Implants after massive weight loss without a lift - could I have good results? (Photos)

Question

I’m a 56 year-old female who was lost 140 pounds. I have significant volume loss in my breasts. I very wide breast bases with not much projection. I would say I have moderate sagging, but the nipple is either at or above the fold still. And I would not need my nipples resized. My question is is it possible to get a decent result in my case just using implants. I’m not interested in really high breasts at my age. And I would prefer not having a nipple incision.incision.

Gary M. Horndeski, MD · Answer

Your breasts are low on the chest wall. The best technique for you is a breast 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 and nipple sensation (in 95%) is maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gregory Lakin, MD · Answer

Thank you for your question. The recommended plan is a combined breast lift with augmentation using a small to moderate implant that matches your base width, placed in a dual plane to avoid a “high, fake” look. The lift will tighten the skin and center the nipple–areola. To respect your scar preferences and avoid a periareolar incision, the implant can be inserted through a low inframammary fold incision, and the lift can be performed as a vertical (“lollipop”) pattern or Wise if more excess skin is present; this approach reshapes and supports the breast while keeping scars off the areola. However, you will need an in-person examination with a board-certified surgeon to confirm nipple position, skin elasticity, base width, implant size and profile, and the least visible scar pattern that achieves your goal.

Daniel Barrett, MD · Answer

Dear higginsrn,

determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Guray Yesiladali, MD, FEBOPRAS · Answer

While implants can restore fullness, they also add weight, which may lead to more sagging over time. Sometimes the implant may even make sagging more noticeable. That is why in many cases a breast lift, even a limited one, is what really makes the shape look natural and balanced again. 
I hope this gives you a clearer picture of your options. Wishing you the very best on your journey
&mdash; Güray Yesiladali, MD

Miguel Mota, MD · Answer

Congratz on the weight loss. Unfortunately I dont see how implants alone will give you the results you are looking for. We would have to use larg implants that will actaully defeat the purpouse beacsue they will weigh down your breasts and it will speed up sagging. A breast lift is essential for good results. A breast lift with implants can be done in one procedure even though some doctors feel its best to do one and then the other. I feel this is a waist of time and added risk of surgery. 
I would putt off on the breast procedure until you are ready for the breast lift. This way you will save time and money.
Dr. Miguel Mota

Leila Kasrai, MD, FRCSC · Answer

It looks like your nipples are below the breast fold, which indicates that a full breast lift may be suitable for you.

Donovan Rosas, MD · Answer

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. Many patients, whether they are aware or not, will benefit from both.
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. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, 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. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos and description, an augmentation alone may be adequate. Most weight loss patients will benefit from both. However, if nipple position is preserved implants alone may suffice
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Warren Schutte, MD · Answer

Congratulations on your weight loss. Great question, as this is a decision that many women face (lift and aug, just lift or just aug). I do not perform breast lifts and augmentations at the same time as literature shows us that we should separate these surgeries. You would need to place a moderate to large implant to make an aesthetic difference, but it is possible to do just an augmentation first. If you desire a tighter skin envelope and slightly higher placement, you can have a mastopexy (lift) months after your augmentation. I have many patients who are technically candidate for both (lift and aug), get an aug first and are very happy with that outcome alone.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. 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

Yucel Sarialtin, MD · Answer

Hello,
Thank you for your question and photo. Following massive weight loss, it’s common to experience significant deflation and widened breast bases, as you described. In cases like yours&mdash;where the nipple is still at or slightly above the inframammary fold, and skin quality allows&mdash;augmentation with implants alone may indeed provide a satisfying outcome without the need for a formal lift or periareolar incision. However, because you have a wide base width with limited projection, the implant selection will be crucial: opting for a moderate or moderate-plus profile implant with sufficient base diameter can help restore volume and shape naturally, without creating a high or “fake” look. Skin laxity can be a limiting factor, and while implants alone can improve projection and shape, there’s a possibility of mild bottoming out over time. Ultimately, your surgeon will assess factors like skin elasticity, breast footprint, and existing asymmetries to determine whether implants alone will meet your goals&mdash;or if a minimal-scar lift might be recommended to optimize positioning. Given your preference to avoid a nipple incision, be sure to communicate this clearly during your consultation so the approach can be tailored accordingly.

Implants after massive weight loss without a lift - could I have good results? (Photos)

Answers (12)

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