I am 5'5 and 110 pounds. I am a B cup and have had a pregnancy. I have grade one ptosis and have been recommended by my ps to have a donut lift and augmentation with 325cc. I am very concerned about scars, and my husband also. He wants me to have only the augmentation.
What's Best For Grade One Ptosis: Donut Lift with Augmentation or Augmentation Only?
Doctor Answers (13)
Grade one ptosis and breast implants
The classical definition of grade one ptosis is a nipple position at the level of the fold under the breast, the center of the nipple and not the areola. You do not have breast ptosis. The donut breast lift will only reduce breast projection or flatten your breast, and result in a scar. You have some pseudo ptosis to be technical, though the bottom line is you will do quite well with an implant alone.
Best of luck,
Web reference: http://www.peterejohnsonmd.com
Augmentation for now, lift in a few yeasr
Right now, you have bottom heavy breasts easpcially laterally and a periareolar lift won't help that at all. An implant can be done and i over the years the breasts seem progressivvly lax, a full lift will fix that without having to change the implants as long as they are in good position and soft. So, you can stage this but don't go big with the implants or above the muscle as this will not lift you and will make the laxity worse faster.
Breast implants or lift with implants
If you like the current shape of your breasts but would like them fuller, I would suggest implants without any type of lift. The "donut lift" will probably blunt the natural projection of your breast without adequately addressing the breast sagging below the areola. If you want to have more fullness of the upper chest wall without the support of a bra, a "lollipop lift" with an implant would be in order - the down side is the presence of scarring that you don't want. Remember, you can always do a lift at a later date. Good luck with your decision.
Web reference: http://www.josephtogbamd.com/
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Combination mastopexy breast augmentation
The answer to this question depends on your expectations and what you are willing to accept in the way of scars. While I could give you a better idea if I was able to examine you, from your pictures, it appears to me that you have a significant amount of breast tissue inferior to your inframammary crease and a significantly long nipple to inframammary crease distance, thus an augmentation mammaplasty alone will leave a significant degree of residual ptosis with lower breast fullness. The result will be breasts that are more full, but will be too droopy for some patients. I would doubt that a periareolar mastopexy alone would be adequate to lift your breasts without leaving them looking too flat with widening of the areola postoperative, a problem with the periareolar mastopexy. I would suggest you discuss your desires and expectations with a plastic surgeon who is experienced in combination mastopexy and augmentation.
Donut lift or augmentation only
As you can see from the variety of opinions, there is not a black and white simple answer. I would tend to agree with doing some sort of lift and augmentation - you already have an element of "psuedoptosis", meaning that there is a lot of breast tissue and skin underneath your nipple. A circumareolar mastopexy may not be enough in that it has a tendency to cause the breast to flatten a bit, the areolas and scars can widen significantly if a lot of skin is removed, and it will not do as much for the excess skin below the nipple. It looks like you have some stretch marks, also. My personal opinion is that 1 or 2 years down the road, when the scars have matured, most women will not be thinking about the scars as much but are VERY concerned with the size, shape and perkiness of their breasts. You need to talk wtih your ps about expectations - are you comfortable with droopier/lower (more natural) breasts that have an implant only, or do you want higher and tighter breasts with more upper fullness, etc. Take in photos of what you are looking for, and consider staging the procedures if you are concerned.
Thanks for your enquiry. Judging from your photo, you have grade 1 ptosis - your nipple/ areola complex is slightly above the crease beneath your breast. You also have mild pseudoptosis or bottoming-out of the breast. You do not need a periareolar mastopexy as the risks would out weigh the benefits. I would suggest only an augmentation which would fill the upper pole of your breast and hopefully achieve the result that you are looking for.
Breast Implants or Lift and Implants?
The issue with you isn't as much the position of your implants, its the fact that the majority of breast tissue you have sits on the lower, outer aspect of your breasts. Implants will enhance the upper and lower aspect of the breast, but the ratio will remain the same leaving you with "heavier" breasts - not lifted or full in the upper area - where most patients prefer. An areolar breast lift will result in somewhat of a lift (but you dont need just the nipple/areola lifted), but this also flattens the breast - potentially exacerbating this look. As much as you don't want scars, the best way to reshape the breast is with a "lollipop" breast lift which narrows the breast base. Although scarring is a major concern, it is likely that without this approach, you will not produce an attractively shaped breast.
Look at galleries of before and after (see attached link) to see the "re-shaping" potential with this procedure.
Best of luck
Vincent Marin, MD
San Diego Plastic Surgeon
You can get augmentation for now
The photo you sent is helpful but it is clearly taken from an angle looking up at your breasts- this angle makes the photodifficult to use when asessing the amount of lift that you need. 'Donut' lifts are useful in some cases but the scars are not always better. There are cases where too much of a lift is attempted using this scar only- the result is a widened scar around the areola and flattening. I'm not saying that you'll have this issue- but I am saying that I'd need better photographs to give an opinion about whterh I think this approach is right for you.
On examination of your breast photograph, you have several options available to you. In general, for a mild ptosis, a breast augmentation with a Benelli breast lift is a viable option, producing excellent results, and the scarring is very acceptable in a majority of the cases. Ultimately, you need to sit down with your husband and plastic surgeon and decide what your non-negotiables are ~ meaning, what are your expectations versus what are you unwilling to accept in terms of visible scars. From there, you can decide what procedure you would be most comfortable with.
Kindest Regards ~
Glenn Vallecillos, M.D., F.A.C.S.
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.
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