Am I a Candidate For Implants Without a Lift?

Hi,

You will definitely need a lift in addition to implants (if you desire to be a DDD). There is a new lifting technique that gives you a full lift without the need of a vertical scar. It also allows for your existing breast tissue to be moved upward and secured permanently to your chest muscles. This allows for a more permanent lift as opposed to conventional lifts.The scars are well hidden around the areola and under the breast mound. So please don't be concerned with scarring.  FYI, keep in mind that implants will always stretch tissue regardless of placement  (above or below muscle), so in time you will end up with the same problem you have now, but worse. Now, if you decide against implants the technique described above will raise and reshape your existing breast tissue to resemble that of an implant, without the weight. Patients are very happy because they have perky, firm and natural looking breasts. Best wishes, Dr. H

Small or large implant you must have a lift.  In fact, in my practice I would not offer you an augmentation without a staged lift followed by augmentation three months later because of the amount of adjustment you need.  You also may not be able to go as large as you desire.  Good luck and get multiple opinions as you are more challenging case.

Judging from the picture on the left of a women without implants, it does not appear that you can get a good result without a lift along with you augmentation. We can put implants in to make your breasts bigger but it looks like from the amount of ptosis (sagging skin) that you have, you will most likely need a lift too.

Larger implants can help to reverse sag, but they have to be placed selectfully. You must have a very experienced surgeon perform this procedure.

Your breasts shape is similar to a tubular breast. Your breasts are long and narrow with a wide cleavage. The areola are disproportionately large for your breast size. You would definitely need to have a lift. As far as being a double D or larger, that is something that would have to be discussed, because I'm not sure your body size can accommodate that. I have done some extremely large breast augmentations for certain patients but it's important to discuss things fully and make sure you understand that that larger breast will lead to sagging much more quickly and then a smaller size breast implant.

When women with saggy breasts want to go bigger, I usually advise doing a breast lift along with the implants. Otherwise, the implants create what we call a “double bubble,” where the breast droops off the end of the implant like a sock. Some of my patients, however, don’t want a lift because they want to avoid additional scarring, so sometimes implants alone can fill out the skin and eliminate the saggy appearance. A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed. If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants.

It is not possible to make your breast look like the photo on the right with implants alone nor with implants and a Mastopexy. You can get a good result with an Augmentation Mastopexy if reasonable size implants are used rather than just the largest implant that can fit. Your goals have to be realistic before any surgery is done or you will not be happy in the long run. 

Implants do not lift breasts.

Lifts lift breasts.

Lifts must lift breast tissue not the skin on the breast. Pick your technique wisely.

My rule is that if the nipple to sternal notch distance is less than 25 cm's, then a Tear Drop circumareolar lift is possible. For greater than 25 cm's, a Lejour lift is appropriate.

All lifts will reduce some volume as part of the procedure. To add volume, add an implant!

Your posted left photo, which I assume is you now, shows asymmetric breasts, enlarged stretched areolae, skin stretchmarks on the upper half of the breasts, drooping breasts with the nipples lying well below the inframammary fold, prominent breast veins and wide spacing between the breasts. If you just put in breast implants these issues will not be corrected and you will most assuredly not be happy. The cleavage cannot be corrected by any surgical means. You will need breast tissue and skin procedures including some sort of lift to correct the other issues. You almost assuredly cannot do this all with one procedure. You can do the lift and implant placement together and then a fine tuning procedure or you could do the lift first and implant placement later.

There may be some surgeons who could do all this in one procedure but that would not be the majority of surgeons and no surgeon can guarantee you will be happy with one procedure. The main problem is the amount of drooping and the severe stretchmarks. No one can fully adjust for changes to the stretcmark skin that take place as a result of surgery while planning and performing the surgery. You also need to know going into this that the stretchmarks may become more visible or noticeable after the surgery.

I also strongly advise agains getting implants as large as those in the right photo. Given your skin and current condition that would set you up for additional surgery  within a couple of years as the stretchmark skin has lost most of its original elascticity. If you want to keep returning to the surgeon for more surgery go ahead and put the larger implants in.
 
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Thank you for sharing your photos.    Based on the left photo, you have a very complex breast shape to fix.     You have very large areolas and most of the breast is loose skin.     In addition the breast footprints are very far apart.   Bottomline, I would want to educate you on what cosmetic surgery can safely accomplish for you.   I do not think a DD/DDD is realistic with your body frame and breast anatomy.  I think a realistic goal would be a full C.    In order for me to optimize your shape, size, and symmetry, I would recommend a full anchor breast lift.    These scars heal very nicely in most patients.   I think the patient photo on the right is not a realistic outcome for a patient with your breast anatomy.    I think it is always important to study the before photos as closely as the after photos to get a realistic understanding of what cosmetic surgery can do for you.   I wish you a safe and happy recovery :)