I'm 39 and I've breastfed 2 children. I'm 136 lbs and 5'6. How can I achieve my goal to look natural and not saggy? (Photo)

I am doing a breast lift and he is Rec 385 round textured HP sientra. I am broad shoulders with very tiny waist. I am worried high profile with the lift may be to fake looking or maybe I want wider with the moderate since I'm broad or will that make me look more broad? I am obviously missing a lot of upper pole fullness after having children and want that to return. I'm sure you can only do so much with a lift but scares me with a lift and using HP.

Doctor Answers 6

How can I achieve my goal to look natural and not saggy?

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Thank you for the question and pictures. Based on your photographs, you should have a very nice outcome with breast augmentation/lifting surgery.  I believe that breast augmentation surgery alone will not suffice.
Ultimately, you will do well select your plastic surgeon carefully and communicating your goals, questions, and concerns. In other words, careful measurements, dimensional planning, and careful communication will be key.

Generally speaking, patients undergoing this combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. It will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery.  
You will find a lot of information on this website and on the attached link.

Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" or "fake" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.

I hope this, and the attached link, helps. Best wishes.


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You actually have some options here... lots of different approaches. I think textured round implants with a lift are a great option. If you don't want to be so big and round, just choose a smaller implant! No reason you need 385... did you pick 385? You can definitely go smaller if you want. The other option may be to keep implants that size, but move to a shaped implant and hold off on the lift. Shaped implants can push the nipple forward more than round implants, and it may be an option for you. In that case, you would have less of the high augmented look, and much less in the way of scarring. That said, you may still desire a lift "down the road" if your breast is still drooping slightly when you aren't wearing a bra. I always give patients on the fence the option of shaped implants and a "deferred" lift, which i provide a the same cost as if they were doing it all at once. 
But basically if you don't want a big and round look, go with smaller and lower profile implants!

Imaging recommended

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Careful pre-operative measurements and sizing are extremely important to achieve the result you desire.  To best communicate that, I believe you would benefit from pre-operative computer imaging (simulation) such as with VECTRA XT.  This can show you how you may look with and without a lift as well as with implants of different sizes and profiles.

Sientra Breast Implants - Do I Need A Lift?

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Thank you for your question and photos. It appears you are an excellent candidate for breast augmentation with a lift. Although an in-person examination is necessary to determine your tissue laxity and specific measurements, it appears high profile implants with a lift will help achieve your desired outcome. Please consult with a board certified plastic surgeon who specializes in breast augmentation. Ask to see before and after pictures of women similar to yourself. Hope this helps and good luck.

I'm 39 and I've breastfed 2 children. I'm 136 lbs and 5'6. How can I achieve my goal to look natural and not saggy

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I think they have chosen the HP implant so that you get the volume without showing implant on the side. The volume may limit the length of your lift scars too so the scars would be shorter..

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Albany NY Plastic Surgeon Sientra expert says - choose your plastic surgeon with care

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Your photos indicate you would benefit from a mastopexy (breast lift) with an augmentation done at the same time.  The textured round Sientra implants for similar volume come in 3 different profiles (low projection, moderate projection and high projection).  The correct profile for your chest depends upon your breast base width, which I cannot measure from your photos. You may be a candidate for any of the three... Your surgeon needs to measure your chest and natural breast dimensions to choose the right implant for your individual case.  The wider or lower projecting the implant, the more upper pole fullness and cleavage you will get.

I hope that your surgeon did all the appropriate measurements before suggesting HP implants.  If not, get a second opinion from a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) who specializes in breast enhancement.  See my video on the linked page below for more information about why your choice of a surgeon is perhaps the most important choice you can make!

Hope this helps and best of luck!

Steven Yarinsky, MD
Albany Plastic Surgeon
4.9 out of 5 stars 41 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.