Breast Augmentation for Lower Nipples, What Size Implants? (photo)

HI,

 

On of the advantages of augmentation is that it can provide a gentle lift. The larger the implant the more lift you receive. Thus your second surgeon is not correct. If the augment is completely under the muscle he may be correct in the fact that the implants will ride high and the breasts will droop off of them. But if the implants are placed in a dual plane or completely sub-glandular, then you will get some lift out of them and be able to go with 340 ccs. I hope this helps.

Regards,

Daniel Medalie, MD

I appreciate your question!

After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

If you undergo a breast augmentation without a lift then implants must be centered underneath the nipple.  In this case, the implants would be subglandular or biplaner.  The disadvantage of both techniques is the implants extrude inferiorly and laterally.  A better technique for you would be Breast Augmentation with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to place the implants, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Smaller implants are more stable long term and less likely to have complications.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and photo.  This is a very common question and there can be many different opinions, as you have found.  The size of the implant is generally not a big consideration in whether a breast lift is necessary or not.  This really has more to do with the amount of ptosis, or breast sag.  The position or elevation of the nipple is one of the most important factors to look at.  Many surgeons will perform an augmentation and a lift in 2 stages, or separate surgeries, if there is question if a lift is needed.  A lift can always be performed in a second surgery if you are not happy with the aesthetics of your augmentation alone.  Good luck.

Without seeing and examining you in person, it is impossible to give specific advice on breast implant sizes.  In our office, we use the VECTRA XT 3D imaging system to help patient visualize what they will look like after surgery with various implant sizes.  We have found a very high correlation with what the computer images show and what we are able to achieve with surgery.  

 

Good Luck.

The third possible choice would be a minimally invasive lift plus an implant.

If you have decided you do not want a breast lift, you've made your decision and could get an implant, and see later if you actually needed a lift, perhaps many years down the line.

Remember the implant should be centered on the nipple.  If the implant is too low, a double bubble deformity might result.

You will most likely get some lift with the implants, but it's hard to say whether or not you'll need a lift as well without examining you.  In my experience, 300cc implants provide a good amount of lift in those patients with minimal ptosis, as you have, and I'd give it a very low chance that you'll need a lift.  You can always get the augmentation first to see how you'll look and if you need a lift this can easily be done at a second, less invasive stage.

I think you will do fine with 300cc.   I do notice some breast shape asymmetry which will not change with implant surgery alone.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

From your photographs it appears that your nipples are just at the level of the inframammary crease under the breast.  I would think that you would do fine with a breast augmentation.  There will be some asymmetry, that was present prior to surgery, that will persists after surgery as well.  As long as you know what to expect after surgery I would think you would be happy with the results. 

You appear to have mild ptosis, or drooping, of the breasts which is also a bit asymmetrical, as the right breast appears lower than the left, and it is also a slightly different shape.  These differences will likely remain with just breast augmentation alone.  It seems as though you are committed to avoiding a breast lift, and I think that is just fine as long as you understand the limitations of breast augmentation alone and have realistic expectations.  I think you would get a very nice improvement with 300 cc implants if you have tried those on and the size works for you.  I would definitely do a dual plane augmentation to address any of the ptosis of the nipples and breast tissues that can be addressed without lifting.  This will help direct your nipples more forward and keep the implants lower in the breasts so that they don't force the nipples down giving the "top heavy" appearance you refer to.  I have done many cases just like yours with very happy patients.  Again, the key to that is managing expectations and selecting the right operation for YOUR personal needs.  Good luck.