I am 5'5 and 110 pounds. I am a B cup and have grade one ptosis post pregnancy. My ps recommended a donut lift with augmentation (325cc). I am quite concerned with scars and so is my husband, so much that he would only wants me to get an augmentation. I want nice looking breasts but I don't really know which way to go...Please help!
Donut Lift with Augmentation or Just Augmentation?
Doctor Answers 18
Breast augmentation with or without lift
I think the augmentation alone would give you the better result.
I also think you have more of the pseudo-ptosis than ptosis, meaning that your nipple is not very low but the breast is herniated below the nipple. And because I believe you have more pseudo-ptosis it makes the lift especially a doughnut lift less necessary. I think the implant size of 325 mL is probably too small.
I believe an implant without lift in your case would give you a natural appearing augmentation but you would have to have a reasonable size implant in order to take up your excess skin.
If you want to be larger and like a natural looking augmentation then a implant alone will work for you. If you don't want to be much larger are want to be the same size as you are now but lifted then you should consider a lift without an implant.
In my opinion doughnut lifts deform the nipples leaving a bad scar and a flat stretched nipple. I much prefer the short scar left, lollipop lift.
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Fromt he photos you posted, you do have some glandular ptosis( or sag). This can be improved somewhat with implants, but a better procedure would be to combine it with either a circumareola lift or vertical mastopexy.
Donut Lift vs Augmentation without Lift
A donut or periareolar mastopexy is only indicated if the nipple/areola needs elevation. Best results are achieved when the lift is accompanied by an implant and the elevation is under 4 cm.
Some guidelines are helpful in achieving a good shape when doing a periareolar lift with implants.
The periareolar lift is accompanied by an augmentation in which the volume of the implant is significantly greater than the existing breast volume. For example, the breast is an A and the implant size is sufficient to increase the size to a B+, C or larger. The shape of the breast will then be primarily due to the implant. As the purse-string suture tightens the skin down around the platform of the implant, a round breast shape is preserved without flattening of the breast.
If the ratio of breast tissue to implant is too great, e.g., a B/C or more with an implant that is sufficient to go up perhaps one cup size, there will be a lot of loose skin and breast tissue contributing to the shape. In this case the purse-string lift will flatten the front of the breast, an outcome that is not cosmetically desirable.
If optimal breast shaping is needed when there is significant sagging of breast tissue below the inframammary fold, then a vertical or inverted-T incision is required. This can be combined with an implant to achieve both optimal size and shape.
Your photographs show a nipple/areola that is already at a satisfactory height, and you have a relatively large breast volume in relation to an appropriate implant. Therefore the operation for you is entirely dependent on your goals for breast appearance and willingness to accept trade-offs of scarring or persistent glandular ptosis.
If a patient with similar anatomy desires no periareolar scar and is willing to accept the droopiness of the gland, then augmentation alone could be chosen. Remember that using an implant alone, will not do more than increase the size of the breast, and would have to be quite large to put enough tension on the skin/breast envelope to elevate it off the chest wall. Long-term this would tend to stretch out the breast with recurrent droopiness, and might be larger than the patient really wants for optimal breast size.
For a patient who wants to avoid a scar on the front of the breast and whose priority is optimal breast size, and whose areola is at or above the inframammary fold, augmentation alone achieves that goal. The trade-off is persistence of some descent of the breast below the fold. This is a mature look, but natural.
If after living with this, the patient wants more elevation and projection of the breast, a lift can be done. Since the augmentation will have filled out the breast/skin envelope, it will be possible with greater predictability at that time, to then choose the appropriate mastopexy technique, which may be periareolar, vertical or inverted T.
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To lift or not to lift
Circumareolar skin excisions will raise your nipples and flatten your breasts. Your nipples are already high on the breast. Your breasts will still be too heavy in the lower aspects. Using large implants will not change that much unless you use very large ones which is never a good soution and can make the problem worse. Your best option for balancing your breasts is with a true mastopexy; either vertical or Wise (small) pattern. If more volume is all you want and then the size implants that give you that volume will be enough or at least enough for now. If you want a better volume distribution then go for a real lift. The scars will fade with time. In most photos you see the scars have not matured and are still pink. It takes a year and a half for all of them to fade and flatten. Take this into consideration when making your decision. This is a hard call for most patients. In my experience if lifting even crosses your mind then it's probably the right solution in the end.
Breast augmentation and limited lifting
This is a common question, and difficult to answer with photos. I would recommend getting several opinions with board-certified plastic surgeons, and you might involve your husband during the discussions. The clinical exam will help, but this problem always involves a lot of discussions regarding the pros and cons of various procedures. To avoid the scar issue altogether, you could just have the augmentation, then a lift later if needed. I an not a big fan of the "donut mastopexy as it only has a very limited effect, and from your picture, I think if you had the combined procedure ( which would help shape the breast optimally in my opinion and address the "glandular ptosis") the so-called "vertical" mastopexy would probably work best although the trade-off would be a little more scarring than the donut mastopexy
Breast augmentation with or without donut mastopexy
I've been doing this for many years now and judging from your picture, you will definitely need a lift of some kind. Placing implants alone to 'take up the slack' does not work well. I've seen too many women come in to my office in tears claiming that if they had been 'told this was going to happen in the long run, they would have never done it!' Implants with time stretch tissue and make matters worse. I have performed many donut mastopexy lifts without any significant scarring. I find that by using a permanent purse string suture around the areola, this keeps scarring and areola widening (if using an implant) to a bare minimum). Or, you could choose to have an Ultimate Breast Lift which reconstructs your breast mound into an internal cone that gives you younger, perky, firm breasts. This technique does not require the need for a vertical scar and lifts your breast mound higher than other conventional lifts. I have had much success using this technique on patients like yourself who do not desire all the scars associated with lifts or the complications associated with implants. Best wishes, Dr. H
Donut Lift with Augmentation or Just Augmentation?
Thanks for the posted photo. If you are ABSOLUTELY against a scar or incision around your areolar than have just the augmentation. Allow 2 to 3 months healing and if you need the donut lift it could be done as a secondary operation under local anesthesia. If you are asking my direct opinion, I would do at least a 400 cc HP implant + donut lift.
No need for the donut breast lift
The "donut" or circumareolar breast lift will not add much at all to your final breast shape. It can in fact create a thickened scar in the areolar region. If you are very concerned about scars you could get breast implants alone. If after a few months you then feel like you need improvement in your overall breast shape you can consider a vertical breast lift ( lollipop incision). I realize this is more of a scar then a donut lift, but it gives a much better overall contour. Based on your photos your nipple position appears to be ok but your have glandular ptosis (sagging of the breast tissue below the nipple). Consult with a few board certified plastic surgeons before making your decision.
Donut lift or just augmentation
from one photo it is difficult to tell. the one thing I will suggest, is not going to large of implant to save a lift. My experience has been that that does not work well. Pick a good surgeon, trust his judgement. The scars in my opinion usuallly do well, except in smokers and there are scar lasers that can help if necessary.
You can go either way
Without sounding like a psychiatrist tell me what you want, because you could go either way. If you want to be higher and fuller then go with a lift plus implants. If you are willing to accept some drooping and not willing to accept a scar, go with the augmentation. Remember, if you opt just for the augmentation there is no reason why you couldn't have a lift 1,2,3...years down the road. This is something that must be discussed between you and your plastic surgeon. Good luck on your decision. Dr. Schuster From Boca Raton FL
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