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Do I Need a Breast Lift During Implant Replacement?

asked 3 years ago by Sloane M. in New York, NY
Latest answer by Robert L. Kraft, MD
Question viewed 5,216 times
Tags: Virtual consultation

I have Saline breast implants that are now ten years old. They were beautifully done and look natural, although the doctor went bigger than I had asked for: a full C instead of a full B. It was his aesthetic call, he said, and at the time, (and urged on by my then-boyfriend) I decided I'd live with them.

Ten years later, I am about ten pounds less and much leaner than back then (5'5", 112 lbs, very fit, 18.5% body fat) and the implants have sagged somewhat. When I see photos of myself, I feel my silhouette is out of proportion, and that I would look much better with slightly smaller breasts, as I had originally intended... and perhaps Silicone this time. To go for smaller, firmer, higher breasts after having larger saline implants, would I need a Breast Lift in addition in order to accomplish this? How are these procedures usually done?

27 answers to Do I Need a Breast Lift During Implant Replacement?

Smaller implants- lift needed

Almost certainly you will want to consider a lift at the same time as your replacement surgery with a smaller implant. If the skin is already loose (droopy), this problem will only become more pronounced once a smaller implant is placed. A board certified plastic surgeon can go over the options with you. You will certainly want to discuss where exactly the implants are (above/below the muscle) , what type of lift will give you the best appearance, whether a complete vs. partial capsulectomy... more

Brent Moelleken, MD
Beverly Hills Plastic Surgeon

www.drbrent.com

Smaller Implants+Weight Loss+10 Years=?Breast Lift?

Aging does often mean a change in skin tone and some degree of breast drooping. If there is less volume to fill the breast, the deflated breast may be droopy. Weight loss can contribute to the deflation. A breast lift may be best to make sure you have the attractive shape and position of your breasts you desire. If you wish to avoid the lift, your surgeon may agree to postpone the lift, replace the implants and see how your breasts drape. If you are unhappy with the... more

Paul C. Zwiebel, MD
Denver Plastic Surgeon

www.pzwiebel.com

Breast augmentation and lift are complementary

Breast lifts and Breast implants accomplish complementary tasks. In a breast lift, the position of the breast and breast nipple is elevated. It does not add volume to the breast. In a breast augmentation, the volume and projection of the breast are elevated. Often, these two procedures are performed together to accomplish both tasks.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

Breast lift with downsizing implants: is it necessary

This is a difficult decision. It is not uncommon for plastic surgeons to stage or separate these operations. No one can predict for sure, how your breasts will look after downsizing. Let me offer an analogy which may help to explain: If you look closely at your friends or women after the health club, you will see a variety of different looking stomachs following pregnancy. I have seen women who have had 3 children have an absolutely flat stomach that is more attractive than many 20 year... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Breast lift can help you end up with a great result

When downsizing the size of an implant, small increments can do well if the skin and other tissue around the breast implant is youthful- this tissue can then contract a small amount for a good aesthetic outcome. You are describing a situation where you already have some "ptosis," or drooping of your breast form, and so it is likely something else will need to be done. It sounds like 10 years after your last operation, your are thinner, leaner, and likely healthier and want a more... more

Adam David Lowenstein, MD
Santa Barbara Plastic Surgeon

Withdraw saline from your implant with a syringe, on the day of the surgery in front of a mirror.

As you stated you currently have saline implants, in the past I have had patient stand in front of a mirror on the day of the surgery and with a syringe and needle, puncture the implant and draw saline fluid out of the implant until you get to the volume you desire. That way you can participate in the decision and get an idea of what the breast might look like simply with a smaller implant. Of course at that point you are comitted to changing the implant and you would proceed to the... more

Darrick E. Antell, MD
Manhattan Plastic Surgeon

A breast lift may be required

It's difficult to know without examining you, but in order to downsize the volume of your implants as well as lift the breast and tighten the skin envelope around it, a lift will likely be required. A silicone implant will also give you a more natural shape, look, and feel in some cases, so this is certainly an option. I would recommend a formal consultation with a Board Certified Plastic Surgeon in your area, and he or she can review with you your options, but from your description, a lift... more

Shahram Salemy, MD
Seattle Plastic Surgeon

A breast lift is not the end of the world

Scribem, When you downsize breast implants, you usually will need a lift. This is because replacing the implants with a smaller volume implant will lead to excess skin since the implant is no longer filling the full volume of the breast and stretched out skin. However, breast lift is not the end of the world. The incisions tend to heal very nicely and if there is any asymmetry between your breasts, this can be improved at the same time as well. One technique that you can do to help avoid... more

David Shafer, MD
New York Plastic Surgeon

Smaller and firmer requires skin removal

If you think about the breast as the skin envelope to your present implants, going to a smaller size (silicone or saline) will mean that you will have more of a skin envelope relative to the size of the implants. You want "firmer and higher" smaller breasts. By definition, going smaller will make your breast skin looser and the implants lower, so one needs to adjust the skin envelope to be tighter. Unfortunately this requires some form of skin removal and this means that in all... more

Francisco Canales, MD
Santa Rosa Plastic Surgeon

Exchange of implants with mastopexy

You are correct. If you replace your implants with smaller ones, after 10 years at your current size, you can expect that the breasts would sag so it would be reasonable to combine the reaugment with a lift. There are many decisions to make in planning the combined surgery (silicone v. saline, above v. below the muscle, periareolar v. T-incision, etc.) Definitely see a board certified plastic surgeon to begin to plan for this surgery. If you had infra-mammary scars from the breast... more

Robert L. Kraft, MD
New York Plastic Surgeon

Removing implants to go smaller may require a breast lift

You may need a breast lift once your implants are removed. This depends on your breast volume, skin quality, and how much smaller you are planning to go. One approach to avoid or minimize the need for a lift involves what is called an in-office deflation. This involves deflating your breast implants under local in your doctor's office. This wil allow the implants to shrink and also for the skin to shrink. You and your surgeon will have a much better idea of... more

William Bruno, MD
Beverly Hills Plastic Surgeon

Implant exchange may mean a breast lift

The answer to your question all depends on your skin quality, your current breast shape, your current nipple position, what size implant you choose, and what pocket you will use (stay over or under the muscle). It may very well be that you need a breast lift and the scars may range from just a circle around the areola to a lollipop scar. Or you may not need a lift at all. Your plastic surgeon will absolutely guide you and help you make the decision that is right for you.... more

Carmen Kavali, MD
Atlanta Plastic Surgeon

Breast lift when replacing implants

There are many factors involved in deciding whether a breast lift would improve the appearance of your breasts when replacing larger implants with smaller ones. The initial location of the implants, elasticity of the skin, amount of droop of the breasts all contribute to the shape of the breasts after changing to a smaller implant. These are complex cases and you should consult with an experienced plastic surgeon who can discuss all the options with you prior to surgery.

Olivia Hutchinson, MD
New York Plastic Surgeon

Implant exchange and breast lift

There are cases when changing from larger implants to smaller ones the surgeon can avoid doing a breast lift. Typically if the larger implant is on top of the muscle, the surgeon can place a smaller implant under the muscle and re-drape the skin over the muscle with some quilting sutures. This can be done in a few selected patients. In some other cases some type of skin corrections is needed, which could involve only a small scar around the areola.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon

www.doctorackerman.com

Breast lift is not always necessary when changing to a smaller implant.

If you wish to change to a smaller implant, it is not necessary that a breast lift be done. The decision depends on the condition of your native breast and the expectations you and your surgeon share. You, as an individual, might be best served by a mastopexy but I would venture a formal recommendation only with a personal examination. In general, though, many patients switch out to smaller implants and do not need breast lift surgery.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

Breast lift is sometimes needed with a switch to smaller breast implants

While it is not possible to make full recommendations over the internet, there are several points to consider based on your description. 1. Saline implants that are still soft and natural and intact do not need to be replaced just because they are 10 years old. 2. Stretched out skin causing droopy breasts may not tighten with an implant in place, even if the implants are exchanged for smaller ones. 3. Several things can contribute to the droopy appearance of breasts... more

Elizabeth Lee, MD
Bay Area Plastic Surgeon

artfulsurgery.com

Breast lift during breast implant exchange

When patients receive a breast implant exchange, some consideration needs to be made for the current state of the breast tissue around the implant. In many cases, the tissue has stretched out around the implant and may require a small lift when exchanging the implant with another implant at the same or similar size. Another option, is to place a larger implant that will help fill the now larger skin envelope. Discuss with your plastic surgeon what options are best in your case. Your... more

B. Pat Pazmino, MD
Miami Plastic Surgeon

Breast ptosis

There is a fine line between a natural saggy breast and the deflated saggy breast. It is hard to determine this without a picture or in consultation. As a rule of thumb if you are saggy now and you go smaller, you will have more ptosis and will require a lift.

Hisham Seify, MD, PhD
Los Angeles Plastic Surgeon

Replacing implants with smaller implants

Thanks for the question - This can be very difficult to answer. It depends on the laxity of your skin, the amount of ptosis (sag) you had prior to your breast augmentation and the position and shape of your implants and how much ptosis you've had since your original implants. Many patients do need a lift after removal of implants but some patients with small volume changes (like what you propose) can get away without it. It also depends somewhat on the amount of sag you're willing to... more

Steven H. Williams, MD
San Francisco Plastic Surgeon

Breast lift surgery can possibly enhance your results

Sometimes patients require a lift, in addition to an augmention, when down sizing or with weight changes. Over time, skin loses its elasticity requiring excess skin to be removed and/or tightened. The amount and degree are determined by the final cup size you you would like to be as well as the amount of elasticity remaing in your skin. Site location, above or below your muscle, as well as the type of implant, slaine vs. silicone ,will also determine the appropriate procedue and your final... more

David A. Robinson, MD
Munster Plastic Surgeon

Tear Drop Augmentation Mastopexy

You are right - you will need a lift at the same time as the reduction in size of your implants. My technique called the "Tear Drop Augmetation mastopexy" is ideal for this problem. This technique involves the lifting of the breast tissue from above the breast which yields exact results with durability. The incision is only around the areola - not a lollipop incision- and the shape is great.

Robert M. Freund, MD
New York Plastic Surgeon

www.breastenlargement.net

You will most likely need a lift

The lift of the breast is designed to elevate the nipple to a youthful position on the front of the breast and remove the extra skin that is allowing it to sit too low. First the implants are exchanged then the skin excess is custom tailored out to create your optimal shape and tone. It requires some scars but will be worth it in terms of the best shape and look.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast lift after implant exchange

It is difficult to give you an answer without seeing you. If your breasts are sagging now and you want to go to a smaller implant, it is more likely that you will need to combine the exchange with a lift procedure.

Steven Wallach, MD
Manhattan Plastic Surgeon

You will definitely look much better with a good breast lift and smaller silicone implants.

To scribemjp, Hi! I have seen any number of women in your situation. So I think I can visualize you even though I have not seen you. I will predict that you need smaller implants (maybe 100cc smaller) and a good lift. You need a lift with either an incision around the nipple only (doughnut scar) or, at the most, a "lollypop scar". HOW the lift is done is critical. The breast tissue itself needs to be moved up on your chest without relying on skin tension. If the lift is done by... more

George J. Beraka, MD
Manhattan Plastic Surgeon

A smaller implant would mean more droop

Your question is very thoughtful. If there is a little sag or droop it sometimes can be corrected with a larger implant, or teardrop shaped implants. You have indicated you wish to switch to a smaller implant, and a round gel implant. A smaller implant usually makes the sag more noticeable. So your choices would be to either accept the droop or sag, or some sort of breast lift or mastopexy. The types of lift include mini or Benelli type lifts that the scar is just around the nipple- areola... more

Benjamin Van Raalte, MD
Davenport Plastic Surgeon

Every case is different

The answer for you depends upon your goals and the condition of your skin and the other tissues. If your skin isn't too stretched out, it may be possible to go a little bit smaller and do a form of internal lift called a capsulorrhaphy. You would need to be evaluated to see if this is a reasonable option. How high you can go without a lift depends upon where the nipples are; you don't want a high mound with the nipples low. I disagree with one of the statements in the previous answer,... more

Richard Baxter, MD
Seattle Plastic Surgeon

Most probably yes, but...

Every situation demands a customized solution. There are a multitude of factors that determine how your breasts look with implants: Location above or below the muscle Whether you have round or shaped implants The relationship between implant width, projection, and volume The position of the implant relative to your inframammary fold The relationship of your fold relative to your chest, etc. Skin tightening can be achieved in various ways although if done to a significant degree usually... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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