Do I need breast implants in addition to a lift? Is it possible to have them closer together? (Photo)

Hi there, I had breast implant surgery a little over 10 years ago. I was very flat and went from an A to a small D (high profile/saline/under muscle). They looked great! Now, after 10 years, two boys, up and down weight changes, I HATE them and am starting to look for surgeons to fix them. I want them big (size D) and closer together. They are naturally far apart but with the amount of tissue I have now is it possible for them to be closer together? Also, do I need an implant, too? Silicone?

Doctor Answers 9

Breast Implants in Addition to a Breast Lift

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It is not necessary. However, many patients achieve a better result by increased the fullness often lost with child-bearing, with the addition of an #implant with the mastopexy, known as Augmentation Mastopexy. In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result.  All in all, an elevated, more youthful breast can be a satisfying result for the patient.

Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Do I need breast implants in addition to a lift? Is it possible to have them closer together?

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Hi and thanks for your question. Consideringbthat it's been ten years and a few kids post your original surgery, you look very good. Because you are so to have abreast lift, I would just recommend an implant exchanghe. You will need to go larger. You also need to realize that your breasts are borderline whether or not a lift is required. So, you need to have realistic expectations. make sure you have an in depth converstaion with your surgeon.

As far as the space that separates your breasts,realize that this is your shape and not much can be done to correct that. By using a larger implant, you may be able to accomodate your bra so that it's not as noticeable.

Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in breast augmentations. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits?

How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.

How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.Good luck

Do I need breast implants in addition to a lift? Is it possible to have them closer together?

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With everything you've been through - ten years post-implants, two pregnancies, associated weight gains and losses - I think you can/should be very happy with the way you look!  As you can see from this site and others, not everyone comes through that with the same result.

There are several issues.  In general, it is difficult to achieve the cleavage that many women want.  The position of the nipples/areolas is hard to change (without leaving substantial scarring) and placing the implants too close to each other (to create "cleavage") risks leaving the nipples too far lateral (to the side) and not centered on the breasts.  Instead, cleavage is best achieved using bras, bikini tops, etc.

If at all possible, I would advise you to try to avoid a lift.  There is much more scarring (and risks and a more delayed recovery, etc) once a lift is added to the procedure.  There are times that it's unavoidable, but I'm not sure that's the case with you.

You may benefit from simply switching the implants you have.  That would minimize the complexity of the procedure and since you had them under the muscle you may need only a partial capsulectomy (removal of a portion of the capsule), although if your skin is very thin (can't assess from photos) you may need the addition of an acellular dermal matrix, such as Strattice.

You should see several board-certified plastic surgeons in consult and see what they have to say, and then make your decision after that.

I hope that this helps and good luck,

Dr. Alan Engler
Member of RealSelf100

Cleavage isn't always easy to create surgically

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Pregnancy and weight fluctuations appear to have stretched out your breasts, however the pics don't appear to show abnormal capsular contracture (scar build-up).  The profile pic appears to demonstrate loss of the upper pole fullness, which could be improved with the use of an ultrahigh profile silicone gel implant, replaced in your dual plane pocket.  Many revisional breast implant patients' pockets are excessively large, laterally (out towards the armpit) so "re-do" surgery often includes procedures to narrow the pocket, analogous to a "bookend", so the implants don't displace outward, upon recumbency.  This could take the form of a suture capsulorrhapy or any of the biological meshes (Strattice, Seri scaffolding, etc.), however these are expensive "add ons".  On balance, given how lax your breast skin appears, it may be beneficial to accept the complete package: mastopexy, an internal bra, and textured silicone gel implants, especially if you desire a larger volume for the following reasons: 1) for equivalent (cc) volume implants, silicone is less dense so delays recurrent droop more than saline; 2) being proactive about offloading the weight of an implant with an internal support may be the fiscally responsible decision in the long run, if it saves you additional surgery and expense; 3) mastopexy provides a "hand in glove" fit so your breast skin brassiere meshes with the biological used; 4) all elements work to produce a round, high and tight appearance, similar to your pre-pregnancy high profile salines.  Good luck.  

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Implant change

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I would consider a quick in office implant removal type procedure while awake and then let your skin shrink for 2-3 months. Then since you want to be big a 550- 650cc or so silicone implant in a dual plane position would be my choice. You may need a small lift but maybe not if your skin shrinks well after current ones gone.
Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 60 reviews

Revision after 10 years

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Thankfully picture. I think that you will need implants to make them fuller and you will need a lift. They can be slightly closer together but not much. Your normal breast are not that close together.

Single stage implant exchange and lift with repositioning of implants

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It looks like your current implants are in front of the muscle.  They need to be put behind the muscle and closer together with an inverted T mastopexy.  There are many studies that show the safety of doing this in 1 stage which is much more affordable without two sets of downtime.  But many would still recommend a two stage procedure the first taking implant from in front and putting it behind the muscle, the second being the inverted T mastopexy.

William D. Leighton, MD (in memoriam)
Scottsdale Plastic Surgeon

Do I need breast implants in addition to a lift? Is it possible to have them closer together?

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Posted photos are at a long focal distance so very hard to advise. In these cases I recommend a few IN PERSON opinions from boarded PSS in Boca Raton area. Appears as the separation will not improve much even with 500 cc + implants. I might recommend 2 operations about 3 months apart. 1st full lift. Second implants...  

Breast implants are not required for a youthful look.

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Only have breast implants placed if you want to be larger. The medial border of your breast as it exists now will always be the medial border. Implants cannot be placed beyond that border.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

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