Breast augmentation? Breast lift? I am 40 year old 5'4" 110lb. After 2 kids my breasts are not as full or perky. (photos)

     A lift will be necessary.  Breast augmentation and breast lift would be appropriate if you want larger breasts.  The type of implant you may choose.  Usually, submuscular is a better choice.Kenneth Hughes, MDLos Angeles, CA

If you are happy with your current breast size then
you may want to consider a breast lift alone which will address the lower half of the breast.  However, if you are looking to increase your
size or add fullness to the upper pole of the breast, than I would suggest an
implant as well.  Be sure to visit
various websites to view before and after pictures of both procedures to help
you determine what result you are looking to achieve.  Ultimately, the decision will be made between
both you and your surgeon following his or her recommendations.

The points you asked about are exactly what a good consultation about breast lift and breast implants will cover in great detail. There are many options and each has advantages and disadvantages. It may be tempting to try and get what you want with just an implant above the muscle but I think you would regret it.  You have what is called pseudoptosis.  That means that the breast tissue sags more than the nipple does. This requires a formal breast lift, using a lollipop incision in most cases.  The lift will help the lower half of the breast. An implant can help the upper half of the breast.  That decision, though, should be made between you and a surgeon you like and trust in an office you feel comfortable.Best,Dr. Pyle

a breast lift will make your breasts more full and "perky".  Placement of a small breast implant beneath the chest muscle will also help improve fullness.  Please consult a plastic surgeon for an in person consultation to help answer your questions regarding type, size and style of breast implant.

Your photos show at least the need for a full breast lift to tighten up the laxity in your lower breast and move the nipples a little higher. The purpose of implants would be to add size and upper pole fullness. Please understand that most of the complication risk in this comes from the implant so if you can be happy without one, you are in the clear. If you do absolutely feel the need for an implant, you still might want to stage the two surgeries by 4 months in order to let the tightening of the lift resolve before adding the stretching of the implant. Combined simultaneous surgeries can also be done but have a higher revision and complication rate.