I've had consults with 3 PS's and am considering around 450cc silicone implants placed over the muscle. I don't want a lift at this time and one PS told me this would be my best option for a lifting effect without a lift. I don't have kids yet and would be open to a full lift in the future, instead of just having a circumareolar mastopexy now. Would HP or mod profile implants be best for upper-pole fullness? And would 450cc silicone in the subglandular position be appropriate for me?
Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)
Doctor Answers 30
Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis?
Breast implants do not lift breasts, lifts lift breasts. Implants fill breasts out where they are. It is difficult to tell from your photos whether you are borderline (nipple at level of inframammary crease but not significantly below; some overhang of breast but little enough that an implant, whose bottom lies at the level of the fold, will fill out the lower pole of the breast adequately so that the breast does not "hang" off of the implant), or whether you are worse than borderline. If you are truly borderline and want to avoid a lift, I would suggest undergoing the augmentation alone and seeing if you are happy. The worst that can happen is that you will need to return at some point for a lift, which is essentially a skin operation, does not require reoperating on the implants, and is associated with very little discomfort. The best that can happen is that you avoided the extra scars and extra expense of a lift, and end up happy with your result.
I would strongly recommend that you do not compromise your breast augmentation result in your attempt to avoid a lift...such as by choosing larger implants than you otherwise would in order to fill out your loose skin (and in the process encouraging post-operative skin and tissue stretching and thinning that is irreversible), or placing the implants over your muscle as you have been told this will better fill our your ptotic skin (in a thin patient leading to a higher risk of a visible upper implant edge, visible implant wrinkles, and longterm stretching and thinning of your tissues). In my opinion, an implant placed under the muscle with the dual plane technique is equivalent in filling out a loose lower pole to placing the implant above the muscle, but still provides better camouflage and coverage in the critical upper pole.
I have had many patients with borderline or mild ptosis have a good result from augmentation alone with careful and conservative subpectoral dual plane techniques, but if someone needs a lift, then they need a lift. And if you are on the bad side of borderline and need to be convinced that you need a minor lift, see what the results are from augmentation alone. Just don't compromise the augmentation procedure trying to avoid a minor lift.
Breast implants alone probably a good option for you
You do have a mild ptosis or slight droopiness to your breasts. However, if you want to go with 450 cc implants, you will probably get enough of the lift from the implants to satisfy you without a breast lift at this time. With time, you can expect to have more drooping and may need a lift later on.
Submuscular Implants placed into a Ptotic Drooping Breast risks Double Bubble or Snoopy Deformity
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.
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Borderline needing a lift
You are indeed borderline needing a lift but it appears that you can avoid it at least for now. It is important to understand that implants do not lift the breast and larger implants do not lift the breast more. The issue of above or below the pectoralis muscle is a separate one with a properly released (dual plane) muscle and I would agree that you need the implant under the muscle for a natural looking result for the upper pole of the breast. A 450 cc implant is almost certainly too big for your breast width and should be sized dimensionally rather than starting with cc's. A lot of forward projection in a high profile implant also doesn't look good under breasts that are low and sloping. I find I am in complete agreement with Dr. Robert Grenley's answer.
Whether or not to have a lift.
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.
Choosing the right breast surgery
Your dilemma is a very common one and one that you need to discuss at length with your surgeon to make sure that you are making the best decision for you. There are many factors to consider. Perhaps most important is deciding what your goals are. Your breasts are lacking in tissue which makes them look deflated and more droopy than they probably are. Placing an implant will increase the volume and fill out the skin. It will not lift the nipple much if any. However, with fuller breasts, they many not look so droopy. You will be larger and your breasts will sag over time just as naturally large breasts will. If you are happy with your current size but want your nipples higher, then you need a lift and there are many techniques for this.
With my patients, I try to help them decide which is more important to them, increasing volume or repositioning the nipple. We have found that often just an implant to restore volume makes their breasts a nice enough shape that they do not want a lift too. I prefer to address the problem that is of most concern at the first procedure and then, if necessary, do a second procedure for the other problem. It is surprising how often the second procedure is not necessary. And I have also found that by separating the two procedures, though it increases cost and recuperating time to have to surgeries, the final results are better and fewer revisions are needed. For my patients when they are droopy, I have found that implants above the muscle give a much more natural appearance contrary to what many of my colleagues find. I have found that submuscular implants tend to be higher (which makes a lift more important) and as time and gravity do their thing, the native breast tissue tends to migrate downward and tends to hang off the implant in a very unnatural way.
I hope this helps with your decision and good luck to you.
Augments alone should be good
as you can see from the other answers, there is more than one way to do this and get a good result. if you have a surgeon you like and you have checked out their credentials and reputation, then follow their advice and i bet you get a great result!
that said, unless you are a bigger person than your photos would suggest, you may want to consider a slightly smaller implant....perhaps around 400cc at most....so as to lessen the chance of problems/deterioration/sagging occurring as time goes on due to the larger size of implant.
Do I need a lift?
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.
The borderline lift
Actually your nipple is at the fold and at the mid-humeral line, and the lift is probably not needed. The breast tissue is thin above and a subglandular implant is likely to cause further thinning over time, so unless there are other issues pointing to a subglandular implant, under the muscle will look better over the years. The HP is rather round, and the moderate profile is likely to be better.
Best of luck, peterejohnsonmd.com
Subglandular implants to avoid a lift
First off, your "ptosis" is mild and glandular (nipples look to be above the crease) so an extended dual plane augmentation should give you a nice result without a lift. Subglandular implants often accelerate breast sagging and can lead to a "rock in a sock" look.
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