To lift or not? (photos)

Question

So Im 38 5'11, 176lbs with 4 kids and have been wanting a breast augmentation for awhile. Im torn on wether or not I should do a lift. Im currently a 38 B. I am scheduled for surgery in January but I am on the fence as to size and if I should or shouldnt do a lift. My surgeon said he wouldnt do a lift because my measurements are right at borderline of me needing one. I would like more upper fullness though. Im attaching inso pics as well as pics of what I look like now.

Ted Eisenberg, DO, FACOS, FAACS · Answer

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

Gary M. Horndeski, MD · Answer

Your results will not be comparable to your ideal photographs because your breasts are too low on the chest wall. You do not have ptotis but they are low. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

Although most photos were unhelpful, it appears that your fold is below your nipple, making an augmentation without a lift suitable. Whether you can achieve the same result as your goal photos remains to be seen, and would require an in person consultation to properly assess your anatomy and predict your outcome.

Donald R. Revis Jr, MD · Answer

Good afternoon,
Yes- a donut mastopexy would be a good idea. Your nipple position is just below the center of your breasts, and therefore postop they will also be just below the center of your breasts, not centered which is proper and the way your goal photos are positioned. Also, if your surgeon attempts to overdissect or lower your creases so that your nipples ARE centered without a lift, you will bottom out and not have the upper pole fullness present in your goal photos- size-wise you probably need Mentor MemoryGel in the 490-560cc XHP range, but we would have to nail this down when I measured your chest, we reviewed photos together, and you were able to try on the implant sizers here in the office.

Daniel Barrett, MD · Answer

Dear ashley83,
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

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Although your photographs offer limited views it appears that you would do well with an implant placement alone.  This is best determined with an in-person examination, however.

Camille Cash, MD · Answer

More information is needed about the implant you are considering.  With the correct implant you will be able to achieve upper pole fullness.  If you are wanting a full perky look with your nipples in a higher position then a lift would achieve this.  If you are unsure about your choices I encourage you to return to your surgeon for further discussion.  It is important that you feel comfortable and confident as you prepare for surgery.