Will a Lollipop Lift Suffice in Conjunction with Implants? Which Size Range for Silicone Implants to Achieve Full C Cup? (photo)

38 yo, 5'2, 109#, mother of 2 breastfed children, last weaned 5 mos. ago. Currently 32A/B. Previously 34C. Pics taken with comb tucked under breast crease for reference of breast crease location. Noted asymmetry of size R>L. First consult thus far recommended full anchor lift. Is this really necessary? Would like least scarring, but will sacrifice for improved shape. Also tried on silicone implants and has difficulty gauging which ones would achieve a typical C cup fullness. Please advise?

Doctor Answers 14

Augmentation Mammoplasty

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I see many patients following pregnancy who are at a point where they could legitimately consider two options: augmentation alone, or augmentation plus mastopexy (breast lift). The advantage of augmentation alone is of course avoiding the incisions and resulting scars associated with mastopexy surgery, while the disadvantage is the fact that the breasts will not have the most youthful appearance possible - they will be very full in the lower pole and the nipple will appear somewhat low on the breast mound. And most patients will feel like they always require a bra regardless of choice of clothing.

The advantage of augmentation mastopexy is the fact that this operation produces a very youthful breast profile, restores most of the breast volume to a level above the inframammary fold (the crease below the breast), and allows most patients to go without a bra with certain clothing options if they so desire. The downside is the surgical scars resulting from skin removal, although proactive treatment of the scars postoperatively (laser treatments, topical agents, silicone gel products) usually results in very favorable and totally acceptable long-term scar appearance.

So it's really a matter of deciding which you prefer - the most youthful breast profile and the associated mastopexy scars (and the freedom of going without a bra), or a less youthful breast profile but without mastopexy scars. It is a decision that is completely up to each patient.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Breast Lift and Implant Options

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It's not unusual to see women who have breast hypoplasia and breast sag following pregnancy. In most cases, the loss of breast volume after pregnancy is associated with the development of breast sag. In the majority of patients, correction of these problems requires combination breast lift and breast augmentation.

Your pictures suggest several areas of concern. Not only do you have breast hypoplasia, but also have breast sag as well. In addition, your left breast is larger and has more sag than your right breast.

Correction of these problems will require breast augmentation with larger fill volumes on the right side. Breast lift surgery will also be required. The exact type of breast left can't be determined without performing a physical examination. Based on the current information, a lollipop incision is probable, but an anchor incision can't be ruled out at this point in time.

The type and size of breast implants used will depend upon your examination and aesthetic goals. Most patients are striving for harmony, balance, and proportion with the surrounding anatomic structures. Typically, they want a natural look with some upper breast fullness.

In an effort to determine breast size in an objective manner, we use external silicone sizers. External sizers are designed to sit on top of the patient's breasts. They can be held against the patient's chest or placed inside the patient's bra. This technique helps the patient visualize what their breasts will look like with a specific sized implant.

It's important to consult a board certified plastic surgeon that has experience with these procedures. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Augmentation mastopexy

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With a deflated skin envelope such as you have, there is a relationship between shape achieved and size.  You basically are going to have choose among 3 options, depending on the size breast you want.  If you want to be the same size, you can get by with a mastopexy, but it will probably need to be an anchor incision pattern.  If you want to be a little larger (a C cup) you will probably need an augmentation mastopexy, and might require a lollipop incision pattern.  If you are willing to be substantially larger (full D size) you might be able to avoid having a lift for some time, but will probably eventually need one.    

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 30 reviews

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Implant sizing and lift

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A lollipop lift will work with with your augmentation procedure.  As per sizing, I consider two factors when selecting implants for my patients:

1.Dimensional planning
2.Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look.  If you have decided on saline implants, then based on the gel sizer you select, we can guide you to the saline implant that achieves a similar look.
Hope this helps.
Dr. Basu
Houston, TX

Will a Lollipop Lift Suffice in Conjunction with Implants?

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First in terms of size, concentrate on how the implants look rather than cup size. There is no definition of cup size that is universally accepted, and many patients have bras in several cup sizes that fit. Choose a size that looks good when you try on implants, and your surgeon will help choose an implants that will most closely meet that look.

Since the bottom of your areola is lower than the breast fold, I would recommend a lift. With implants and no lift, you may end up with the unattractive appearance of the breast draping off the implant. 

The type of lift would be determined on examination, and sometimes in the operating room after the implants are in place. I think a vertical, or lollipop lift would suffice, but if the areola is raised enough that there is too much breast skin underneath, a horizontal excision of the excess might be needed.

Thanks for your question and for the photos attached. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

A/B cup to full C with Breast Lift

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    With your amount of breast tissue and chest wall width, I would recommend 400 ml high profile implant submuscular with circumareolar or anchor lift, realizing that the anchor lift will lift the breasts higher and make them tighter.

Mastopexy and augmentation

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Based solely on your photos, it looks like you may be a good candidate for a lift and an augmentation.  I try to limit incisions as much as possible, and you might be a good candidate for a vertical lift.  As for the implant size, it is best to review this in person. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Best Option for Breast Augmentation/Lifting?

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Thank you for the question and pictures.

I think you will benefit from a vertical mastopexy or a short  horizontal scar “anchor” mastopexy.

 In regards to breast implant size/profile that will best achieve your goals, preoperative communication regarding your desired goals  with your plastic surgeon  will be critical.   
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 “very natural”  or “C cup fullness” 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.

By the way,  in my opinion, you are wise in  being willing to accept additional scars for an improved contour and longevity of operation.

Best wishes.

Will a Lollipop Lift Suffice in Conjunction with Implants? Which Size Range for Silicone Implants to Achieve Full C Cup?

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If you have to have ONLY one operation use up to 400 cc UHP implants with a full lifting or anchor. If you are willing for 2 operations 3 months apart. I would do full anchor lift first than UHP implant at a desired range. 

"Lollipop" lift plus breast implants sufficient?

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Although a classical "anchor" lift is a reasonable option, it is not the only one.  There are several versions of the vertical lift (aka lollipop) which should work fine for you if it is done by an experience plastic surgeon. For one possible solution, feel free to visit my website and go the the structural mastopexy section in the breast portion of the website.  In terms of implant sizing it is increasingly difficult to find a common language in terms of cup size.  Some of the bra manufactures have upsized their bras for marketing purposes, so no one really knows what "C" or "D" means anymore.  My patients have found the anatomical breast sizers to be very helpful.  These are special shells that sit on top of the breast inside a stretch bra.  They do a much better job of simulating breast volume than the old method of placing regular breast implants inside the bra.  The patient typically finds a size that works for her, and it really isn't important what cup size this turns out to be.  If you think the breast is beautiful who cares whether one manufacturer calls it a "C" and another a "D"?

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 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.