Unhappy with the lack of volume and perkiness - what size and type of implant do I need? Do I need a lift too? (photos)

With appropriate planning and selection of the current implants, technique and soft tissue support...you can easily achieve a good outcome. You should see someone who specializes in revisionary breast aesthetic surgery and truly understands breast surgery very well. Best of luck.

Hi, thank you for sharing your question. You are a great candidate for breast augmentation but will likely also benefit from a lift. The need for a lift and the exact implant specifics are best determined together with your surgeon after an in-person evaluation.

Your breasts are sagging but not severly, so I don't think the breast lift (mastopexy) is necessary. Inframammary fold incision, dual plane type 2 or 3 surgery and high projection 320~380cc implants are recommended.When Mastopexy is performed, scars are visible from the front, so if the degree of sagging is not severe, it is recommended to correct it only with implants. Of course, if you do this, the sagging may be slightly less corrected.

I think you are a good candidate for breast augmentation. It looks like your nipple rests at or slightly above your breast crease in the side view, which likely means you do not need a lift, especially if you are considering a larger implant. Deciding on which type of implant (smooth round vs. textured anatomic) and what position to place the implant (above or below the muscle) are important details that should be determined with an in person appointment. Hope this helps.

The technique I recommend is a lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed is maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Over the years, your breast tissue has stretched and become more ptotic. (Saggy) In order to gain more volume, you will have to place an implant. The size will depend on your breast and chest wall measurements. To obtain large breasts, I would guess at least a 500cc implant. A breast lift would also be necessary to achieve the best results.

Hi. What you have experienced with your weight gain and loss is very typical. Breast augmentation can give you back a shape and fullness. The size of the implant you choose will determine how natural or fake the result is, and this is dependent on your goals and desires. To get more perkiness of your nipple position, you can consider a breast lift as well. To determine the best choice for you, I would suggest an in person consultation with a board-certified plastic surgeon who can explain all of these options and what the expected outcome would be with each one. Best of luck!

You would benefit from an implant as well as a breast lift to achieve the optimal result. The size of the implant would be determined from in office sizing or 3D photo simulation, the type should always be a round and smooth implant; there is no difference in outcome between round and shaped implants, and shaped implants are always textured, which carry a small risk for implant associated lymphoma and have a 3 to 5 % failure rate of keeping the shaped device in its proper orientation on the chest wall.

Dear FigDrops,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Judging by your photos, it does appear that you would benefit from a lift. Adding an implant to the lift would give you obviously more volume as well as more upper pole fullness. Sizing is very patient dependent and this is something you and your surgeon should spend a great deal of time assessing with in office sizing as well as looking at before and after photos.

Hope that helps.