Considering a breast augmentation - Is my desired look achievable?

Question

Im 26, 5’4, 159lb (goal 120-130) my highest weight known was 276. My breasts look terrible now after weightloss but they have always been hideous. I remember hating the way they looked as soon as they started coming in. Ive always dreamed of having the perfect, perky, natural, looking breasts that everyone desires. Is this even possible for me? Or am I destined to look botched no matter what? Ill schedule a consultation closer to my GW but Im just curious. Me vs ref pics from google

Gary M. Horndeski, MD · Answer

The technique I recommend is a lift using The Bellesoma Method. 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.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Moises Salama, MD · Answer

Thanks for your question. For your pictures, you seem to be a good candidate for a breast lift with implants to address the droop/sag, add volume to your breasts, and reduce the areolas. I recommend you schedule a consult for a proper evaluation. Please always consult with a board certified plastic surgeon. Take care, Moises Salama MD, Board Certified Plastic Surgeon

Derek Fletcher, MD · Answer

First, congratulations on your weight loss journey!
I think you are a good candidate for a two stage strategy beginning with: Stage 1 - dermal sling mastopexy to place the nipples in the ideal position, use your existing breast skin to add support to your breast mound, and improve symmetry; Stage 2 - breast augmentation to restore volume in all quadrants. 
Your goal photos are helpful, but not realistic. Those patients had very different starting breast shape and tissue type. They did not need a lift and shaping prior to augmentation. That said, you can still achieve a beautiful shape. It will take more time, more surgery, and require a skilled surgeon.

Thomas Trevisani, MD · Answer

Congrats on your weight loss! In person exam is essential. Based on posted photos- it appears that you are not a candidate for breast augmentation alone. In order to achieve perky breasts - a lift/reshaping/mastopexy is required . In the right experienced hands you can expect a more youthful, more rejuvenated breasts. I suggest that you seek an experienced Board Certified PS

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and pictures, congratulations on your weight loss.  To get the best result, you will need a staged lift followed by breast augmentation 3-4 months later.  Your wish breasts do not have a lift, you will be best served with an anchor scar lift.  You definitely can still get great fullness. Good luck at your consultation.

Harry T. Haramis, MD, FACS · Answer

Unfortunately, massive weight loss can adversely affect breasts. To avoid post op changes, you should be at your ideal weight before any breast surgery.

Your exact wish pictures will be difficult due to skin and tissue changes which are very different.

Best results would be with implants plus breast lift. Implants alone will only give more upper fill and will not address sagging.

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

Daniel Barrett, MD · Answer

Dear Intellectual91747,
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 thats being brought together to support the breast and hence improves longevity. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

You would do well with a lift, but I would suggest not choosing a large implant since your sagging tissue will not support much additional weight.

Mytien Goldberg, MD, FACS · Answer

No one should be destined to book botched. You have tuberous breast deformity with significant loose skin from massive weight loss. The tuberous breast deformity is when the nipple areola is very large and the nipple to fold distance is short. That is why you never like the way the look when they first came in. After the weight loss, your skin becomes loose and then collapse over. You can have perky and fuller upper pole of the breast with a combined procedure breast augmentation and lift. Don't be discourage, the fuller and perkier breasts are within reach. Good luck in your journey

Mark Eberbach, MD · Answer

It appears from their photographs that you have lost a substantial amount of weight and have drooped considerably.  This may have been part of your initial anatomy as well.  There is excess fat in the anterior axillary fold and a descent of the axilla skin laterally with looseness of your back.  The breast with a mole is larger and lower.

While your desired outcome is unlikely, you can get close with a several stage procedure.  In my hands stage I would be a breast lift with back and axillary lift.  After a period of healing that might be 6 months or perhaps a little longer one could come back with a final revision with augmentation.