What kind of lift and what kind of implants do I need? 36, 2kids, 5'6", 151 lbs (Photo)

I've seen 2 PS who have 2 different opinions. What type of lift and implant would work best for me. I'm currently a full droopy 36C. Don't want larger than a D But want perfect perfect breasts. Not too fake but enviable for being questionable natural, but perfection natural. And yes, I think I need a tummy tuck. Both docs said yes. Thanks in advance!

Doctor Answers 21

What kind of breast lift and implant will give a "perfect" breast?

Thank you for your question and helpful photos.

You would benefit most greatly from a breast lift, and you would need a vertical scar (lollipop) at a minimum.  Most likely, the scar will need to be extended under the breast for the best shaping.

An implant would give you more upper pole fullness (rounded upper half of the breast).  HOWEVER, you have skin that has lost its elasticity.  Your skin will provide very poor support for any implant, which means your implants are likely to drop downward more than you like.  I tell my patients that I can change skin quantity, but I cannot change skin quality.  If you want your implants to stay high and your breasts to look "perfect" (round), you would benefit from having an ADM placed to support your implants.  ADM is acellular dermal matrix (I use Surgimend)--a collagen sheet--that is sewn to the ribs in the fold of the breast and to the muscle edge over the implant.  This makes a collagen bra inside to support the implant.  You could still have implants slide downward, even with the ADM, but it's much less likely.

Warmly,
Dr. Kavali


Atlanta Plastic Surgeon
4.5 out of 5 stars 39 reviews

What kind of lift and what kind of implants do I need?

Thank you for the question and pictures. Your pictures clearly demonstrate significant breast ptosis. As you state, you will benefit from breast augmentation/lifting surgery; a Vertical or "anchor" breast lift is indicated.

You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.

Some general thoughts may be helpful to you as you learn more:

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%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation.
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, while at the same time removing some of the balloons rubber surface. 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.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. 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. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS (will not be "perfect") 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.
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. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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, proportionate look” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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, after the use of temporary intraoperative sizers.
I hope this, and the attached link (dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes.

Breast Lift with Implants

Hi Gadda, Please put an index card in your breast fold. If your nipple is at the edge of the card or below, then you would be a candidate for a lift, either a vertical or anchor or areolar incision. If your nipple is above the edge, you could be a candidate for an internal lift called the dual plane. Please see the web reference and video reference below. Be sure to seek a consultation with a BC PS to be sure.
    Now to the second half of your question about what type of implant.  Here are a few tips for you because this is perhaps the hardest decision for a patient to make, as well as the surgeon. Also see the video attached to my answer. We spend up to two hours for our BA consults to be sure there is careful communication. We do a full exam in front of a full-length mirror taking six exact measurements. We put your photos on a large computer screen for imaging, and go over your “ideal-size” photos. We then save this information to your password protected “web account.”
First and foremost the implant should fit the dimensions of your breast and tissue cover. Balancing the implant to your over-all body shape and tissue cover is essential.The main thing is to have the diameter of the implant fit the diameter of your breast "foot-print". Higher profile implants tend to have a smaller diameter. Higher is really a marketing term, but often translates into the same volume implant with a narrower base. Saline implants actually tend to decrease in diameter as they are inflated! The average size chosen over our last 7,000 breast implants was “350cc”. BUT, 90% of our patients tell us they wish they were bigger a year after BA. (We will see you every year for routine checks at no charge.) It’s like your mind incorporates the "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patients that they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office by placing them into a special bra. The implant is also flattened somewhat when under the muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account for flattening of the implant in the partial sub-muscular pocket. Once you decide on a size you like, then add on 25cc, because in real life the implant will be flattened slightly by your tissues. Multiple measurements need to be taken to fit an implant to your exact anatomy. Have your surgeon's office show you the charts of the implant dimensions for the various profiles of silicone and saline from the manufacturer. Then you and your surgeon can piece together the puzzle by matching your measurements, with your wishes, versus your tissue cover and the available implants to arrive at a surgical plan. Keep in mind larger implants tend to have more problems over the years. Since silicone implants wrinkle less than saline implants, they might be your best bet.
You can also approximate this at home by measuring out an equivalent amount of rice placed into a cutoff foot of old panty-hose, and put this in your bra. Wear this around the house for a while, and see what you think. Implant size must square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion.
Therefore, I use a wide variety of methods, but the implant size is always established preoperatively. Also, patients are advised to bring reference photos demonstrating their ideal size and shape. A photo album of patient pictures is maintained to assist them. These photos ultimately help in determining where the implants will be placed, since they can be shifted inside (to provide more cleavage), to the outside, up or superiorly, and down or inferiorly during surgery. In determining the final size selection, I always place the highest priority on the preoperative measurements and potential tissue cover. Finally, your verbal requests are factored into the analysis.
We use the quick-recovery approach, so click on the web reference link below to have this explained and you can see the list of Quick-Recovery (Flash-Recovery or Rapid-Recovery) Breast Augmentation articles from peer-reviewed surgery journals. It is a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs. It causes far less trauma to surrounding tissue than traditional approaches, and it dramatically reduces pain and recovery time. In published studies of BA patients, 95-percent of women interviewed after the procedure returned to normal daily activities within 24-hours. Quick-recovery BA is not a “gimmick.” These specialized techniques, which actually speed recovery and get you back to your daily routine, kids and work, are published in our plastic surgery journals. Because these PS journals are “peer-reviewed” and edited, they are the gold-standard in our field as being valid science. Therefore, these are sound techniques, not marketing hype.
Be sure to see only a board certified plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of ASPS (The American Society of Plastic Surgeons). Also, ask if the PS has an established, high volume breast augmentation practice, performing several hundred breast augmentations each year. Be sure the PS has been in practice for a while, about 20-years might be a good gauge. Does the PS offer all three incisions? Discuss the implant type (gel or saline), shaped "gummy bear" or non-shaped, smooth or textured, implant pocket (over or under the muscle) and the "quick-recovery approach." Ask to see their before and after photos if you didn’t see any on their website. If they are experienced, they should have several 100 breast implant patients for you to view. I would also recommend that your doctor offer you the chance to talk to past patients who would be happy to discuss their experience with you. You need to feel comfortable, so make sure the environment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or she has ever published journal articles in professional peer-reviewed journals, which they can provide you.
All the best, “Dr. Joe”



Breast Implant Sizing and Lift

Factors which contribute to the outcome of Breast Augmentation are #size, #shape, and #profile. The #profile is determined by the amount of #projection versus roundness that the you desire, as well as the #size of the implant and size of your chest. Also, the placement or incision location will also have an effect on profile.
This may also provide some insight. If a woman wears a size 36 AB bra and would like to be a C cup, which is the average size that women wear and the average size bra that is sold, she needs a volume of approximately 350 to 390 cc to make that change. This becomes less if she's wearing a 34 bra, because it has a smaller strap size and the cups have a smaller diameter. A smaller diameter implant would then be a volume of approximately 300 to 350 cc. In the same way if she was more petite, maybe a double zero or size one and wore a 32 AB bra, then to become a 32C cup she would only require about 250 to 300 cc. The profile is determined by the amount of projection versus roundness that the you desire, as well as the size of the implant and size of your chest.
The intentional result of a Breast Lift (#Mastopexy) is to improve the shape and position of the breast without reducing their size. It is used especially for breasts which sag or droop (#ptosis) as a result of aging, weight loss, pregnancy, or breastfeeding. However, many women report more satisfaction if an implant is used at the time of #mastopexy. The implants further shape their breasts, restoring superior fullness or volume which may be decreased over time.
In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

What kind of lift and what kind of implants do I need? 36, 2kids, 5'6", 151 lbs

Hello dear, thanks for your question and provided information as well..
The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast…

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 358 reviews

Breast & Tummy Tuck

A breast reduction surgery with vertical scar and without using an implant would be a benefit for you.
You do not need an implant as you have enough breast tissue.

If possible you could combine the breast reduction together with  vaser liposuction for your upper abdomen,back and belt.

By combinating both treatments you will achieve a  good result.

Ozge Ergun, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 12 reviews

Best Implant size with lift

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below:

Breast Lift with Implants

The photos show a significant amount of breast sag (ptosis) and a standard breast lift (with or without implants) would be appropriate and necessary to get you the result that you're looking for. If you wish to increase the volume of your breasts it will be necessary to add implants. There is the likelihood that the breasts will 'look' somewhat smaller if a lift alone is performed. Although no breast tissue is removed during a breast lift, the reshaped breast does have a tendency to look somewhat smaller. An implant can be used to increase the breast size and volume. Exactly how large an implant would be entirely up to you.

For the best results seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and special skill in cosmetic plastic surgery as well.

For more information aboutr breast augmentation and breast lifts please see the web link below.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon
4.4 out of 5 stars 25 reviews

What kind of lift and what kind of implants do I need?

Thank you for your question.  Based on your photos, you appear to be a good candidate for a breast lift with implants.  The lift would probably be either a lollipop or anchor shaped lift depending on your exam.  Implant selection can be aided by trying on different sizers in the office to get a better idea of the look that you want.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 16 reviews

Lift, implants or both

We all strive for perfection BUT we work on human bodies that continuously change and perfection is not always the final outcome. Instead, the outcome may be exceptional, fabulous and more than the patient ever thought possible. That being said, there are many options for breasts as far as lifts and implants go. It all depends on the look the patient desires. In my practice, the patient tries on the implants in order to choose which size looks good on them and fits their personality. The breast lift will depend, again, on the look you desire. Based on your photo, you would be a candidate for either a vertical or traditional mastopexy. Then depending on the size implant you choose we will determine whether the two procedures could be done together or separately. Reason being, the breast lift is making everything tighter and higher, with the implant trying to make things larger. Doing the two procedures at the same time can sometimes work against each other, causing wound healing problems. Continue to do your research, look at photos and consult with only Board Certified Plastic Surgeons prior to making this very important decision.

Clayton L. Moliver, MD
Houston Plastic Surgeon
4.5 out of 5 stars 29 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.