to the breast with minimal scarring. I personally often also place the implants through the same circumareolar scar avoiding a scar in the lower breast crease.
Lift or not?!?
Your situation is very common. The answer lies in your expectations! What will make you happy. If you want the breast higher and perky like high school then you likely need the lift. If you are comfortable with a more mature look then you can avoid it. In addition, a larger implant will take up some of the redundancy and reduce some of the need for the lift. However, never go bigger than you are comfortable just to avoid a mastopexy. Choose the size that is right for your frame, then do what you need to do to get a great look. Finally, ask to see pictures of the surgeons work. Not all surgeons work is the same. Good Luck!
You seem to be at the borderline of whether a lift is needed or not. Think of it this way. If you do an augmentation with sufficient size and projection, you can probably get away without doing a lift, but you will not be super perky. If you do a lift, you will be quite perky but have additional scars. Some surgeons may suggest a 'donut' lift with the scar just around the nipple, while others may suggest a 'lollipop' lift with the scar around the nipple, then down from the nipple to the breast crease. One other thing to think about, if you are undecided about the need for a lift or not, you can always do the augmentation with the above risks (of not being super perky) in mind, and you haven't burned any bridges, as the lift can always be performed at a later date if you are unhappy with the degree of perkiness. A plastic surgeon will do a good physical exam in order to give you the best idea of what your post-operative result will be like, as well as give you options of various techniques (i.e. above the muscle, below the muscle or below the fascis (covering) of the muscle) which will all give different results. This assessement needs to be done in person as your skin elasticity is assessed in the process as well.
Pablo A. Prichard, MD
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