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Will saline implants alone give me my desired look of fullness and will I have a good result without a breast lift? (photo)

I want to achieve the look of fullness (especially in the upper pole) and possibly the appearance of a mini lift. Will saline implants do this for me? Would you recommend high profile for this or moderate/moderate plus? My current bra size is 36D and I look proportionate with DD breasts. I have a fuller figure; I am 5'3" and 125 lbs. I am in moderate physical condition. I am 31 years old and have lost 70 lbs since the birth of my two children. Thank you for helping me, I appreciate your time!

Doctor Answers (11)

Breast lift essential for fullness you desire

+2
Many women refuse breast lift because of the ugly vertical scars of the traditional technique. For that reason, a new technique was developed called The Mini Ultimate Breast LiftTM. Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Aligning the areola and breast tissue over the bony prominence of the chest wall maximizes anterior projection without the need of implants. This technique avoids the ugly vertical scars of the traditional technique, maintains nipple sensation and the ability to breast feed. 22% of women who undergo breast augmentation alone require revision within 2 years because they are dissatisfied with the result. A frequent cause of dissatisfaction is not performing a simultaneous lift when necessary.

Best Wishes,

Gary Horndeski, M.D.


Texas Plastic Surgeon
5.0 out of 5 stars 125 reviews

Breast augmentation

+2
Based on the photos provided I  would recommend a lift with augmentation, you will have excellent results with either saline or silicone.  It would be in your best interests to achieve a long-term stable weight (if not there already) prior to undergoing the breast procedure.
I would suggest in person consultation with board-certified plastic surgeons for more precise advice.

Marwan R. Khalifeh, MD
Chevy Chase Plastic Surgeon
4.5 out of 5 stars 55 reviews

Saline implants enough?

+2
Your desire to have more fullness in the upper pole will likely be best achieved with implants. Wether or not you need a lift in addition is harder to tell from pictures alone.  Based on what I can tell you will likely have the best result by adding a lift as well. It really depends on what you want as a final result. Those issues are best determined during your consultation with a plastic surgeon.  Good luck. 

Michael Marion, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 5 reviews

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Breast

+2
Thank you for the pictures.



I strongly think that a breast lift with implant placement will definitely enhance your breast and give you volume.


Dr. Campos

Jaime Campos Leon, MD
Mexico Plastic Surgeon
4.5 out of 5 stars 154 reviews

Saline breast implants

+2
Regardless if you use saline or silicone you may have difficulties getting much upper pole fullness due to the laxity of your tissues, especially with your weight loss.  These questions are best answered in a consultation but likely you are going to get your best result with a lift as well as implants.

Terrence Murphy, MD
Englewood Plastic Surgeon
4.5 out of 5 stars 8 reviews

Breast sagging needs to be corrected before breast augmentation.

+2
You will certainly need breast lift since you have sagging of breasts.  After a lift has been accomplished any implant (saline or silicone) can be used to enlarge size.

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 10 reviews

Will saline implants alone give me my desired look of fullness and will I have a good result without a breast lift?

+2

Thank you for the question and pictures. You are asking good questions that are best answered during in person consultation with board certified plastic surgeons who can demonstrate significant experience helping patients in your situation.  Based on your photographs, I think you will benefit from breast lifting surgery.  A circumareolar breast lift will not suffice in my opinion. Whether any “lollipop” or “anchor” incision pattern is necessary will depend on your physical examination and goals;  often, in my practice, I make this determination during surgery after placement of temporary sizers and the use of a tailor tacking technique.

Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, 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 increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities,  anesthesia and surgery facility fees (minimally) are patient responsibility,  when returning to the operating room for revisionary breast surgery.

 Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.

Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.

I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. 

The use of the tailor tacking technique is very helpful.  Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

 Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts.  Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.

For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc).

 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately.

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 in 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.

Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.

On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.

Some general thoughts regardind size/profile of breast implants may also be helpful to you.

1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your balances so that's why I have Friday night desired goals  with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile 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 "C or D cup" etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.

 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.

The attached link may also be helpful. 

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 727 reviews

Breast implants will not lift the breast

+1
Thank you for your question and photograph.  From your photographs it appears you do have breast ptosis or sagging.  No breast implant saline or silicon, high profile low profile moderate profile or any profile will lift the breast.  A surgical breast lift will be required to get the fullness that you desire.  Be aware saline implants can cause visible rippling.  Please consult a board certified plastic surgeon who is an expert in breast surgery.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 31 reviews

Good result without a breast lift?

+1
Neither saline nor silicone implants alone without a breast lift will produce a good cosmetic result with your anatomy.

Following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest that you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) through the Smart Beauty Guide that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.5 out of 5 stars 14 reviews

Will saline implants alone give me my desired look

+1
Implants will definitely give you volume, but your breasts are low enough that without a full lift you will not have an acceptable result.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

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.