Breast augmentation alone, lollipop lift or full anchor lift? (photos)

I have had "sagging breast" all my life. No kids. I REALLY want to avoid the scars and hope to retain the option to breast feed. Tissue firm and full, not squishy or flat. I slouch, so when I stand straighter, the ptosis improves to just at the crease. One PS says I can get away with a circumareolar and implant. A second one recommends lollipop or even full anchor lift. I know these are only photos and not in-person, but expert opinions welcome.

Doctor Answers 12

All you need is a lift

Just my opinion, but here goes:

1. You have more than enough breast tissue and great quality (firm as you say it) to reshape your breasts with a lift only.  This would be an easier recovery, fewer potential complications and save you lots of money.

2. You 100% need a full anchor lift if you want this done correctly.  Circumareolar lifts have zero power and will not get you the best shape possible.  Your nipple needs to come up too much for just a lollipop or circumvertical pattern- you will need skin and some tissue removed from across the bottom of your breast (by your fold) in order to get the best result.

You will do wonderfully in the right hands and with the right technique.  Make sure you are consulting with board certified plastic surgeons that get amazing results with breast lifts.  I trained at Emory in Atlanta and I know who the best plastic surgeons are in that city- and there are some great ones.  Hope this helps.

-JGH

What to do

You have Grade C ptosis where both nipples have fallen below the level of the inframammary fold.  A circumvertical (lollipop scar) mastopexy will give you a better result than a circumareolar or donut mastopexy.  If you want a "perky"  result than go with the circumvertical.  Wise pattern is another type of mastopexy that will work but give much longer scars.  

Richard Zienowicz, MD
Providence Plastic Surgeon
4.8 out of 5 stars 45 reviews

Which is the best breast lift option for me?

Thank you very much for sharing your photos. You should retain the ability to breast lift with any of these procedures. A straight forward answer would be that an Anchor Lift is the procedure that will give you the most lift. If you are looking to have the best outcome possible, if you have no problems with having the anchor lift scars and you want your breasts to be as perky as possible, then the Anchor Lift with the correct size implants is the procedure for you. You are already a large cup size so, too big of an implant might give you too much volume and this will eventually lead to sagging breast in the future.

I see that you are afraid of the larger scars associated with lifts like the anchor and lollipop lift. But please remember that the larger the scars, the more skin we can take out and the more tissue we can rearrange. *This ultimately means the more lift we can achieve. The horizontal scars on an Anchor Lift  are actually hidden in the breast crease. These scars actually give the breast the most lift and the best shape. Scars will heal nicely with time and there are many scar treatments such as creams, gels and silicone strips that really help keep scars as nice as possible. 

Using large implants implants will fill out your breasts and give the illusion of "some" lift. But in my opinion large implants alone will not be enough in your case. You would end up with large sagging implants that would be probably too low on you, in order to compensate for the low areolae. A circumareeolar Lift or Donut Lift, would only lift your areolae about 2-3 cm. I feel this would not be enough. We would need to combine the correct size implants with enough of a lift in order to achieve the best results possible.

Ultimately, a circumareolar lift with implants will not lift your breast tissue, only your areolae slightly. It will not tighten up the skin enough to give you an adequate lift either. If you do not want your breast too perky, or if you do not feel you need to have the most lift possible, then you could get away with a Lollipop Lift. But in the end, The difference in scar from a Lollipop Lift and a Anchor Lift, is the horizontal scar at the bottom, and it is hidden beneath the mammary fold. I feel this extra scar well worth it! 

Best of luck on your decision,

Dr. Miguel Mota


Miguel Mota, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 31 reviews

Lift?

You are certainly going to require a mastopexy, and it really a matter of how much skin must be removed in order to get a good shape.  I think from these pictures, you need too much of a lift to get a good result with a periareolar incision--this technique will give a relatively flat shape to the breast, even with an implant.  My best recommendation would be at least a lollipop or probably even a 3 incision pattern lift to get the best shape that will last the longest for you.  Of course, you should get in person consultation with an experienced plastic surgeon, which is better than any opinion based on a set of pictures.

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 16 reviews

Breast augmentation alone, lollipop lift or full anchor lift?

Thank you for the question and pictures.


 After review of your pictures, it is clear that you WILL benefit from breast lifting surgery. You will not end up with an aesthetically pleasing results if you undergo breast augmentation surgery only.


 If you were to undergo breast augmentation surgery only I think that one of 2 types of “results” would be predictable:


1. You will end up with “big and low” breasts and unhappy with the aesthetic outcome etc.


2. You will end up with the breast implants sitting high on your chest wall with the breast tissue lower down,  again creating an aesthetically unpleasant outcome. You will find that you will continue to have breast skin sitting on top of upper abdominal wall skin, unless you lift the breasts.


For some patients the necessity of additional scars is a “dealbreaker” ; for these patients it is better to avoid breast surgery altogether.  On the other hand, many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.    


Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%.  



Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift.. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation. To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery.  


 Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.   I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer.  The use of the tailor tacking technique is very helpful. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.   



 Patients should be aware of the complexity of this combination procedure and achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc). 



 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved. 



Given the complexity  of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer). 



Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery. Having discussed some of the downsides  and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. 



 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful.  Best wishes.

What kind of lift?

As you mentioned, two doctors have examined you in person and come up with different opinions.  An opinion based on pictures alone would certainly be less valuable.  That said, I tend to agree more with the second doctor's opinion.  I think that your sag is too much to remedy with a periareolar lift alone.  This would move your nipple/areola up by a centimeter or two but it would not lift your breast tissue or tighten up the skin enough to give you an adequate lift.   Also, since you are apparently already a D/E cup, I doubt that you would want to add more volume by adding a breast implant.  You seem to have enough volume already.  If you are still conflicted after seeing two doctors then I would suggest getting a third consultation and let that be the tie-breaker.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast lift

If you are overall happy with the volume, then a lift alone could be appropriate. This might be a Lollipop incision to a "T". 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Implants and lift candidate, some advices:

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Respectfully,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 175 reviews

Breast augmentation alone, lollipop lift or full anchor lift?

Thank you for your question and photos.  Based on your photos it appears that you will need an anchor lift in addition to implants to achieve the best result.  However and in person examination is necessary for accurate advice.  Please see an experienced a board certified plastic surgeon.  For more information please read below:

Breast lift with implant

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, the best shape and contour could be achieved with an implant and a wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  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.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 79 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.