Second breast augmentation - will i need a lift? (photos)

Question

Hi, I am due to have a second BA due to age of implants 13 years and natural sagging due to my age 56, I have been told I will need an uplift and implants, I am not keen on the uplift due to the scaring and just generally concerned about the extra work involved in this. Is it necessary to have an uplift, I think the surgeon was suggesting with out the uplift I would need bigger implants to fill the loose skin, is an uplift the only way forward. My implants are above the muscle and saline.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos alone, if you are seeking to address the laxity of the skin envelope, you have 2 options:
-Mastopexy to reduce/tighten the skin envelope
-Upsize...however you may not be amenable to the degree of upsize necessary to fill.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Ronald J. Edelson, MD · Answer

The photos you present are limited but it does appear that you have too much skin and your nipple is low. Going with a larger implant instead of a lift is often a mistake.  If you need a lift that’s what you should do.

Frank Agullo, MD · Answer

Look at where your nipple points in those photos. It's aimed down, and the breast has slid off the front of the implant. That's a skin and soft tissue problem, not a volume one, so a bigger implant won't pull it back up. It just adds weight to skin that's already given out, and a 13 year old saline above the muscle tends to bottom out faster when you load it. Bigger and still droopy.

Here's the deciding question: where does your nipple sit against your fold? At or below it, which is what yours looks like, and you need a lift. The implant fills you back out up top, the lift puts the nipple back where it belongs and takes up the slack skin. Yes, there's a scar. It settles, and it's the version that actually lasts.

Get measured in person, nipple to fold, before anyone picks implant size.

#StayBeautiful,

@RealDrWorldWide

Gary M. Horndeski, MD · Answer

I recommend explantation with breast lift using the Bellesoma. 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.

Michele A. Shermak, MD · Answer

Hello! Thank you for your question. Your photos are a bit hard to decipher but it does look like you would benefit from a lift. The issue is that you have saline implants above the muscle, making a lift challenging for recovery. The safest option for you would honestly be to 2 stage. Undergo implant exchange with movement of implant from above to below the muscle. And if you need later on the lift will be much safer. It may be that you are happy with the implant alone which would be great. Best of luck to you! Be sure you are seeing an experienced board certified plastic surgeon. You can find one at plasticsurgery.org.

Sameer Karkhanis, MS, DNB · Answer

Hello. My recommendation would be to a breast lift along with implant exchange. Normally breast tends to sag with age and for more youthful appearance at 56yrs I would definitely recommend a lift. We routinely do these surgeries at our Centre for Cosmetic Surgery. For any further queries feel free to connect with us. 
Thank you.

Regards,
Dr. Sameer Karkhanis,
Centre for Cosmetic Surgery, Mumbai, India
+919833571333

Second breast augmentation - will i need a lift? (photos)

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