Fernando Ovalle Jr., MD

Hello and thank you for your question. In reviewing your photos you have minimal/no ptosis (i.e. the nipple position seems to be at the level of the inframammary fold). My best advice would be to seek an in person consultation and physical exam with a board certified plastic surgeon, as it is possible you may not even need a lift at all! If one is needed, it would be an overall minor lift (1cm or so), and can certainly be achieved through a crescent shaped skin excision pattern at the top of the areola. Thank you for your question and good luck on your journey!

Hello and thank you for your question! Fat graft "take" or survival is something that is not an exact science. Typically, anywhere between 50-75% (average about 2/3) of fat cells transferred from one site to another will stick around permanently or "take". This is because, as a living cell, the fat cells are waiting on your body to "grow in" new small blood vessels and "feed" those cells oxygen. Those that don't get enough oxygen/nutrients will "melt away" and be resorbed by your body. Sometimes they can turn into scar tissue/fatty oils cysts as well. Typically this process happens over the first few weeks after the transfer, so that is the most important healing time period. Things that can affect fat graft take/survival include patient factors such as overall good health (medical conditions like diabetes, autoimmune conditions, etc can impair healing), smoking status (nicotine reduces small vessel blood flow and can increase the risk of infection, wound healing issues). Prolonged direct pressure also reduces localized blood flow to an area, so this is why many advise to avoid sitting on the fat grafted areas the first few weeks. Technique factors such as how much fat is grafted in one session can also influence fat graft take - i.e. if too much fat is grafted at once, the tissues will be too "tight" and less of the fat cells will survive as they compete with each other for the available oxygen and nutrients. To answer your specific question, intercourse itself would not cause fat cell death, but it is typically recommend to avoid strenuous physical activities for the first several weeks after surgery to improve your healing. Thank you and good luck on your journey!

Hello and thank you for your question. In my experience, with the amount of sagging/ptosis of the breast that is present here, the best result will be to also do a lift at the same time as your augmentation. Usually this can be done in a "lollipop" or "short T" scar pattern, and over time the scars will fade very nicely. Right now, the position of the remaining breast glandular tissue and nipple/areola is too low to look "right" if only implants are placed (these will sit up higher on your chest). Thank you and good luck on your journey!

Hello and thank you for your question! Skin irregularities can happen after liposuction. There are some that get better and some that don't. At 4 months post op, you are in the chronic phase of healing (meaning all of the acute inflammation, swelling, etc has gone down, but there are still slower changes happening as the tissue mature). Sometimes, areas of "induration" or lumps/bumps under the skin can be apparent during this time. These are commonly the "self-defense" mechanism of the fat cells remaining and their response to the inflammatory processes during the post op healing. These areas can commonly get better with time, massage and gentle warm compresses. Sometimes, skin irregularities happen because fat cells too close to the surface of the skin were removed. These sometimes get better on their own with time as tissues fully settle, and this can take 6-9+ months. Typically if sometime has not gotten better after this time frame, this could be permanent. My best advice is to follow up with your surgeon of record and get their specific recommendations. Thanks again!

Hello and thank you for your question! There unfortunately is no true straight forward answer. Breast tissue is typically slightly denser than saline or silicone, and this can be anywhere from 5-10%+ difference. From a pure math standpoint, my educated guess is that a slightly smaller implant than 400cc (i.e. 360-380cc) will likely look "about right". However, an implant in the 400-425cc may also look great on your frame. It would be very difficult to tell you that a given implant would "make you look like nothing ever happened." This is because this is highly dependent on multiple variables such as: the quality of your skin envelope, post-reduction scar positioning, implant type (silicone vs saline), implant profile (moderate vs high), how your chest wall accommodates volume now. Implants project can differently than natural tissue. Even if volume is similar, shape, cleavage, and feel can vary. Natural breasts often had more lower pole fullness and ptosis (sag), while implants tend to sit fuller up top unless combined with a lift or fat grafting. The next best step is to have an in-person consultation with a board-certified plastic surgeon who can: Review your operative records, evaluate your current breast footprint, use either 3D imaging or sizers to help predict how certain size implants would look on your body. Good luck on your journey!