20 y.o F with loss of upper pole volume after weight loss. I am a size 2 nl (what I am now) but I had gotten up to a size 6 in '11. After returning to my nl weight I had lost vol. in my breasrs and believe to have low grade ptosis. Interested in mastopexy but was on the fence about augmentation as well for the upper pole vol. Due to sagging unable to wear strapless bras or dresses. Would like to get opinions now that I posted photos for you to reference. Thank you.
Mastopexy and Augmentation? (photo)
Doctor Answers (23)
You can achieve the upper pole fullness but you definitely need a lift
From your photos, you have what is considered grade 3 or "major" ptosis of the breasts. A breast lift alone can give you fullness superiorly: however, you're going to lose some of your volume. I would guess you would lose about 1/2 cup size with a lift alone. I'm starting to use more acellular dermal grafts (ADM) as an internal brassiere to help support the breast. I find that patients maintain a very nice shape for a lot longer with this procedure. You can always add a breast augmentation later if you feel that you didn't get enough fullness superiorly.
Breast Implants and/or Lift?
Thank you for posting your photos along with your post.
The degree of how much upper pole fullness you desire may not be attained by lift alone and implants may be required at this point.
It is true that lifts will leave you with certain scars but implants alone will not provide you with a lift but rather more ptosis (sagging).
That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.
Thank you for your inquiry.
The best of luck to you.
Breast Augmentation/Lift Concerns…
Thank you for the question and pictures.
Most of the young patients I see with your starting point and goals choose to proceed with breast augmentation as well as breast lifting surgery. In my opinion, at this point, the best way to achieve upper pole volume is with breast implants; a breast lift or small reduction may be necessary depending on exactly what your size goals are.
Of course, the downside with breast lifting is the presence of scars; these scars may or may not be acceptable to you. When the time is right seek consultation with board-certified plastic surgeons; ask to see lots of examples of their work. Communication With your chosen plastic surgeon will be critical in determining breast implant size/type/profile that will most likely help achieve your goals. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “D cup” etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I hope this helps.
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Mastopexy and augmentation with implants
I would disagree with several responses I see at this point. There are multiple mentions of using "small" implants with a mastopexy as if you can just choose any size implant and make it work or put it in the upper pole of the breast to fill out this area. It is true that a mastopexy does not "fill in" or "fill out" the upper pole of the breast the way an implant does, but a properly sized breast implant of the lowest profile and therefore volume will increase your apparent breast size by about one cup size. With an inferior glandular pedicle mastopexy, the upper pole tissue can be advance up or imbricated to help fill the upper pole and the length of the upper pole is shortened which makes it look less scalloped. Your tissue characteristics look ideal for this.
I also disagree that properly lifted breasts look smaller. In my experience, just like a bra that contains and elevates low breasts, they actually look bigger although they are not projected forward. The skin envelope is not "tightened" and there is no significant tissue volume removed. I would also argue that it makes no sense to me to remove breast tissue to make the breast smaller and replace it with an implant.
You look to be ideal for a true glandular elevation and lollipop incision approach to mastopexy. In the future it may be reasonable to add some fat grafting to the upper pole rather than a "small" implant, but I cannot recommend this yet for young women for cosmetic purposes. More study is needed to make sure there is no cancer or detection risk to fat grafting in the breast.
Breast Implants and Lift
From what I have read you have 3 very different answers here so you realize it is a hard question to answer. For me it is simple in these situations. You first have to decide if you want to be bigger or not. Even if you do not want to be bigger I totally agree with Dr. Clark's response that she gave you. I have found that most women really desire the upper pole fullness for sundresses and all the other stuff you have listed in your question. In my opinion a lift alone is almost not good for most of the women that I see. The reason I say this is because the breast can only be lifted so far up on the chest. It will NEVER be lifted high enough on your chest if you want that upper pole fullness. It may look that way in the beginning but they will sag over time. Only an implant will keep that upper pole volume that you desire. I always resect a good portion of the lower breast tissue when I perform an augmentation and lift together. This is done for several reasons. One, in a patient like you who might want to stay the same size you can place an implant and remove some tissue to balance that. The second reason I remove the lower pole tissue is because this is the tissue that over time will sag and cause the bottomed out look to your breast. I have found if you leave this tissue, which is the worst quality tissue in the breast by the way, it will look bad down the road. My patients are ecstatic with their aug/masotpexy surgeries. I learned most of this stuff from guys who have been doing this for 20-30 years and it has helped me obtain great results early in my career. So yes, you have lots of breast tissue and a lift will give you great volume but it will never fill the upper pole of your breast in the long run years down the road. Only an implant will maintain the upper pole volume and even an implant will drop over time but not as much as the breast alone will.
Breast implants and lift
You have ptosis and need a lift. You would benefit from small implants to add shape and volume where it is lacking.
Breast lift alone or with implants
Thanks for your pictures and question. It appears that you would be a great candidate for a breast lift. You should get a very good result since you already have good volume to your breasts. The question of adding an implant is entirely based on what your goals are. Most patients will want at least a small implant as once the breasts are lifted, they feel they look smaller than they wished. Also, restoring upper pole fullness that patients are truly looking for is more easily achieved with an implant. Make sure you speak with a board-certified plastic surgeon. Good luck!
If you like your volume I would consider lift alone
Thank you for the question and the photos. I personally think you are a great candidate for a breast lift alone. If you can make your breasts look close to how you would like them to look by lifting and shaping them with your hands then you will likely just need a breast lift. You have enough volume that will allow you to get a very nice result with a breast lift alone. You could always decide to get an implant down the road if needed. The link below shows the before and after photos from one of my patients who underwent a breast lift alone.
All the best,
Dr Remus Repta
Breast Augmentation with implant
I would recommend a breast lift with a small implant to preserve upper pole fullness. When performing a breast lift alone I have found that most patients lack upper pole fullness, even when they have adequate breast tissue to start. If you don't want to be too big, but still want upper pole fullness, a little more breast tissue can be removed so that the implant won't make the overall breast size too large.
Breast lift vs augmentation
If you are not looking to make your breast bigger than what you already have then all you need is breast lift which will reduce sagging and enhance upper pole fullness. If you are seeking to add volume in addition to what you already possess, then adding a small implant to the lift will give you the larger and fuller breasts that you seek. In any case, in order to reduce the sagging and flat upper pole you need to have a breast lift. For sure, the amount of upper pole fullness is greater when you add an implant but if you are unwilling to add volume then adding the implant will make your breasts heavier and larger than what you want. Make sure you are comfortable with the surgical scar that comes with breast lift surgery.
Stewart Wang, MD FACS, Wang Plastic Surgery