Is it possible to do a breast reduction and lift without implants and still have fullness?

Question

I'm tired of having heavy breasts to carry around all the time and of having to buy an XL shirt just so it'll fit my breasts. I'm a DD and would like to be a C but I'm concerned about implants and about having flat, hanging, sagging boobs after as well? I've had the gastric sleeve surgery done and I'm down almost 80lbs and I'm maintaining after two years. I also don't want to have to worry about implants.

Krishna Vyas, MD, PhD, MHS · Answer

Yes, it is possible to achieve a breast reduction (and lift) without implants while still maintaining some degree of fullness. A breast reduction typically includes a lift as part of the procedure. During a breast reduction, excess breast tissue is removed to reduce the size and weight of the breasts. This process also involves repositioning the remaining tissue, tightening the skin, and lifting the breasts to a more youthful, higher position. The combined reduction and lift can restore a more natural, aesthetically pleasing shape by addressing sagging and improving the breast's overall contour.
Another option is using a technique called auto-augmentation mastopexy, where breast tissue is repositioned from the lower part of the breast to the upper part to create fullness without the need for implants. This technique can provide a lift while maintaining a natural, fuller appearance, especially for patients with sufficient existing breast tissue.
If you're concerned about flatness or sagging post-reduction, discussing these options with an experienced plastic surgeon can help you achieve a lifted, fuller look while avoiding implants. 
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Matthew S. Kilgo, MD · Answer

Hello.Thank you for your question.While it is possible to maintain upper pole fullness with a breast reduction, particularly with certain techniques that remove only the lower portion of the breast tissue, you will not likely have increased fullness in the upper breast after breast reduction. Several techniques exist to achieve upper breast fullness with a lift without the use of a breast implant. A technique called auto-augmentation mastopexy transfers breast tissue from the lower to the upper breast to create more volume in the upper breast. The overall breast size can also be reduced using this technique. Another way of providing more fullness to the upper breast is by utilizing fat transfer. I hope this helps. Good luck.

Jeffrey Lisiecki, MD · Answer

Yes, it is possible to have good fullness without implants, especially when you have a good volume of breast tissue to begin with.  A lift can help reposition that fullness to a better position.  Fat grafting, especially to the inner and upper breasts, can also really help add fullness to the key areas while not adding too much size overall to your breasts (and avoiding an implant!).

Gary M. Horndeski, MD · Answer

Thank you for you question,       The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible without an implant. Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

Daniel Barrett, MD · Answer

Hi Amron79, 
  
Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. 
  
Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift. Also, price range for breast lift is around 10k to 15k depending on whether you need a lollipop or a donut mastopexy.
  
Another important consideration to make would be the breast implant type and sizing selection. In fact, this is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient.  
  
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements. 
  
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match. 
  
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
  
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals. 
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Tania Medina de Garcia, MD · Answer

Hello dear!!
Thanks for the question and provided information as well. 
It depends on your current size and the amount of tissue you have. Unfortunately, without pictures, it is very difficult to give you a proper answer. l recommend you to make an appointment with a board certified plastic surgeon to talk about your goals and anything you need to know.
Good luck :)

Christopher J. Inglefield, MBBS, FRCS(Plast) · Answer

Hi There. Thank you for your question which is very important.  You say you are a DD now an dwould like to be a C.  Therefore, very simply you are a good candidate for a small reduction and uplift.  You certainly do not need an implant to achieve any fullness as you have enough of your own breast tissue.  You should have a consultation with a Plastic Surgeon who specialises in Breast surgery so that you can be fully assessed and discuss the best option for you.  Good luck.

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