Early into my surgery journey - would like any second opinions on the treatment offered. Any suggestions? (photos)

I am 42yrs and have had 3 kids, I love fitness and have reduced further and am sagging considerably, I have spoken to a surgeon who has recommended a full lift including surgery on my submammary folds and as I want implants he has suggested anatomical textured high cohesive implants which I'm not adverse too I just have no idea, I know this won't be the last surgery I have but don't want a second as they are still too low etc, any information - opinions would be happily recieved - thank you!

Doctor Answers 7

Breast lift with augmentation or augmentation only

You are a border line case between considering a breast lift with augmentation or augmentation only.
Under some conditions if you want to avoid the scars of a breast lift, you could consider breast augmentation only.
In order to be able to reply to this I would like to know the relationship between the nipple position and the inframammary fold.
It is not well identified to the photos that you have attached to the question.
If your nipple is to the level or higher than the inframmamary fold, you could even have breast augmentation only.
In this case you would need a special technique which is not the one that we usually do.
The other possibility is to do breast lift with augmentation, which is the easier solution for your case.
Because, as I told you, you are a borderline case a long discussion might be done with the plastic surgeon of your choice in order to decide what is more suitable to you.

Early into my surgery journey - would like any second opinions on the treatment offered. Any suggestions?

Thank you for your question.

You will certainly benefit from a combination of Breast Lift (Mastopexy) and augmentation with Implants. I try to minimize the incision by using a vertical scar mastopexy especially with pigmented skin. An anchor lift would do a good job but would leave you with more scarring. Please discuss your concerns with your surgeon and decide accordingly.

All The Best !

Ajaya Kashyap, MD
India Plastic Surgeon
4.9 out of 5 stars 163 reviews

Breast Lift and Augmentation


Thank you for your question and photos. Your surgical options depend on your aesthetic goals somewhat. If you would like your breasts lifted, nipples repositioned and a perkier- filled out breast, then an anchor breast lift with implants would be the best option. Implants can be round or anatomical- each have pros and cons. If the size you choose is not too large, doing both procedures together may be an option. I recommend that you discuss this further with a board certified Plastic Surgeon who specializes in these procedures. As well, my patients find it helpful to try on the implant sizers in the office with a form-fitting T-Shirt in order to get a feel for the look and size of implants.

All the best

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Mastopexy with Submuscular implants

Cohesive silicone gel implants under the muscle with a full anchor lift needed to tighten up your breast. 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 42 reviews

Needs a combo

A combo of a lift and implants will be necessary to help restore your breasts to their previous more useful shape.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 18 reviews

You will do well with a breast lift and implants

Hello Sarah and thanks for reaching out to us! Based on your photos, I think you would benefit most from a breast lift with implants. When I discuss with my patients about breast lifting techniques and also use of implants, I break down the different topics into parts.

The easy way to decipher what each procedure produces is that implants increase breast volume and add upper pole fullness. Implants are placed in either a subglandular or subpectoral pocket centered over the left and right chest breast footprint. In your case, because your skin appears thin, I would recommend subpectoral placement. It will also give you a more natural look. When you have ptosis/sagging, where the nipple-areola complex is at the fold or lower, your breast will continue to hang off of your chest onto your upper abdomen even after implants. In fact, in patients with such sagging who undergo an augmentation without a lift, their breast tissue hangs off of the implant that is sitting on their chest, creating a shape like Snoopy's nose, hence called a "snoopy" deformity. Implants can not give a therapeutic lift and taking shortcuts will only lead to suboptimal results. In some borderline cases of ptosis, breast augmentation can be performed and if there is unsatisfactory sagging, then a lift can be performed later at a second stage, but in your case, an in person examination will be most instrumental in going over your lifting options in conjunction with implants.

Two lifting techniques that are very good ones in the right patient and I use are based on the following:
1) if it is mainly the nipple position that needs lifting, I like the circumareolar approach (also called a donut lift)
2) if a large portion of the breast tissue/weight needs to be lifted, a circumvertical (also called lollipop) and sometimes a full anchor incision is needed as the circumareolar approach in my mind is not strong enough to hold the weight of the breast and results in stretching of the areola and drooping over time.

There is a lot that goes into implant selection -- your breast volume, the amount of cleavage you want to achieve, your base width, your rib shape/projection, etc. Also, when it comes to bra sizes, most women are not accurately sized for their bras. Please keep in mind that a breast implant is a round object and has a certain diameter. Your base width on each side of your chest will determine "how big of a ball" or what diameter implant you can reliably go up to with a socially acceptable cosmetic outcome. The implant will "augment" or increase the size of your breasts to an amount acceptable to you and your surgeon. There is no correlation between height and weight and base width; therefore you need an in person examination to be accurately measured. You can also compare the moderate profile with high profile implants and see which look you like most. The profile of the implant will determine how much upper pole fullness and overall projection you portray. In the setting of a breast augmentation and a lift, there is no advantage to using a textured anatomical implant as you can achieve a very natural look with the lift and round implant under the muscle.  The textured anatomical implants run the risk of rotating and looking abnormal when this happens while the round implants do not run into this problem. Furthermore, at the recent American Society for Plastic Surgeons' meeting, a paper was cited where patients had placed on one side an anatomic textured implant and a round moderate profile implant of the same size on the other side and no plastic surgeons could tell the difference between the sides several months later.

Make sure to seek consultation with a board certified plastic surgeon with expertise in aesthetic breast surgery. I hope this helps answer your question and if you are uncertain about the recommendations made by the surgeon you met with recently, I encourage you to get further consultations. I wish the best of luck to you.


Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 25 reviews

You will benefit from a Breast Implant

Hi. With realistic expectations, you will benefit from 400 cc implants. I would not recommend Breast Lift in your case, not yet. 

Karthik Ram, MRCS, DNB
India Plastic Surgeon
4.9 out of 5 stars 50 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.