Subglandular Implant - Lollipop Lift Now or Later?
Doctor Answers (11)
Subglandular Implant - Lollipop Lift Now or Later?
You have several issues to address, asymmetry, droop and inadequate volume. In my practice I would not suggest trying to correct all of these on the same day. I suggest doing a lollipop scar lift and allowing it to heal for a few months before doing a sub muscular augment. The scars will heal better, and you are far less likely to need a touch up or revision later. After healing your augment can be done just as it would be for any other patient.
Mastopexy with implants
If you do not want a mastopexy, implants should go subglandular or you will have what we in the plastic surgery industry call the "double bubble effect." Ideally, for perfect breasts, I would advise a mastopexy (lollipop or anchor, not periareolar) with an implant either subglandular or submuscular but you have to realize that breasts drooping is genetic, they're probably going to drop again regardless of where the implant are located. If they're subglandular, the implant will go with the breast. If they're submuscular, the implant won't drop.
What are the option for sagging breasts after breast feeding.
It seems that you have significant sagging of your breasts as well as the asymmetry. You appear fit and trim, and you stated your breasts were C/D cup currently.
For an optimal result, this combination of findings usually requires a breast lift with a lollipop style incision at a minimum.
You need a consultation with a plastic surgeon who can examine you and discuss the treatment options that will best meet your needs.
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Lift with implants
Thanks for all the great info. You may be able to have implants with a periareola lift. But then again a small vertical incision may be required if the breasts appear too loose. An exam would be helpful, but the photos and info help. You look very thin, and I would definitely go under the muscle to help minimize the risk of rippling superiorly.
Lift now or later?
Thank you for posting the photographs, it is very helpful. Looking at the photos, I would say that you need a lift now as implants alone will not be able to tighten the skin adequately. The type of scarring - periareoloar, lollipop or inverted T - is down to the individual surgeon to some extent and the degree of lift needed. Whatever technique you have, it will leave you with a scar around the nipple, which is the most obvious one. Good luck.
Add the vertical scar
Subglandular placed implants in attempt to address ptosis in my personal opinion is a bad idea. Eventually as you astutely have noted, the implants will droop. A vertical scar mastopexy with submuscular implants is what I would reccomend. On my website you will find an animation video explaining the technique. Good luck.
Web reference: http://www.tarrantplasticsurgery.com
Breast lift with augmentation
I think the first surgeon's recommendation is better. You have a degree of ptosis (sagginess) that can't be corrected with just impants (or a periareolar lift). If you want enhanced volume with implants, you need also to have a lift like the vertical scar ("lollipop") lift.
Submuscular Breast Augmentation and Mastopexy?
Thank you for the question and pictures.
Given your body type and goals, I would suggest a sub muscular (dual plane) breast augmentation (preferably with silicone gel implants) along with a vertical mastopexy. This can be done in a single or 2 staged procedure; I generally make this assessment/recommendation after examination of the quality of skin present.
This is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.
The combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.
In my opinion, the decision to do the operation in a single or two staged fashion becomes a judgment call made by a surgeon after direct examination of the patient. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
I hope this helps.
Full Mastopexy with Submuscular implants
I would recommend a one stage procedure with a full (anchor) mastopexy with submuscular implants. A periareolar lift would lead to no lift and a lollipop lift would lead to an elongated vertical distance from your areola to your breast fold. It's not the length of your scars but the final shape and long term result that leads to patient satisfaction. Your breast skin appears elastic and you have low body fat with visible ribs which would deter me from subglandular implants as well as the vascular compromise it may cause. Discuss all with a qualified plastic surgeon at your consultation.
Simultaneous breast augmentation and lift
The changes you describe are common after pregnancy (asymmetry, deflation, drooping). Based on your photos, I think silicone implants placed below the muscle, with an anchor type incision would give you the best result. I realize that may not be what you want to hear since the anchor scar is more extensive than a peri-areolar or lollipop scar, but it will give you the best shape and contour. Lesser scars will give you a lesser lift, and lesser result. When patients and surgeons try to get away with just a periareolar scar in a case like yours, it routinely leads to dissatisfaction since now you are left with larger breasts that are just as droopy. Silicone implants tend to look more natural than saline, and a submuscular position often looks more natural, leads to less capsular contracture, and allows for easier visualization of the breast tissue on mammogram.
Really think about the scars and decide if you are willing to accept them in return for an improved shape. Some surgeons prefer to do the surgery in two stages, with a lift first, and then an augmentation once you have healed. Other surgeons find it reasonable to do both in one step, with the understanding you may need a smaller touch-up later. With the staged approach, you know to expect at least 2 surgeries. With the combined approach, you have the potential of having just 1 surgery, and maybe 2. Definitely go with a board certified plastic surgeon for this type of surgery. Good luck!
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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