What do I do - implant with or without lift? Saline or Silicone? (photos)

I never had cleavage except when gorged. at 34B, 3 kids, I would like to have some. What would you suggest given I would like to have this along with a BBL? My only concern is scaring my skin doesn't do well with scars.

Doctor Answers 6

Breast lift with BBL

It is difficult from your photos to tell exactly whether you need a lift or just an augmentation. Based on the photos I think that you will need a circular lift for optimum shape and augmentation will give you more cleavage but there are limits to how much cleavage you will have. Everything in this surgery is a compromise between size and shape and longevity As far  as having a breast lift and augmentation at the same time as a BBL that is a very bad idea . After breast surgery your only comfortable position will be on your back. After BBL your only comfortable position will be on your stomach or on your side.  The two surgeries are not compatible unless you're willing to be absolutely miserable for more than a month.  Even if you were willing, the change in position would compromise the results on either side 

Sacramento Plastic Surgeon
4.9 out of 5 stars 106 reviews

BAM with/without lift, and implant type?

Hi Exotic Belle
First you need to have a full exam which includes history and examination of your goals and what you will and will not put up with (e.g., scars etc.)
To my eye, it looks like you will need a lift.  My recommendation is that you go under the muscle to make up for the loss of support creating your southward descent of tissues.  Size of implant and type (silicone/saline) is best addressed during the consultation, and is largely based on your goals, etc.Another thing to consider is staging the procedures vs. having the lift and BAM at the same time.There is no one right answers, and each decision will mean compromises, so think on it and make the choices best for you.
All the best.

What do I do - implant with or without lift? Saline or Silicone?

I think the issue that you need to reconcile with your surgeon first is the desire to have cleavage without a bra. Although you might have had that when engorged with breast milk, an implant will not do the same thing. It will make you larger and the cleavage will only be there while in a bra. Otherwise they will move downward and outward like a naturally large breasted women without milk engorgement would have. the lift will reposition the breast tissue better but it alone will not give you cleavage without a bra

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Breast Implants With Or Without Lift

Thank you for the photos and questions. It is not possible with certainty to tell from the photos what would give you the results you want. Breast implants will make you larger and restore upper breast fullness. Breast lifting will correct sagging. A detailed examination is necessary to determine the proper size and shape of the breast implants and whether you would benefit from breast lifts. Saline vs. Silicone may come down to a personal preference. Again, an exam is needed to best advise you. Please consult with a board certified plastic surgeon to learn about the breast surgery and BBL and come up with a plan that will help you accomplish your goals and good luck!

David S. Motoki, MD
Draper Plastic Surgeon
5.0 out of 5 stars 16 reviews

Mastopexy and implants?

One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask,  “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. When using round implants, I prefer gel over saline as there is better maintenance of the upper pole fullness unless the saline implant is grossly overfilled and very firm. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.6 out of 5 stars 38 reviews

Lift with Implants

Based on the photos you have shared you would benefit from breast lift with implants.  Breast lift surgery will reshape your breast for a pleasing cosmetic result.  Implants will add volume.  Your surgeon should monitor your scars until they are healed and matured.  Scar management should be discussed as you heal.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 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.