Hi! Ive been wanting to get impants. I went to several consultations and no one seems to be sure if i absolutely need a lift or not. I am 34C right now and i look great in a bra but not without one. Theyre just not as high and round as i would like them. If i got implants would it look good or do i need a lift? my absolute nightmare would be to pay all this money and end up with mom boobs- big and low. But i really dont want the lift scar. also would it last without lift or sag after a while?
Wanting Breast Implants- Do I Need a Lift Too?? Please Help ! (photo)
Doctor Answers 36
You don't need a lift with breast augmentation.
Any ptosis of the breasts you have is extremely modest. A breast augmentation only should give you an excellent result and avoid the scars that accompany mastopexy.
Do I need a lift with my augmentation?
Since you've said you don't want the scars that the lift requires, it seems you've ruled that option out. Any reasonable size of implant will give you some lift and you normally get lift roughly equal how large an implant you choose. The bigger the implant, the more the lift. You're not alone in finding yourself in a quandary as what to do. I've heard this same story many, many times. What I've found works best for most women is to get one or two bras you want to fill after your augmentation and put larger and larger implants in the bra, in front of your breast until you reach a size that you know is too large for you. That will be different for each woman. Then go back down to the largest size you can be happy with and that's the one that will give you the most uplift and the size you most likely will be happy with. It's the largest size you can be happy with and so the one that will give you the most uplift. As to your question about will you develop more sag in the future, the answer is of course most likely yes. But probably no more so than you would have without an implant. A natural part of aging is that your skin slowly becomes thinner and loses some elasticity, and that means your skin will be looser, and for the breast more sag. But the process is very slow and something you already know. You have some control over this by how you control your weight, the types of exercise you do, and of course pregnancy usually has a big influence. Usually your Plastic Surgeon can show you examples of patients with sag and the improvement after implants. But no one can predict exactly how your breasts will change in the future. From your photos I would guess that an implant about 400-450cc would give you good improvement and raise your bra size about two cup sizes. You have to help your doctor by deciding what size you think will be best for you. Good Luck.
Breast enhancement with implants and/or mastopexy (lift)
Start with an augmentation in the sub-glandular position with gel implants. At some time in your life you will probably want to have a lift, but you will probably wait until you have had children. You can save the scars and the expense for now - you will be very happy with a simple volume addition and can always opt for the lift later.
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No lift required!
You have a minimal amount of drooping to your breast. An implant would help provide more fullness. No lift needed!
Breast lift with implants or not
From your photos, it appears that you would look better with the lift than without. The standard mark that most plastic surgeons start with is whether your nipple is below the inframammary crease or not. It appears that yours are below, especially your right breast, meaning you would be best served to have the uplift too if the latter is true.
I would suggest you should be conservative with the implant size if you want long term duration before they sag again. More weight = more sag. Remember that everything sags with time, and you do want a long life.
With time, and in most people, the scars are fairly imperceptible, and they are covered with a bathing suit, bra and an evening gown or low cut sweater.
There is no perfect solution and in virtually in every procedure there is a trade-off. You have to decide if the trade-off is a good one. If you prefer, you can always do the uplift later.
Breast Implants - Breast Lift
It seems like you are that patient who comes in a few times a year who is on the fence of needing an lift with implants. I recommend the following:
1. check the credentials of your plastic surgeons and make sure they are board certified by the American Board of Plastic Surgery
2. Consider a dual plane augmentation with more internal lift dissection that will allow the nipple/areola to rotate up after implant surgery
3. Consider subglandular placement of implants
4. consider using larger implants in the spectrum that is offered to you as a safe fit and be critical of the outcome 6-12 months after the surgery to see if you truly need a lift
Breast implants alone or with a mastopexy
You appear to have an issue that many patients do. You want the upper pole volume of an implant that sits in a relatively high position, but you don't want the scars on the breast that would be needed to keep the implant in that position. You just need to come to terms with what is most important to you. If you opt to have the implant alone, it will need to be centered behind your areola in order to appear natural. This will necessitate that the implant and your breast appearing a bit low on your chest wall. This might make you happy and would be a great option for you. But if you want the breast to sit higher on the chest, then you will simply have to have the mastopexy and the scars that go along with it. I would suggest having the implants placed alone (under the muscle or in the dual plane position) with the understanding that you might opt to have the mastopexy in the near future as a second stage procedure. I have a fairly strong opinion against placing the implant in the subglandular (over the muscle) position in your case. It is often suggested for patients like you because there is a bit more of a natural lift with the subglandular placement. Unfortunately, your breast shape is already telling you that the skin is not able to handle the volume that you have currently or have had in the past. That is why your skin envelope is a bit loose. Placing the implant in the subglandular space, in my opinion, is a great way to put optimal stress on an already weak skin envelope with an almost certain worsening of the "drooping" appearance that you have. It is a short term fix with a long term problem. Place the implant under the muscle and minimize your risk for future headaches.
Breast lift with breast implants
This is a common and tricky question. You have enough breast tissue to disguise implants and provide a natural looking result. As you probably know, implants can either go above the pec muscle or below. There are advantages to both but the most significant advantage to putting the implant above the muscle in your case is the added lift that it would give you. The biggest disadvantage are the higher risks of having a tight scar around the implant (capsular contracture) and palpability of the implants.
Having said all that, you end your question asking about the longevity of the procedure without a lift. There is a very reasonable chance that, down the line, you will need a lift to provide your best appearance.
Be careful to choose a board certified plastic surgeon and best of luck with what should be a rewarding experience.
Implants with or without a lift
You cannot simply look at your photos and determine what surgery to do without being specific about what you want as an end result. What a patient wants, as well as what she will tolerate, varies from patient to patient. Thus, the procedure(s) will vary. Your surgeon should carefully and very specifically discuss what you will be happy with. This may involve a range of results in terms of size, shape, and position of your breast. Once this is agreed on, it becomes a matter of finding the "best fit" custom procedure. Round or shaped, smooth or textured, saline or silicone implant, with or without crescent, periareolar, vertical, short-scar, or inverted-T pattern lifts will all give a variety of results. Many times it is a matter of a patient compromising with the surgeon about the "best fit" procedure. I can usually find that "best fit" procedure for individual patients, but it involves a lot of time and discussion about the pros and cons. And it can only be done accurately in a face-to-face consultation. Anything else is a shortcut.
Robin T.W. Yuan, M.D.