Multiple consults, mixed opinions. Do I need a lift with my implants? Pretty sure the right side has Pseudoptosis. (Photos)

Question

33 years old, 5’8. Trying to figure out if I truly need a lift. The right side is lower than the left and also has pseudoptosis. My goal is a perky breast with natural slope however still wanting the fullness. Thoughts are 380cc. Just trying to make the right decision on if I truly need a lift. Is my situation really worth the vertical scars? Could I get away with just different size implants to fix the differences in breasts? will my nipples still be pointing forward without a lift?

Harry T. Haramis, MD, FACS · Answer

In my experience, implants alone will “lift” and fill your breasts without a lift.

They will look natural and you can avoid the extra scars. Larger implants (380 range) usually yield better results.

All breasts are different right to left before and after any surgery. Sometimes, different sized implants will improve symmetry, which can be determined intraoperatively.

An exam and consultation with a plastic surgeon is recommended to better discuss your options and expectations.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Do I need a breast lift? You might not need one. Click on the link below to read my recently published paper on this very topic. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Ronald J. Edelson, MD · Answer

Ideally a lollipop type lift combined with implants would be the best option. The advantage is that the scars are less than a full lift. Do not get a crescent or donut lift. If you really wanted to get implants alone I think it would be okay as long as you know your nipples will be a little on the low side.  You could truly go either way as far as the lift is concerned

Ozge Ergun, MD · Answer

Thank you for your question. Whether you need a breast lift depends on your nipple position, skin elasticity, and the degree of asymmetry between your breasts. In some cases, implants alone can improve fullness and the appearance of mild pseudoptosis, while in others, a lift may be needed to achieve a more symmetrical and lifted result. Using different implant sizes may help address volume differences, but it cannot reliably correct differences in nipple position or breast skin excess. A unilateral lift may be an option if the asymmetry is primarily on one side. An in-person examination is essential to determine the best approach for your anatomy and goals, especially if you wish to achieve a fuller, naturally sloped breast shape while minimizing scars.

Best regards,
Ozge Ergun, MD

Best regards,  
Ozge Ergun, MD

Gary M. Horndeski, MD · Answer

Your breasts are asymmetrical in volume, shape and position. One inframammary fold is higher than the other and one nipple is higher than the other. I recommend a circumareola approach around the lower nipple-areola complex to raise it to match the other side and then implants can be placed. You may need one pocket lower than the other to correct for that.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John LoMonaco, MD, FACS · Answer

Your nipple position is good, and you have a small, short breast skin fold.  An implant can reliably "take up" that fold. A modest sized implant should not cause too much new sagging but this depends on your skin quality, age, and genetics. Cheers from Texas !

Mustafa Aydinol, MD · Answer

You can have a good result with anatomical implants to support the lower pole and maybe a unilateral lift from the areola to make them symmetrical. I don't think that you would need a full lift. However, because your skin is loose, it is likely that you might end up with a little bit of loose skin in the future. Because this is an ongoing dynamic process, you might need touchup in the future.

Tyler Frew, MD · Answer

Hi there,
Good news first: pseudoptosis is the situation where implants alone work best. If your nipples sit at or above the fold and the extra tissue is mostly below, an augmentation alone can often give you that full, perky look without the vertical scars. If the lower right side has a nipple that sits below the fold, I'd suggest a lift on that side only, rather than lifting both, so you get symmetry with half the scarring.
A few honest points to help you decide:
- Implants mostly push the nipple forward, not up. They'll fill out the lower tissue and point the nipple ahead a little better, but they won't truly raise a low nipple.- Using a bigger implant on the lower side to "even things out" is tempting, but it usually isn't the fix. The extra weight on the lower side tends to drop further over time, and the difference can come back. Most of the time it works better to use similar implants and adjust the tissue on the lower side.- 380cc on a 5'8" frame can be very reasonable, but the right size depends on your chest width and how much tissue you have. Try sizers on in a sports bra and a tight shirt. 3D imaging such as Crisalix can also show you the result with and without a lift.- Vertical scars do fade well for most people, but they're permanent. If a lift isn't truly needed, it's fair to skip it. If it is needed, skipping it usually means a revision later.
Since you've had mixed opinions, ask each surgeon exactly where your nipple sits relative to your fold on each side. That measurement usually settles it. Personal advice really needs an in-person exam, so let your surgeon confirm it in person.
All the best!

Mats Hagstrom, MD (license on probation) · Answer

If the nipple sits below the IMF(infra mammary fold) then generally, you need a lift with implant augmentation. 
You included one lateral picture showing your left breast and in that view, your nipple is clearly above the IMF. You didn’t include a sideways picture for the right breast and we can’t tell on the frontal image if the nipple is above the IMF, but guessing that it is.
The left breast sits higher on the chest wall than the right side on almost 100% of people.
Thisis true for both men and women.
 Unless the person has asymmetrical ptosis The left nipple typically sits higher than the right side.
Your breast don’t seem all that different in regards to the size so the difference in implant size should be subtle.
I suggest your schedule in person consultations with plastic surgeons in your community.
Bring pictures of your breast to use as a reference during the . Ask providers to show you before and after pictures of previous patients who had similar breast characteristics and this should give you a good idea what you can expect in regards to the outcome.
Some women are right on the verge of needing a lift. If they have the lift, the Aesthetic outcome is often better than if they didn’t.
It does come with the scar, however.
In your case, you’re probably fine to have a standard augmentation without a lift. You can always add a lift if you’re unhappy with the outcome later.
There are a lot of decisions to be made for this procedure. Provider selection it’s probably the most important variable. In the hands of the right provider, you should have an overall positive experience for the good Aesthetic outcome and be guided correctly.
You didn’t include any information of what the surgeons who you consulted with suggested.
It would be helpful to understand the relationship between your nipple height, and the IMF on the right side to give you an accurate assessment.
In regards to the left side, you’re good to go without the lift.
Best,
Mats Hagstrom MD

Multiple consults, mixed opinions. Do I need a lift with my implants? Pretty sure the right side has Pseudoptosis. (Photos)

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