33 yr old, 5' 9", 165, Breast Lift with Breast Implants (Photo)
Doctor Answers 14
Breast Augmentation And Breast Lift Options
Although your history and pictures are helpful, it's virtually impossible to make a specific recommendation without a physical examination. It's possible that your aesthetic goals could be met with a dual plane breast augmentation, unfortunately, this approach wouldn't totally correct your asymmetry.
For this reason, bilateral breast augmentation performed in combination with a mastopexy might be a better choice. The specific type of mastopexy would depend upon the physical examination. This approach would result in correction of asymmetry and optimize the breast contour and shape. It's downside would be additional scarring.
Breast implant size will depend upon the patient's anatomic findings and aesthetic goals. Most patients want harmony, balance and proportion with the surrounding anatomic structures. They also want a natural look with slight upper breast fullness. For this reason, we utilize external sizers to help make this determination. It's also important to realize that the complication rate for this combination procedure increases when larger implants are utilized. Under these circumstances, the incidence of scarring, wound breakdown and infection is higher.
If you're considering breast augmentation in combination with breast lift surgery, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.
Breast Lift with Implants
I can see why you are confused, but you seem to have a great goal of high and tight with smallest implant. The larger implants give more lift initially, but you are right, then you have more weight to bottom out. Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). Also, ask if they have an established, high volume breast augmentation practice, performing several hundred breast augmentations each year. Ask to see their before and after photos if you didn’t see any on their website. If they are experienced, they should have several 100 breast implant patients for you to view. I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you. You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.All the best, “Dr. Joe”
Breast lift with implants?
The general rule of thumb is that if the nipples sit below the inframammary fold (the crease under the breast), then a lift is recommended. However, there are several other anatomic factors of the breast as well as the patient's desires and expectations that further determine whether a lift is performed or not with or without an implant. Because a breast lift tightens up the breast envelope and breast implants expand the breast envelop, you are more limited by this fact than any other when trying to go with a large implant. One way around this issue is to have the procedures done separately, for example have the lift done first then 6+ months later undergo the breast augmentation with implants. In general it is always best to fit the implant with the patients breast anatomic dimensions thus minimizing immediate as well as long term complications. Glad to help.
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33 yr old, 5' 9", 165, Breast Lift with Breast Implants
Kenneth Hughes, MD
Los Angeles, CA
A breast lift plus implants is necessary to correct your asymmetry.
The best option is to have your breast implants placed beneath the chest muscle. Although some plastic surgeons do it, I would never place implants larger than 350 cc to 400 cc when done in conjunction with a breast lift. Very large breast implants 500 cc and over cause a risk of nipple areola damage and other potential complications.
For more information on combination breast lift and augmentation please read the following link:
Breast asymmetry: what are my options?
Breast lift and implants
What size implants? Is lift necessary?
Need a lift with BA?
I think with an ample implant, like a 550, you would not need a lift, maybe just a little crescent skin removal on the left to elevate the nipple 1/2 inch. 550cc is ample, and I would recommend you get sized with the implants you are considering to guess-timate where you will land after surgery. Your surgeon should have sample implants you can put in a bra to simulate results with those implants. You should be fine with "bottoming out" if the implants are placed under the muscle and not directly behind the breast which puts more weight on overlying tissue, exacerbating sagging. The question is also which is more important: the lift or the larger volume? If the answer is lift, then go with smaller implant and explore your options with a board certified plastic surgeon. Good luck!
Will implants alone do the job?
(Are they American Board of Plastic Surgery [ABPS]-certified plastic surgeons, or do they claim "board certification" without specifying which board? There are many real boards that have little or nothing to do with plastic surgery, and a few "bogus boards" that "certify" doctors of varying backgrounds, whose common desire is to perform cosmetic operations without full plastic surgery training (2-3 years, not weekend courses) and American Board of Plastic Surgery certification. These "cosmetic surgeons" often claim certification by the American Board of Cosmetic Surgery, which is NOT and ABMS (American Board of Medical Specialties) member board. The ABPS is a member of the ABMS, and is the ONLY board that certifies doctors trained in plastic and reconstructive surgery of the entire body. But I digress; let me try to help you with your decision.
Looking at your photographs, it is impossible to see where your nipple is in relation to your inframammary crease, and a pencil test will tell. If your nipples are at or above the level of your inframammary crease, then implants alone will have a very good likelihood of yielding a nice cosmetic result without lift. This, of course, avoids more scarring and more (minimal) risks, as well as less cost. And you can always add a lift later, but can never "take it back."
From your description and stated bra sizes (notorious for inaccuracy since all bra manufacturers size differently), you want to go up anywhere from 1 to a maximum of 2 cup sizes. You are tall and have a big chest, so it will take around 250cc to equal one cup size. Neither of your consultants is wrong, but obviously one is more eager to fill your breast skin more aggressively and lean you towards a larger result, whereas the other is more conservative. When implants are added to a lift (any variety, usually), taking away skin and adding volume are opposing goals that can lead to incisions healing poorly or opening up, so I see where the surgeon advocating slightly smaller implants is taking a safe(r) route. BTW, 200cc is less than 7 ounces, or just over half a can of pop, so the difference is not as huge as it sounds, but may be just enough to lead to troubles when a lift plus implants is planned.
If you are OK with slightly larger implants, why not try augmentation alone? Sure, you won't be high, tight, and "Baywatch coconut" perky--is that really what you want?--but you can always add a lift later if you really want one. Bottoming out is not a function of large implants, its is most commonly associated with short inframammary crease to nipple distances, and trying to lower a crease to accommodate implants. Works just fine most of the time, but not always. Too many surgeons blame "large implants" as the "cause" for bottoming out.
But you want "largest possible" and that = big(ger) implants. However, you also stated you wanted "highest tightest lift possible" which is incompatible when asking if implants alone can achieve your goal. This is why personal discussion about the pros and cons of the various options are critical to achieving as close to your (somewhat incompatible) goals as possible. Click on the web reference link below for examples of my patients with varying degrees of breast droop who had implants alone (case 6--450cc, case 11--460cc, case 14--500cc, case 24--660cc, and case 31--550cc L and 600cc R), then click on my website photogallery and look at breast implants plus lift or breast lift alone to see what can be accomplished. Best wishes! Dr. Tholen
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.