Ptosis Too Severe to Get Away Without Having A Lift
It seems like I have been having this conversation an awful lot with patients lately. Your photos show that your breasts are asymmetric in terms of size, and the degree of Ptosis (sagging) with your right breast being larger and, more importantly, more ptotic. In addition your breasts are low on your chest wall which further complicates the situation. I would not try to correct your situation but just doing implants. Your left breast is possibly borderline (hard to tell for sure with just photos) but your right breast has sagged too far to get a good result with just an implant. If you try to get away with just an implant you will likely end up with a snoopy breast. Alternatively, because your breasts are low on your chest wall, a submuscular implant will likely get pushed down and out from under the muscle and down into the breast tissue. The result will be an enlarged but otherwise low or sagging breast, with little fullness in the upper breast where it is desired. I doubt that is the result that you are looking for.
It is perfectly understandable that patients are concerned about the scars associated with a breast lift. When done carefully, these scars can be very acceptable and they are far superior to a poorly positioned breast implant or other breast deformity caused by trying to correct sagging breasts with just an implant alone. Every couple of months I see a patient that is unhappy with their breast appearance after trying to improve their breast by just getting a large implant placed too low. Often these patients have had their surgery done by someone who is not certified by the American Board of Plastic Surgery. These so-called Cosmetic surgeons do not have the education, skill, or experience to successfully perform the more complicated procedures of a lift with an implant. Unfortunately it is the patients who suffer.
Understandably you may not wish to have the additional scars of a breast lift, but you would be better served by having an implant with a lift.
Can I get away without having a lift? Or is my ptosis too severe?
Breast augmentation with a lollipop lift
will give you a better shape to your breasts while avoiding the full
scar associated with the anchor lift.
Select a plastic surgeon who performs hundreds of breast augmentations
and lifts each year, has great reviews, and has great before and after
Kenneth Hughes, MD
Los Angeles, CA
I agree with your plastic surgeon. You need a mastopexy to get the best results
Hi racerwifeof4. After looking at your pictures, I think you would benefit from a breast augmentation with a periareolar mastopexy. This could be done with a scar that hides very nicely around the areola, and will not significantly detract from your results. If you are still anxious, I suggest to spend more time speaking with your plastic surgeon. Good luck!
When I have a patient that is a possible lift candidate, I recommend that the decision to have a lift must be donfirmed. Whether the lift is done at the time of augmentation is your final dexidion, but I want my patients to at least be accepting of a lift postop if it becomes necessary, so that decision needs to be agreed-upon before we start any part of the process.
Breast lift + implants
It looks like you need more than just implants. Implants alone do not provide enough lift and since you have more glandular ptosis you need a more formal lift.
To lift or not to lift
Thank you for your photo and question. Although, I photo is no substitute for a physical exam, I am inclined to agree with your surgeon. You have obvious ptosis on your right and borderline ptosis (pseudoptosis) on your left. Your skin envelope looks loose to my and my concern with a sub-muscular implant placement is that your breast tissues will slide off of the breast, leaving you with a double contour deformity (snoopy breast). Try not to focus too much on the scars. A mastopexy (lift) combined with the an implant is a very powerful tool to help shape the breast. While all of my patients are concerned with the potential scars, the vast majority of my patients would rather have a better shape and look to their breast. The scars will fade with time and eventually become hardly noticeable. Additionally, a breast lift would allow your surgeon to better control the asymmetry and even out your breasts. I would suggest that you revisit this again with your surgeon to make sure that you make the best choice for your situation. Good luck.
Need for breast lift?
The general rule of thumb is that if the nipples sit below the
inframammary fold (the crease under the breast), then a lift is recommended.
However, there are several other anatomic factors of the breast as well
as the patient's desires and expectations that further determine whether a lift
is performed or not with or without an implant. Because a breast lift
tightens up the breast envelope and breast implants expand the breast envelop,
you are more limited by this fact than any other when trying to go with a large
implant. One way around this issue is to have the procedures done
separately, for example have the lift done first then 6+ months later undergo
the breast augmentation with implants. In general it is always best to
fit the implant with the patients breast anatomic dimensions thus minimizing
immediate as well as long term complications. Based upon your photos, your left breast is indeed "50/50" however your right breast is more likely to require a lift. In this instance, many times it is better do lift both of them to achieve better overall symmetry of overall shape, position, and scars. Once you are ready, consult with
a board certified plastic surgeon that can then perform an in person physical
exam and help you best decide on a final surgical plan.
A breast lift plus implants will give you a better result
There is nothing wrong with having a biplanar breast augmentation with the understanding that in 3-6 months you may need a breast lift for an optimal result. However you may not want to have 2 surgeries instead of 1.
There are many benefits and advantages to having your breast implants placed beneath the chest muscle. However if you are going to have a sub-muscular breast augmentation it makes the need for a breast lift even more important.
I would revisit your plastic surgeon home you like and have a thorough discussion of these options. If the surgeon feels that a biplanar breast augmentation will be adequate then follow that doctors advice. However be aware that because of the ptosis that you have it is likely that in 3-6 months you will need a lift based on your photographs.
Getting Away without a lift
Your example is tricky. It is always possible to get away without a lift, the question is how willing are you to accept the appearance without one. I would question the decision to go below the muscle. In borderline cases it is often better to go above the muscle as the implant in this position can provide a small amount of lift without the added scar of a formal lift. When cases like yours come up, I remind women that there is not a medical need for a lift, and it is certainly possible to have your implants first and then decide if you want a lift later. Getting the surgery just right is also a little easier in two operations. Most women won't put up with that, though, and there is still a high likelihood of a good result by doing both in one.
Your breasts are fairly low on your chest and it is possible that implants beneath the muscle will be above your breast tissue, leading to the double bubble you mentioned. A dual-plane augmentation can balance this out somewhat.
May be worth another discussion as the in person exam is a lot more valuable than me or someone else just looking at pictures.
Breast Implants with or without a Lift
Thank you for your question and pictures. Advice is always more reliable following an in person consultation, but these are some thoughts I have from your photos. It appears that your nipple position is below your breast crease and breast volume has dropped to the bottom of your skin envelope. Your two breasts are different in size and shape. An implant can fill up the deflated skin envelope, but may not give you the best shape. I think your best outcome will be with a lift in addition to the implant. You can have the lift at a second stage. This will allow you to see if you are satisfied without correcting the nipple position and skin differences.