Do I need a breast lift, or could I just get a bigger implant size? (Photo)

Question

I had saline implants placed submuscular 20 yrs ago. I never really thought my breasts were droopy but when I went to a PS consult recently he said I had waterfall deformity, slight animation deformity, and that one of my implants had broken partly away from the muscle creating a sorta “dual plane” scenario. He recommended a full anchor lift and wasn’t sure how big I could actually go as far as implant wise. Could I possibly just get a bigger implant size? I really don’t want a lift.

Chul Hwan Seul, MD, PhD · Answer

Currently, the sagging is not severe and the waterfall deformity is not severe, so in my opinion, it is better not to lift, and if there is damage to the implant, it is better to change only the implant to a similar size. If the implant is made larger than the current size, the shape will deteriorate, so lifting would be required. This lifting surgery (mastopexy) inevitably leaves scars.

Randal Haworth, MD, FACS · Answer

Even though you were recommended an anchor scar mastopexy, most people don’t realize that a proper vertical lift will be able to successfully treat most cases of breast ptosis. Based on your photograph and question, you may be a good candidate for a breast lift with an even smaller scar , which is the Benelli mastopexy. With a Benelli, the scar is confined to the perimeter of the areola and is not only able to make it smaller but also able to tighten the surrounding breast skin as well to a certain degree.

I hope this helps, good luck !

I hope this helps, good luck !

Gary M. Horndeski, MD · Answer

The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated 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 if not injured during your previous surgery. 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.

Farbod Esmailian, MD · Answer

It really comes down to expectations. You can go bigger and forgo the lift, but you will still have some pseudoptosis, which is when the nipple is in a good position but the lower pole breast tissue and skin hang down below the fold. You do have that now and a bigger implant wont necessarily address that. A donut lift will address that, partially or for a short period of time. A donut lift is not the best lift and if used when a better option is needed then you have distortion and stretching of the areola over time. I have nothing against a donut mastopexy, I do use it in my own practice, but it needs to be used with caution. A vertical lift can also be used in your case, but it will tend to increase your nipple to crease distance and you already have a longer distance to begin with. A full lift (anchor) will address the sagging or pseudoptosis the best but you have more scars to deal with.

Hope that helps.

Hope that helps.

Daniel Barrett, MD · Answer

Dear achiz758,
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

Connie Hiers, MD, FACS · Answer

Going bigger will just make your problems more noticeable with more sagging from extra weight and more drooping over the implant.  Please listen to the advice of your surgeon.

Antonios Mitsakos, MD · Answer

By this I mean if you are happy with the overall shape of your breasts an uplift is not mandatory in any scenario. A mild ptosis (droopiness) can be compensated with slightly larger implants indeed to an extent but it all depends on the look you are going for. My advice is for you to see a surgeon who is more flexible with the options they give you.

Hilton Becker, MD · Answer

You do have significant ptosis  (sagging) therefore some form of lifting would be beneficial.
If you wanted to replace your implants I would recommend placement above the muscle .

Douglas Taranow, DO, FACOS · Answer

I disagree with an anchor lift.  I feel you may be able to have either a periareolar (around the nipple scar) or a lollipop lift.

Darryl J. Blinski, MD · Answer

The photos show the need for at least a 400 cc HP implant, with bilateral donut lifts. Fee $8,000. Best to virtual consult with….

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