Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)

Hello MF35,

Subglandular implant placement in a ptotic breast, especially with a large implant, will quickly lead to a large ptotic breast.  I specialize in implant revision and see this all the time.  No matter how large an implant is, it will never allow the ptotic nipple areolar complex to rotate up into a better position on the breast mound, yet some surgeons do it all the time.  Another concern I have is that your inframammary folds sits high on the chest (hence the reason in your case you have breast ptosis), and a large implant will require the doctor to substantially lower the fold to properly place the implant under breast mound.  This puts you at high risk for double bubble phenomenon, as well as severe rippling.

Many surgeons, including myself, have chosen to adhere to principles based in evidence or scientific evaluation, as opposed to a subjective belief system of 'what works'. One measure of how well this objective and quantifiable system works is looking at complication rates.  The national average for complications within three years of surgery is 25%, which can be reduced to 2-3% when adhering to evidenced based principles.

You should not place an implant above the muscle just to obtain a false sense of a lift that is always temporary. In the end, you will have recurrent 'drop out', or worse, a 'ball in sock' appearance, especially with larger implants or high profile implants.  Further, subglandular implants have a host of other complications and problems that can be avoided by a partial subpectoral placement.  'Subfascial' placement shows no difference than subglandular placement, and therefore provides no benefit when examined in objectively.

A partial subpectoral placement of low or intermediate profile, properly sized implants, with a possible mastopexy (depending on your physical exam, but based on your photos you will benefit from one) will yield a long lasting, pretty result with the lowest risk of complications.

I would keep looking for a surgeon in your area who doesn't consider a large implant a real alternative to a mastopexy. 

Best of luck.

 

You may not need a breast lift, however to determine this you would need a consultation with a surgeon who has experience with performing breast augmentation on breasts affected by mild to moderate sagging. You can consider Allergan Inspira Truform 2 implants with a narrower base width for more projection.

Submuscular Breast Augmentation even with dual plane dissection often leaves the Breast Implant in a higher position than a Subglandular Breast Implant. Your Breast are Ptotic (sagging) and Submuscular Implantation risks a Snoopy Deformity in which the implant rides higher than your natural Breast tissue.

For this reason I would use the Subglandular Breast Augmentation approach unless you are willing to have a Breast Lift at this time. A Breast Lift can always, many say preferrably, done at 6 months after Breast Augmenation.

In your situation I would go with a Moderate Profile as opposed to a High Profile. The High profile has a narrow base and will not conform as well to the shape of your Breast as will a moderate profile.

As to size of Implant I suggest you use the Rice Test described in the link below to get an idea of what additional volume will give you the look that yo9u want.