Will I need a lift? Don’t want the scars that come with it , suggested I could do 375cc over the muscle. (photos)

Question

I was told during a virtual consultation that I needed a lift. I don’t want the scars that come with it so the surgeon suggested I could do 375cc over the muscle. The problem is that the pictures I submitted may not have been accurate since I was still breastfeeding. I stopped a little over a month ago and they’re returning back to normal. Could I get away with out a lift? I also don’t want them to end up dropping and sagging.

Gerald Minniti, MD, FACS · Answer

what's most important it that you have substantial asymmetry that will likely be worsened by augmentation alone. The 'good' breast will get a nice lift, the 'bad' breast will get waterfall deformity and worsen the symmetry even more. As for placing implants over the muscle, well that's just bad medicine. There is a mountain of evidence that over the muscle increases your risk for capsular contracture, implant palpability, and wrinkling. Stop worrying about the scars; done by an expert and they will become invisible to you quickly. Most importantly, a lift will create a breast that is beautiful in shape and symmetrical.

Finny George, MD · Answer

Hi, thank you for sharing your question. Proper implant placement may be able to avoid a lift however an in person evaluation is the best way to determine this.

Daniel Barrett, MD · Answer

Dear Awesome126716,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

If your goal is to have larger breasts and look good in a bra then implants alone will suffice. If your goal is to have an aesthetically attractive breasts without a bra then a lift should be added.

Laurie A. Casas, MD, FACS · Answer

Thank you for your great question! Based on your photos I agree that you will be much happier with the result if the board certified Plastic Surgeon does do a mastopexy at the same time so that your nipple areola can be moved higher up and any extra skin be tailored. I hope this helps.

Miguel Mota, MD · Answer

Hello and thank your for posting. If you are adamant that you don’t want the scars that come with a lift you don’t have to get a lift. Just understand that the results will not be as good. Large implants can fill out the breast and can give an ilusión of a lift but the areola placement will not improve noticeably. Especially on your right breast that seems to be much lower then the left. It will also not help with your asymmetry. So, can you really avoid the lift and get away with it? I don’t think so, unless you are ok with the type results I just mentioned.

That said, the correct size implants with a Benelli Lift, which is a peri-areolar scar lift (around the areola only), can help with symmetry and give you a slight lift as well. This reduced scar is not the best option but it is a good option and it might be the perfect compromise you!

Best of luck,
Dr. Miguel Mota

That said, the correct size implants with a Benelli Lift, which is a peri-areolar scar lift (around the areola only), can help with symmetry and give you a slight lift as well. This reduced scar is not the best option but it is a good option and it might be the perfect compromise you!

Best of luck,
Dr. Miguel Mota

Gary M. Horndeski, MD · Answer

If you had 375 cc implants placed over the muscle then they will descend inferiorly and laterally because of the added weight from the implant. Also when implants are placed in front of the muscle you are cutting the supporting ligaments of the breast. The technique I recommend is 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.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon, 6 months after you are done breast feeding, 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

Ronald J. Edelson, MD · Answer

I agree you need a lift. Without a lift you are better off doing nothing at all. A lollipop lift would work well
In your case so you have less scarring

Tyler Frew, MD · Answer

Hi there,
For the best symmetry possible I would recommend the lift. It will allow the surgeon to remove excess tissues and reshape your areolas. 
Of course if you don't want the lift you don't need to get it, you just have to be aware of what can be done and what cant be done.
I would send the surgeon more updated photos of your breast and see if the plan changes. 
All the best

Will I need a lift? Don’t want the scars that come with it , suggested I could do 375cc over the muscle. (photos)

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