Thank you for the question and picture.
Online consultation will leave you with less than precise advice.
Generally, I would suggest that your first concern should be obtaining the best results possible (scarring concerns should be secondary). Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.
In other words, if you select your surgeon based on the offer of a “limited scar” procedure you may be disappointed with the results.
In person examination by well experienced for certified plastic surgery where your goals can be discussed in detail will help you decide which type of breast lifting will be necessary.
You would need to put a card under your breast in the breast crease to accurately see what would work best for you. You do not look real low, fortunately, but your nipple points slightly downward. Other views would be helpful too, to see if you would be a candidate for a dual plane internal lift. Ask yourself how much breast tissue is below the crease and, is the nipple at or above the crease?
Seventeen percent of my augmentations are done with a dual-plane approach to lift breast tissue, elevate the nipple-areolar complex, and release a tight breast crease. This is technically a breast enlargement procedure—I call it the “internal lift.” It creates a breast pocket above and below the muscle (hence the term “dual”) where an implant is inserted. By releasing the breast attachments on top of the muscle, the breast slides upward around the implant. This technique avoids the more extensive scars of an external lift, and can be especially useful in ﬁxing early sagging. This is done through a short incision in the breast crease. All the best! Dr. Joe
There are varaiations with breast lifts and implants. Commonly I perform a cirumareola lift when I perform a breast augmentation and this is sufficicent in many women with mild ptosis.
Breast implant with a circumvertical breast lift
Based on your photo I would recommend a breast augmentation with a vertical mastopexy (lollipop lift) to give you the best possible shape. The vertical component of the incision is important to give a nice contour to the breast compared to the circumareolar (Benelli) alone. This will not be sufficient in your case to give you a nice result, in my opinion. I would consult with a few board certified plastic surgeons for a more complete evaluation.
"Donut" breast lift with scars just around the nipples works well together with implants.
Just going by your one picture, I would say that minimal scar breast lift with silicone implants over the muscle will work well for you.
Here is what I do with patients who have your type of situation. I recommend doing the implant only, usually on top of the muscle and wait 3 months to re-evaluate. If the patient desires a lift can be performed at that time. I have never had a patient decide on the lift after they have seen the improvement with the implants alone. You save a lot of scarring that way. I am not a fan of the circumareolar mastopexy; it flattens the breast and you don't get much of a lift.
Options for implants and lifts
What is required depends on what your goals are. First determine what will make you happy, then the surgery will be more obvious. You can then modify the surgery if the potential scars are not acceptable. In general, the more shaping you want for your breasts, the more scars you will need. You definitely need scars around the areola. Whether you need implants or vertical scars will depend on what you goals are.
Robin T.W. Yuan, M.D.
Breast Lift with Augmentation.
Ask several doctors and you get several opinions. I don't know if that is helpful or just confusing. Unlike Dr. Freiman, I am a fan of the periareolar or Benelli mastopexty as the only scar is on the edge of the areola. While it is true that the mastopexy by itself will flatten the breast, in my experience of several hundred of these procedures, when it is combined with a dual plane augmentation, the flattening is gone after 6-12 weeks and leaves one of the most natural looking breasts I have seen. The scar is not very attractive at first and takes several months to look good. I am of the opinion that if we are also augmenting the breast we want that skin in the lower breast to hold the implant and unless the skin is excessive, I prefer to not remove it. Good luck sorting all this out. Best to find a surgeon you feel comfortable with, see photos of his work, and trust his opinion, whatever it is. There is rarely only one correct answer.
Thank you for the photo. A front photo would also help as well as your weight, height, and the width of your breast. Obviously an examination would be best. Based on the side view, a vertical mastopexy with superior pedicle would be best. The prodecure actually reconstructs the breast and uses the breast parenchyma as a sling. The resulting scar looks like a lollipop (not an anchor). The Wise pattern is also an option and will leave you with an anchor scar. Besides the extra scar, this type of mastopexy uses the skin as the sling as opposed to the internal tissue. I would suggest against a periareolar mastopexy (Benelli) since it will flatten your breast.