What would be the best solution? (photos)

I recently had a consultation and the doctor said since I'm still young I could just put implants in- I hate the sagging and sizes of my areolas. What would be best to achieve evenness, smaller areolas & a small breast implant

Doctor Answers 18

What would be the best solution?

Size and shape of breasts can often play a critical role in a woman’s self-esteem. Fuller and bigger breasts are often associated with reproducibility therefore it is a desired condition. There are different kinds of breast augmentation operation types. Breast augmentation can be performed either with breast implants or autologous fat transfer. There are also different types of breast implants like teardrop or round implants. These implants also can be placed under or above the muscle. As you can imagine there are several different options for breast augmentation. The best way to understand which one is more suitable for you is to get a physical examination by a plastic surgeon.


Turkey Plastic Surgeon
4.9 out of 5 stars 79 reviews

Best solution?

You have answered your own question.  If it is the sagging and areola size you find disturbing then a vertical mastopexy, auto-implant technique will accomplish lift, reduction of areola size and redistribution of breast tissue into the upper pole.  If upon simulation of this procedure the breasts seem too small I would consider fat grafting if your need is a half cup size.  A cup size or more, you will be better served with an implant in my experience

Patient's goals should be of utmost importance

and since you want smaller areola and more perkiness, you will need a lift and have to accept the scarring, risks, and additional costs of having a lift.  If you want to be larger, then an implant is needed as well... or if you just want to be a little fuller, you could get fat grafting to deficient areas after you've healed from your lift.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Breast lift with augmentation

From your photos, you seem to have a fair amount of breast tissue already. You should be able to get a very nice result with just a breast lift. If you'd like to increase your breast size you could do so easily at the same time with an implant. Be sure to express your goals and expectations with your chosen surgeon. Good luck! 

Dean Vistnes, M.D. Vistnes Plastic Surgery San Francisco Bay Area

#drdeanvistnes #realself #breastlift

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 42 reviews

The best way to achieve what you want

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. 
See the below link on some suggestions on finding the most qualified Plastic Surgeon for a  Breast Augmentation.

What would be the best solution?

Thank you for the question and pictures.

 After review of your pictures, it is clear that you WILL benefit from breast lifting surgery. You will not end up with an aesthetically pleasing results if you undergo breast augmentation surgery only.


 If you were to undergo breast augmentation surgery only  I think that 2 types of “results” would be predictable:


1. You will end up with “big and low” breasts and unhappy with the aesthetic outcome etc.


2. You will end up with the breast implants sitting high on your chest wall with the breast tissue lower down,  again creating an aesthetically unpleasant outcome. You will find that you will continue to have breast skin sitting on top of upper abdominal wall skin, unless you lift the breasts.


For some patients the necessity of additional scars is a “dealbreaker” ; for these patients it is better to avoid breast surgery altogether.   

On the other hand, many patients (If properly selected and who are doing the operations at the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.    




Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time.  This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate;  obviously, the need for additional surgery, time off work/life  considerations,  and additional expenses  our “factors” that should be considered before undergoing the initial operation. I would say that, in most communities,  anesthesia and surgery facility fees (minimally) are patient responsibility,  when returning to the operating room for revisionary breast surgery.  




Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging  of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand,  when performing breast augmentation/lifting surgery we are increasing the breast  size with breast implants;  on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift.. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic;  removing too little breast skin/tissue can also be problematic.  Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  The analogy I use in my practice is that  of a thinned out balloon,  being expanded with additional air; I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation. To achieve  a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve.  Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit)  as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane)  and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would;  therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur  and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer.  The use of the tailor tacking technique is very helpful. 



 Breast lifting involves removal of skin ( and tightening of the breast skin envelope)  while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate  size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications.  Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.  Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. 



 Patients should be aware of the complexity of this combination procedure and achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness).  It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation.  The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery,  Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia,  lateral displacement etc). 



 Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues  to causing skin or tissue necrosis.   Poor scarring,  pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc.  Patients may also be dissatisfied with breast size, shape, and/or how the  breast implants and overlying breast tissues “interface” with one another.    Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least.  Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved. 

 

 I hope that this summary of SOME  of the issues surrounding breast augmentation/lifting surgery  is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful.  Best wishes.

Augmentation Mastopexy

Hello,

I question the credentials and/or the expertise of the surgeon you consulted with. You would not have a nice result with implants alone, and would be saggier and more asymmetric than you are now. Breast lifts are for young people too; they are designed to make your breasts look sexier, even with scars (that are likely to be inconspicuous or nearly invisible). Go visit a few ABPS certified/ASAPS member surgeons that specialize in all aspects of breast surgery, not just implants. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

What would be the best solution?

Given your concerns about your sagging and the size of your areolas, you appear to be a good candidate for a breast lift with a small implant. I am a big fan of the vertical or lollipop mastopexy. This is a demanding procedure and I suggest you find a very experienced aesthetic breast plastic surgeon. All the best.

Young woman with saggy breasts and wide areolae.

I disagree with the recommendation that you proceed with breast implants alone since they may enhance the sagginess of your breasts and would certainly widen your areolae.  I feeling based solely on your photograph is for you to consider a full uplift to reduce your areolae and raise your breasts alone or a full uplift combined with placement of conservatively sized silicone or saline breast implants.  Meet with a few ABPS board-certified plastic surgeons to discuss your options and be certain that your making the right decision for you personally.  Good luck and best wishes.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast lift, reduction and augmentation combination #plasticsurgery

A reasonable solution for your type of breast anatomy would be a breast reduction to eliminate sagging breast tissue, a breast lift to reduce areolar size and augmentation with a reasonably sized silicone implant.

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