Breast augmentation with mastopexy
The breast lift with augmentation is a very tricky operation because on one hand you are trying to make the breast bigger and on the other you are taking skin away making the skin covering (envelope) smaller. A conservative approach is to stage the procedure and do the breast augmentation first and see how you like the result. You can then do the mastopexy lift as a separate procedure once you have healed. One problem with the periaeolar/circumaeolar mastopexy is widening/enlarging of the aereola in the months after surgery. Make sure you look at several before and after pictures of this procedure and pay careful attention to the appearance of the areola in the photographs.
Circumareolar lift unlikely to improve fullness without implants
Circumareolar lift is all about nipple position. The goal is to keep the nipple forward and on the front of the breast. The breast will not appear fuller, in fact the geometry of circumareolar lift can have the opposite effect and reduce projection of the breast. You are courageous to send your pictures and I feel you will do well with implants alone. The scar from a circumareolar lift can be acceptable when necessary, though regrettable when it is not. The best approach is augmentation, and let everything settle and shape for many months. If you are unhappy the lift can easily be done as a second step, though again I don't think you will find that you need it.
Best of luck,
One other benefit of the circumareolar lift is the ability to limit the size of the areola as well as to lift it. The tradeoff is the scar.
If fullness alone is your goal, you will be pleased with the results of augmentation alone.
If, however, you intend on wearing anything revealing and are concerned about the position of the nipple on the breast mound, then a breast lift may be something you should consider.
Of course, as stated below, you can have the augmentation first and always undergo a lift at a later date.
Circumareolar Lift with Breast Implants to increase fullness
A well done breast augmentation may be sufficiently pleasing to the point you may not need ANY breast lift in your case. If in doubt, as you are, I would have the breast augmentation alone and wait up to 4-6 months to see how the breasts settle. If you are happy with the results, you need not have anything else. But, if you want a lift - a periareolar lift may get you the best result.
Just looking at the side view of your photos suggests taht an implant will not be enough. You may be able to only have a circumareola lift with the implants.
Do I need a Breast Lift, or will Implants alone Achieve my Goals?
Depending on your goals for the size of your breasts, I do think that you would be a candidate for breast enhancement via an augmentation alone.
This is not to say, however, that I think you would achieve your best outcome through this approach... This would be a compromise procedure, with a necessarily compromised outcome- no breast lift scars, but less than ideal shape. Your nipple would still be a bit low on the breast, and the volume of the implant may sit a bit lower on your body than you would prefer.
If you asked me a different question- "What would you recommend if I said I wanted the most beautiful breasts possible?" Then I would say that your best bet is to have a breast lift with your implants.
As far as the technique goes, there are of course many different techniques for lifting of the breast... But in my opinion, it is a mistake to think that the techniques are all options for all patients, and that the choice of breast lift technique should be based on the patient's preference for scar location and size...
It is important to understand that each different breast lift technique will necessarily alter the shape of the breasts is a very characteristic way, and that if an inappropriate technique (based on the starting shape of your breasts) is chosen, you will most likely not be happy with the shape of your breasts after surgery. And in my opinion, it's all about the shape...
Some of the worst outcomes I see are in women who had one breast lift technique or another because of the scar they wanted to have- despite the fact that the shape of their breasts made them poor candidates for the procedure they underwent. And this is very difficult to correct after the fact.
I definitely understand when patients say they are concerned about breast lift scars... I know what you're worried about....
I think that the key to achieving the goals for patients like yourself is to realize that if you need a breast lift to achieve the ideal shape- do the breast lift. But do EVERYTHING possible to make the scars as inconspicuous as possible. With an appropriately aggressive approach to scar management, guided by a very experienced breast surgeon, you can have the shape you want, AND inconspicuous scars.
Breast lift with implants
This is a very common question-- do I need a lift or can I get away with just the implants, and no lift? Most of the time, if we think a patient would benefit from a lift, it's hard to get the ideal result without it. The one instance when we MAY be able to get a nice result without a lift is if we place the implants above the muscle in someone with just a little bit of droop to the breast . This will correct it a bit, but there are some downsides with this approach, including a higher chance of seeing the ripples of the implant or feeling the implant, especially in thin women. My advice is to decide what is most important to you personally-- the best chance at the best shape, or the least incisions. This will help your surgeon guide you through the pros and cons of each approach, so you can decide which option is right for you.
Do you need a breast lift?
From your photos, anatomically you need a breast lift to get the best result from a classical breast shape standpoint. If you just do an implant your nipple will stay low, but it is up to you to decide if that is acceptable to you. When I pose this question to prospective patients and show them the photos of unlifted patients who have had implants and then come to me unhappy, I have not yet had a patient who has seen the photos and said they they'd be okay with that result.
So the choice is yours, lift now or lift later when you are more comfortable that you need it. But I'll wager that if you don't do it, you'll be back to have the lift in just a few months.
Can I have implants alone or do I need lift?
Hi Tracy2222. In my opinion, ideally you would have a lift. However, you can have a nice result with implants alone and your goals have to taken into consideration. I do believe that in time, you will need a lift to maintain an optimal aesthetic result. However, every patient's aesthetic sense is different and you may be very happy for several years. You can address the lift if and when it becomes an issue for you. Recognize that the implants will most likey accelerate ptosis (drooping) of the breasts. Having implants will not result in a "static" result but one that may need revision in the future to maintain a pretty result. Hope this helps.
The circumareolar lift will only partially correct the glandular sagging or ptosis you have. The lift will not increast fullness and may actually reduce the forward projection of the breast since it has a telescoping effect on the nipple area. The only way to get increased fullness is with an implant. However, the other consideration is the relationship of the nipple to the implant and breast mound. The circumareolar lift can help to normalize this relationship but at the price of a scar. You mihgt want to do the implant, see whether you can live with the results, and add the lift an a second surgery when you are convince that it is absolutely needed for you to be happy. Shape is temporary, scars are permanent.