Stats: Donut lift, 350cc(R),400(L)silicone unders. Was adamant in stating I wanted perky breasts not larger & saggier breasts. Expressed concerns about(R)breast being lower & gave ok for more aggressive lift. PS opted for donut. Have stated dissatisfaction & PS recommends internal bra w/ larger implant. Not convinced this will give me more perky & youthful breasts. (R) breast is now my special "utility breast" as it sags on my upper ribs. Vertical lift the way to go? Vertical w/ saline overfill?
Would Vertical Lift Yield Perky Better Shaped Breast? (photo)
Doctor Answers 11
Breast Augmentation/Mastopexy Revision?
Thank you for the question and pictures.
It is really not accurate to give you advice without a clear communication of your goals. You state that you want more “perky and youthful breasts'; unfortunately this description can mean different things to different people. If I were a meeting with you I would ask to see “goal” pictures of what you would like to achieve. From there a treatment plan could be designed.
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Breast lift with vertical scar
I believe the short scar vertical lift would be the best procedure for you. It would improve the shape of the breast and the appearance of the nipple. The problem with the doughnut lift is that it creates a flat breast with this bread nipple. The vertical lift creates a better shape of the breast. The longer scar wise pattern lift makes a flatter breast. Another advantage is that the shorter the star the stronger the base the breast and the less problems with bottoming out, the breast falling, over time.
In my opinion I don't think you have to use an implant to make cleavage. The function of the implant should only be to make the breast larger not to make shape. I think it would be a mistake to use a larger implant because the heavier the implant the faster breast will go down over time. I also don't think overfilling the implant will help to give more shape and may cause problems in the future.
Bigger isn't better for you
If you go bigger, the weight of the implants plus gravity plus your poorer elasticity will almost certainly lead to a more matronly bottom heavy result. Also as you have substantially excess skin in the lower pole, I would recommend a full T mastopexy (central pedicle technique) because leaving the excess skin will also contribute to eventual sagging again. An in person exam is critical so these are not recommendations, just comments from your photos.
It is important for patients who need lifts to realize that they cannot get the full perky look that a flat and tight chested patient can. Going bigger to try to get there just leads to more sagging in the end. Realistic expecations are key here.
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Vertical lift for perky breast shape
The sag you have with a long distance from nipple to breast fold on your 'utility' breast is caused in part to the large breast implants and D-cup size. A vertical lift might help combined with a smaller breast implant. The larger implant could be the wrong way to go unless you truly want to push up the cup size.
Best of luck, peterejohnsonmd.com
Lift and augmentation
It would be nice to se your pre-op photos and know aht your preop bra size was. I think you may be better off with smaller implants and a lift, but without an exam I can not be sure.
Breast Lift to Improve Breasts
Based on your photographs I believe you have a tiny ribcage circumference, because your implants look so much bigger than stated. As for your implants being 'under', I'd hazard a guess that 80% to 90% of your implants have dropped below the lower edge of your remaining pectoralis muscle. Although many women might think your result nice, I do hear and agree with your issues and have concerns about the choices made prior to surgery by your surgeon.
Additionally, I have other concerns about your surgeon's recommendations about re-operation. I am not certain what he refers to as an 'internal bra' (plication of the internal capsule, reinforcement with an acellular dermal matrix?), but with these implants and your current appearance, I'm skeptical that would help. A larger implant would be a terrible idea; your implants are already inappropriately large for your anatomy, and they are the cause of your sagging, or increased sagging despite your donut lift. A larger implant will make matters worse, with even more tissue stretch, and tissue thinning. Your tissues will be transparent and your rippling will be epic. Going with saline is equally bad if not worse, for all the same reasons as going bigger, but also because saline has the additional characteristic known as 'water hammer effect', which means that cc for cc, it will drop even more than silicone gel.
You mentioned that you originally wanted perky breasts, not larger or saggier. Good! You have the proper mindset for what needs to be done to help you: smaller implants and a mastopexy. As for type of mastopexy, your nipple to fold distance is already rather long based on your photo, and a vertical mastopexy won't improve this situation where the bottom of your breast (and implant) curves down well below your inframammary fold. A short scar/modified anchor scar will shorten this distance, and in conjunction with implant reduction, lessen the curve and sag. Please bear in mind that I don't have the benefit of a true exam, and could possibly deviate from what I've told you based on such exam.
Breast implant revision is a complex task, and should really be performed by seasoned experts. I suggest you begin interviewing a few surgeons with excellent reputations for this. Needless to say, they should be certified by the ABPS, and be members of ASAPS. You should get a great outcome that I think will make you happy.
Best of luck!
Would a vertical lift help?
Thanks for the post op photos. It would be interesting to see your pre-op photos as well. I would also like to know what size bra you wore before the surgery.
In looking at you now, without the ability to examine you personally I would recommend at least the vertical lift and smaller not bigger implants. The weight of the implants tends to drag the breast down and the doughnut or periareolar lift is good for smaller lifts only. I would seek several opinions from board certified plastic surgeons in your area before proceeding. Good luck from Dr. Schuster in Boca Raton
Breast Lift with implants
Thanks for posting pictures. While not as informative as seeing you in person, it allows us to give some general recommendations. My advice would be a smaller silicone implant placed under the muscle with a traditional lift/mastopexy. This will allow for a nice rejuvenation of the breast and correction of your asymmetry. Cutting corners and not doing a full lift, in my opinion, would limit your results.
What to do
It is hard to say without an exam or preoperative photos what to do. Going larger is not necessarily an answer. A more definitive lift will help in cases like this. When women have more existing breast tissue that is sagging, the results are not the same compared to small breasts that simply need enlarging. The problem here seems to be poor communication. A patient can be very sure of what they want but that does not mean it is possible. The obligation of the surgeon is to as best they can set expectations and inform their patients.
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.