Is it a good choice to get a breast augmentation with perioral mastopexy? (Photo)

Hi.
Thank you for your pictures and your question.
Looking at your pictures, I would recommend you a T-inverted breast lift with implants. In my experience, it is better to choose decent sized implants (300-380 cc) in order to avoid sagging, expanding areolas or wide scars. Unfortunately you have too much excess skin on your breasts for a periareolar lift since with this technique the breasts can be lifted maximum 2 cm. 
I would recommend you to consult again with your surgeon or get a second opinion from another certified plastic surgeon.
All the best
Dr Marco Carmona MD

Looking at your photos, you have almost grade 3 ptosis with loss of breast volume. An implant will help achieve the volume you desire, but a periareolar mastopexy will not give you the best result. Although patients prefer to have short scar techniques such as the vertical scar or the periareolar scar techniques, the scar can be thicker, crinkled and wider in these procedures as the skin is bunched up when suturing it together to keep the length of the scar down. This can result in a flattened appearance of the breast in the lower or central part of the breast depending on the technique used. A wise pattern (key hole pattern) scar allows the best possible redraping of your breast tissue, although at the expense of longer scars. There is always a risk of your areola stretching out and becoming larger in future with a peri areolar mastopexy.

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 vertical or wise pattern breast lift.  I do
not ever recommend a Bennelli or circumareaolar (donut) lift.  Over time,
the areola tends to enlarge with a thickened scar.  The other even worse
problem with a circumareaolar lift is that it flattens out the shape
of the anterior breast over time.  A vertical or wise pattern lift with an
implant can result in a very nice shape if good technique is
used.    The size 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.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

I don't think a peri-areolar mastopexy will give you enough lift. I would suggest a circumvertical technique which will leave you with a 'lollipop' or 'tennis racket' shaped scar. I have found the Vectra-XT imaging system to be extremely helpful in helping patients visualise the surgery and make an informed decision about the best option for them. I would advise seeing a surgeon who can offer this service. Best of luck.

Thank you for your question and photos.  Based on the picture showing your desired look, I would suggest that you have another discussion with your surgeon. You are unlikely to get that much improvement with just a peri-areolar mastopexy.  The power of that operation is greatly exaggerated and the most common result is a flat breast with wide areolas and wide scars.   I reserve that procedure for someone with very borderline ptosis that needs maybe 1cm to 2cm (maximum) of nipple elevation.  Although in-person exams are better, from your photos I would recommend a formal vertical lift with either a lollipop or inverted T scar.   Good luck. 

A periareolar lift or a Benelli lift does nothing to actually rearrange the breast tissue and lift it into a perkier position. It removes excess skin in a donut shape around the areola. This type of "lift" does not have good long-term results. Yes, there is less incision/scar, but the outcome is not as long lasting or effective.The areola tends to spread/enlarge with time as all the tension is placed on the one circular incision. If the implant placed is too big,  there may not be enough laxity to do a more effective lift (vertica/lollipop or wise pattern/anchor). An alternative is to select a smaller implant that allows a lift that actually places your breast tissue in a more lifted position. Best of luck! 

Many patients come to me requesting a lift and some desire for augmentation. The volume decision is an easy one - select a desired volume and we will augment with an implant or with fat grafting. Be warned that augmentation does little to lift the breast and in most cases, the added weight results in further breast sagging!For the lift, many patients make their choice for procedure based on the scar created by the lift procedure;1-A periareolar scar or donut scar is an incision around the areola.2-A lollipop scar is an incision around the areola and a vertical incision down the breast at the 6 o'clock position.3-An anchor scar is an incision around the areola, down the breast at 6 o'clock and a scar that traces under the breast along the inframammary fold.The scars however do NOT describe the actual lift. Lifting breast tissue by just removing or tightening skin, without reshaping or lifting the breast tissue will be short-lived and result in sagging breasts with new scars - a lose-lose procedure.In order to make a beautiful, long-lasting lifted  breast, the tissue of the breast must be reshaped and lifted to its new position. If done well, the skin around the lifted breast will contract around the tissue minimizing the need for skin excision and the ugly scars. It is this reasoning, that most of my patients will get either the periareolar scar or the lollipop, but few get the anchor scar.Further, I offer patients who qualify physically, my teardrop augmentation mastopexy (a periareola lift with augmentation) or a Lejour lift with implant. The teardrop procedure lifts the breast tissue by lifting the tissue on the upper half of the breast resulting in more upper pole fullness. Projection is provided by the implant and tightening of the lower half of the breast. If your nipple to sternal notch distance is less than 25 cm's, you can get this procedure.If you look at some of my photos on this website, you can see how beautiful the results can be with this technique.For more information, please read my book "Cosmetic Breast Surgery - a complete guide from A to Double D".

You would most likely get the best result with a full breast lift with breast augmentation. Please seek an in person consultation with a board certified plastic surgeon in your area. Be sure to express your goals and expectations to your chosen surgeon. In my practice in the San Francisco Bay Area I have come to the conclusion that the happiest patients are those that have realistic expectation on what a procedure will and won’t do for them. Good luck!
Dean Vistnes, MD. 
Vistnes Plastic Surgery 
San Francisco Bay Area 
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