Donovan Rosas, MD

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum greater separation of the breasts less dramatic cleavage. This space can be narrowed (with some risk of synmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and midline migration of the implant (the dreaded "uni-boob"). With regards to your specific question, there is no "natural" way to enhance without weight gain (which comes with obvious drawbacks). Surgically, I would recommend augmentation. You are a reasonable candidate. A wider device might help with your concerns. However, I would discourage straying too far from your BWD. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Fold position is an anatomic landmark for the base of the breadth. As we age, skin can stretch and there can be some descent. The laxity and excess can be used to lift the breast and redefine/restore its position on the chest, Based on your photos, there can be the perception that your fold is lower due to the deficiency of volume. That being said, you do not appear to have sufficient laxity to draw the breast mound upwards to re-establish the fold at a higher position. I would recommend beginning with an augmentation. A narrow width higher volume device is preferred. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both. There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision. A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred. Based on your photos, your nipple position does not demonstrate an absolute need for lift. Nipple areolar complex position is preserved. The left side has some pseudoptosis. You would likely benefit from an augmentation. That being said, there is no substitute for an in person exam. There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision

I will typically counsel patients to expect implants to sit higher for several weeks initially. The lower pole tissue needs time to stretch. The larger the implant the greater time needed for stretch. The smaller the pre-op patient the longer stretching can take. I will usually delay revision until 6 months (at the earliest), Based on your photos, your implants appear to have settled significantly as compared to earlier immediate post op. The right side has always been higher and can be noted in pre-op photos. Options for revision include implant exchange or artificially raising the left via pocket revision to achieve greater symmetry. As always discuss your concerns with a board certified plastic surgeon (ABPS).

Tuberous breast is not, technically speaking, a "yes" or "no" question. There can be different points on the continuum. The typical hallmarks include a high, tight fold with "puffy" or distended areola, minimal breast tissue and potentially herniation of the breast tissue through a tightened ring thus the "tuberous" label. It is a congenital deformity which usually manifests at puberty. To what degree it manifests will vary from one patient to the next. Treatment of tuberous breasts varies depending on the degree of the breast architectural distortion. Surgical correction typically involves: -areolar reduction -submuscular augmentation -release of constricted breast tissue All of these techniques work in concert to correct the tuberous deformation of the breast. Based on your photos, you demonstrate some mild features of a classically "tuberous" breast. Regardless, you would benefit from augmentation. Exercise, massage or hormonal supplementation will not address anatomy. As always, discuss your concerns with a board certified plastic surgeon (ABPS).