What is the best Uplift & implant technique? I need some other surgeons opinions???
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Breast augmentation with lift
It is very difficult to advise on this without photos, it would be best if you can upload a few.
Generally speaking i recommend the following.
There are pros and cons to the placement of breast implants and the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in these sub muscular position. Also, the immediate recovery period may be more comfortable after sub glandular breast augmentation as compared to sub muscular breast augmentation surgery.
The goal of breast surgery is to achieve beautiful breasts. Beauty is determined by several factors including symmetry, skin tone, position of breast on the chest wall, position of areola, cleavage and volume. I recommend you undergo a circumareola approach leaving a scar only around the areola. With this technique, it is possible to lift your breast tissue higher, reshape your breast tissue to create upper pole fullness and increase your cleavage. At the same time, the implant can be placed. I recommend silicone gel implants placed retro-pectoral since they look and feel more natural. Your desire for 300 cc implants may not be appropriate and you may benefit from a smaller implant. Placing the implant over the bony prominence of your chest wall then elevating your breast tissue and the areola all in the same horizontal plane will maximize projection. This allows the use of a smaller implant to achieve the desire projection. The smaller imlant is less likely to dislocate or distort with muscular activity.
Mastopexy-Breast uplift techniques
The second, more extensive uplift is one that results in a scar around the areola("donut uplift"). The areola is marked smaller. This is performed under general anesthesia administered by an MD anesthesiologist as an outpatient. The main negative is that this may result in a minimal uplift/reshaping of the breast and may result in a flattening of the breast with bad scars and stretched out areola.
The final or full uplift (mastopexy) results in a scar at least around the areola, down the breast and possibly even around it (like an anchor type and as in a breast reduction). This is done as an outpatient under general anesthesia administered by an MD anesthesiologist.
Minimal breast tissue is removed and primarily skin with reshaping of the breast and uplifting it. The procedure takes about two hours and the patient is placed into a bulky bandage for about five days and then into a bra which she wears day and night for two weeks.
Light activity is permitted after several days and full activity after two weeks. The pain is usually minimal.
The usual complications like infection, bleeding, loss of sensation can occur but are minimal. Scarring is the main negative and the scars heal well in about 80% of the patients (flat, minimally spread and white). In 20% though, the scars are red, raised off the surface and the scars are spread.
Something can be done to minimize them though. Usually, breast sensitivity or the ability to breast feed is not interfered with.
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Thank you for your question. It would be impossible to make any recommendations without more information including a physical exam. Based on what you've written, it sounds like you will need a lift to treat your sagging and loose skin and an implant augmentation. Exactly what type of lift will depend on your anatomy. As per implant sizing, several factors are taken into consideration. Please make sure your PS is board certified by the American Board of PS. Best wishes,