Would you recommend a periareolar lift in my case? I am open to all suggestions. (Photos)

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

You are a borderline case between breast augmentation only and augmentation with breast lift. This is why you may listen different opinions from different doctors.
Based on the photos, my personal opinion is that no lift is needed, so you can avoid scars. This does not mean that the ordinary techniques are suitable for your case. Dual plane technique in combination with high profile implants and some other maneuvers will give you a satisfactory result withought the scars of a breast lift.
Regarding the deformity that you are afraid about, I would say that it is not a problem, if the pocket under the muscle is made properly, The animation is minimal and not important relatively to the advantages of the subpectoral placement. Keep in mind that in the dual plane technique the implants are placed under the muscle.

Your breasts are low on the chest wall, asymmetry in volume, shape and position.  You would benefit from a lift using a no vertical scar breast weight transfer technique.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  Later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices.  6% fail with the first year and 30% fail within six years.  Fat tranfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

The risk of dynamic muscle deformity is increased with larger implants, with the problem occurring most often when the implant diameter exceeds the breast base, or the inframammary fold is disrupted. Your breasts would not do well without a lift, and my preference would at least be a periareolar lift, and possibly a vertical on the droopier side. 

Dear princessjazz99,
my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thatsbeing brought together to support the breast and hence improves longevity. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I don’t think theperiareolar lift will do much for you.  Rather thanthe periareolar lift lift I suggest you look into the lollipop lift instead. It will give better lift and shape and be more effective at  creating symmetry.

Your procedure would best be addressed with implants that are placed in a dual plane (partially behind the muscle) as well as a donut (periareolar mastopexy).  You have some asymmetry between the two side and it would best be addressed with a skin excision procedure, i.e. mastopexy.As far as implant placement, when the implants are placed behind the muscle completely (rarely done) or in a dual plane, you will have some animation deformity when your flex your muscles.  This happens in every patient who has implants behind the muscle.  It may be more pronounced in some and not in others.  But the benefits (less rate of capsular contracture, less rippling, smooth upper pole) definitely out way the animation deformity issues.Make certain the surgeons you are seeing are board certified plastic surgeons.Hope that helps.

Thank you for sharing your questions and pics. The implant size is likely in the range that you could go to once verified with breast measurements. You do have some breast, nipple and areola asymmetry that a life would be able to correct. A periareolar might be sufficient on the right side, but you might need a small vertical component on the left as this appears to be more ptotic. I prefer a circumvertical lift on both sides to control scarring as well as overall skin tightness/breast shape. The inspiration photos are likely closely achievable. 

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive (some want smaller less droopy breasts and others want larger less droopy breasts).
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision/transverse limb.
When a woman wants the volume restored (in the upper pole), or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children.
Based upon your photos, it is difficult to say for certain whether a lift will be necessary (if there is any ptosis/sagging it is likely mild). There is no replacement for an in-person exam. Augmentation alone will not achieve a lift as the two procedures are mutually exclusive. If a lift is needed an augmentation is unlikely to be adequate.
With regards to your specific question, the scar burden of a breast lift varies directly with the degree of ptosis/sagging. The more significant the correction needed...the greater the scars. Slight ptosis can be corrected by a "donut" or circumareolar mastopexy/lift. Moderate ptosis may be addressed via a "lollipop" lift or vertical mastopexy. The most significant degree of ptosis will necessitate an "anchor" or Wise pattern scar.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon (ABPS). Patients should discuss their concerns with their physicians in order to make an educated decision.
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
Real Top 100
RealSelf Hall of Fame

Hello and thank you for your question.  Congratulations on your weight loss.  You are a great candidate for a breast augmentation using a dual plane technique with an areolar reduction.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon