Would I be a good candidate for silicone gel over the muscle without a lift? (Photo)

I have had 3 different consults for a breast aug and I am already confused! First PS suggested breast aug with silicone gel "over" the muscle which would not require the scarring of a breast lift. The second PS said he would do saline under the muscle with a breast lift. The third PS said he would only do a lift without the implants.

Doctor Answers 13

Would I be a good candidate for silicone gel over the muscle without a lift?

The real question that you need to answer is what do you want your breasts to look like and how big do you want them to be. An implant alone will increase volume but not change your shape. Your breasts have a considerable amount of sag in the picture and implants alone will give you a larger saggy breast-they will not lift the breast, only add more volume.
A breast lift alone or with an implant if you want additional volume is the best option for making your breast look more perky and elevating the nipple position

Would I be a good candidate for silicone gel over the muscle without a lift

I do not think the implant filler is off great concern although if the implant is positioned  on top of the muslce, the saline implants do eventually show more ripples. I think that with the shape and position of your breasts, that an implant alone on top would leave you larger, yes, but also saggier in a short period of time. I do think a lift is beneficial, with or without the implant.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Would I be a good candidate for silicone gel over the muscle without a lift?

Thank you for your question and photograph. Depending on your desired appearance, the best enhancement would be obtained through a breast lift and implants. The implant will add breast volume - if this is something you desire - while the lift will help elevate your natural breast tissue, remove excess skin and raise your nipple and areola into a more youthful position.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

Three opinions!

Actually, each of those recommendations has a place. It depends on your goals for the final shape/form and size. BA alone is marginal unless you accept breasts still tilting downward off the implants, which then is O.K.

Lift with implants is fine if you want larger breasts with better shape/form. Lift alone seems to be O.K. from the pictures if your breast tissue is fairly firm and you want better shape/form but the same or slightly smaller breasts.

This profession is ALL about meeting patient expectations, not whether or not we "can do" an operation. The greatest result from the "wrong" operation for the patient's goals is a failure. Think about your goals and discuss them fully with the surgeon whose recommendation seems closest to that.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 69 reviews

Breast lift with or without implants

Thank you for your question but sorry to hear about your confusion. Each of the procedures you mentioned will provide a different result. The difference between saline and silicone will be negligible for you given the amount of natural breast tissue you have which will conceal the implant. If you don't wish to have increased overall volume or increased upper pole fullness and roundness to the breast, then you do not require an implant. A lift will provide a more youthful lifted appearance to the breast with the nipple sitting at the most projecting aspect of the breast but will not provide much upper pole fullness. Each of these options should be described to you in great detail by each of your consultation surgeons so that you may make an educated decision as to which procedure is best for you. It is at that point that you should choose the surgeon with whom you are most comfortable. Hope this helps


All these options can be very confusing.  Which you choose depends on your goals.  If you are set on being larger, then you need an implant.   However your nipples are ptotic and an augmentation alone will result in volume in the upper pole with lower positioned nipples.  You appear to have a tight lower pole as well as dense breast tissue which would make an augmentation and a lift at the same time a bit more challenging.  My recommendation would be to do a vertical lift to position the nipples at the apex of the breast or slightly higher.  Then later if you still would like more volume, undergoing an augmentation with an implant.  

Lift or not

It is not a perfect world.Simply put,if your nipples are ABOVE the inframmmary folds then you have pseudoptosis and not true ptosis and this can be corrected with an impant ie silicone and maybe some fat grafting.I usually go above the muscle in this case.If your nipples are BELOW your inframmmary fold then you probably need a lift or mastopexy.Many times this can include an augmentation.Soemtimes I will do a lift and rather than place an implant will graft a patient's own fat to give their breast more volume.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 54 reviews

Would I be a good candidate for silicone gel over the muscle without a lift?

Thank you for the question and pictures. I think that you will benefit from breast lifting surgery. Although there are cases where well-positioned breast implants can create the "illusion" of a breast lift, breast implants do not ACTUALLY provide a breast lifting effect.
Based on the position of your nipples/areola complexes on your chest wall and the amount of breast skin "sitting" on your upper abdominal wall, I do not think that you will do well with breast augmentation surgery alone.
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Be careful with your decision-making; revisionary breast surgery can be more costly in many ways. Best wishes.

Breast augmentation vs mastopexy

Hello and thank you for reaching out. It is difficult to pinpoint a recommendation from only the photos you have provided, but a mastopexy or breast lift might suit your wanted results better than just a straight augmentation. The weight of the implants could cause your breasts to sag with just an augmentation, so that would not be the procedure I recommend. However, if you are interested in just having your current breast tissue higher on your chest wall, and are not interested in anymore fullness at the top of your breast, then a mastopexy with no implant, is what you are looking for, just remember you will go down 1 cup size with just a lift. There is a lot of information that goes with each procedure, so once you chose which surgeon you feel most comfortable with, discuss each procedure and review the details. Best Wishes.

Full breast lift with implants

Thank you for your question and photo.  Although you will be left with scarring on your breasts, I think you would be best suited with a full breast lift with modestly-sized implants.  Implants alone will NOT lift your breasts and only cause your breasts to sag more with time.  

All the best,

Dr. Results
Miami, FL

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.