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.

Thank you for your question and the photos. First, let me point out....implants do not cause lift. They add volume to your breasts.  There is a limit to how much volume can be added. Here are some things to consider:

1. As you get older, your breast skin will age, stretch and become thinner even without an implant.  The larger any breast, augmented or not, the worse it will look over time due to skin stretching.

2. Adding any implant to your breast adds weight and will produce stretch and irreversible thinning of your breast tissues over time.

3. The larger the implant, the greater the amount of breast tissue stretch that will occur.

4. Adding excess weight to the breast almost guarantees that it will look worse over time, with increased stretch and sagging.  It is impossible to predict whether or when this will occur in any individual patient.

5. Adding weight to your breast with a large implant may cause you to need further surgery in the future, particularly mastopexy (breast lift) with additional visible scars and risks.  You will incur additional costs, time off work, risks, and trade-offs if additional surgery is necessary.

6. Excessive breast tissue stretch from a large implant can make you more likely to have surgical complications with healing problems if the tissues become very thin.

7. As breast tissues thin, You will definitely be able to feel your implant and portions of the implant may be visible through your skin and visible rippling or wrinkling may occur.


8. If excessive stretch or complications occur (and this is unpredictable), it may even become necessary to remove the implants, with compromise in the appearance of your breasts and probable visible scarring if breast lifting (mastopexy) is necessary when the implants are removed.

Return to your 3 PS's to discuss these issues and have all of your questions answered. I hope this helps.

I hear what you are saying, but like many of my colleagues feel that large subglandular implants will eventually sag due to the implant weight and skin laxity.  Subpectoral placement tends to be better for upper pole fullness and may be combined with a periareolar mastopexy if necessary.  For narrow breast width, I frequently use moderate plus implants, rarely HP.  Yes, after pregnancy a breast lift may be beneficial. 

Thank you for the photographs and for your question.  You have a very slight degree of droop.  In your situation I generally recommend placing the implants, allowing them to settle and consider a lift or tightening of the breast only if necessary after about six months.  While implants above the muscle would give more lift I generally favor implants below the muscle because they tend to look more natural and mammography is better. In someone like yourself I favor the wait and see approach because once you have the scars  associated with a lift you really can't take them back.  If you do the implant first you have burned no bridges.  While a 450 implant is a generous size it will give a lot of elevation of the breast. In my experience most people with your starting situation will generally do fine with just the implant, particularly a high profile implant.

As long as you and your surgeon are on the same page and are comfortable with a possible future lift I would take the option that starts out with the least scarring.

Best of luck.

 

 

I believe that you could have implants placed in a subectoral dual-plane or a subglandular pocket.  While some subglandular augmentation patients have no problems, if you do have some of the problems stated below, these problems can be extremely difficult to correct later due to thinning out of your tissues. 

From your pictures it appears that you absolutely DO NOT need a lift.  Your nipples are very close to the midhumeral point of your arm where they should be.  You have a very high inframammary fold which can cause some confusion in this regard.  I treat patients such as you with a technique that I call 'cold-subfascial.'  I use a transaxillary approach so there are no scars on the breast nd because this technique actually supports the implant into a tear drop shape I use low profile implants.  Low profile implants give a larger radius and allow more upper pole fullness.  You appear to have a rather wide chest and would benifit from this strategy.  I hope this helps!

 

All the best,

 

Rian A. Maercks M.D.

When you're in your spot, it is a tough call.  You may find it helpful to look at before and after photos of patients with a similar breast shape after augmentation with and without a lift.  Once you see what you can reasonably expect, you can make a more informed decision.

Hi there-

While I realize that some of my colleagues do recommend placing implants over the muscle for women with slight to moderate sagging of the breasts when they don't want a lift, I could not agree more with my colleagues from Seattle and Memphis. I think this would be a short term fix with long term unhappiness for you, and would make future procedures much more complicated and expensive as well.

I think your best bet is a dual plane augmentation, and I personally would not perform a breast lift at this time. You can see a good example of this in a patient similar to yourself by following the link below.

Based on your photos, you would be better served with a submuscular implant in a dual-plane. You have very little breast tissue in the upper poles of the breast and the implant will be very obvious without much soft tissue to cover it. Rippling and ridging may become a problem for you in the upper pole. As for the lift, if you have adequate stretch of the lower pole skin, the implant can allow for some upper rotation of the nipples as this skin is filled out by the implant. A higher profile implant will achieve this more than a lower profile implant. It is not uncommon to have the augmentation performed first, and if your are unhappy, to have the lift performed later.