Breast Aug vs. Breast Aug with Lift
Thank you for sending photos. It is hard to say exactly without examining you and doing measurements, seeing your skin quality etc. There are many schools of thought; staged procedures, going back to do the lift later, doing the lift first, etc. Lifts can be different, depending on how much skin you need to have taken away. Anchor, lollipop, or donut mastopexys are options. Sometimes we will book the case as an augmentation with lift and wind up doing less surgery. Sometimes you release the tissue and you have more skin then you thought. Always good to get at least three consults from Board Certified Plastic Surgeons in your area. Together you will make a plan that fits your goals and your anatomy.
May achieve good results without lift
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.
Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate. Best of luck.
Breast Augmentation +/- Lift
Thank you for sharing your photos. I do think you would benefit from small lift with your implants to help give you optimal symmetry and shape, which you will not be able to achieve with implants alone. Here are my criteria:
Candidates for a Breast Lift (Primary Breast Shape Concern):
1. Patient is happy with breast size in a bra, but desires improvement in shape.
2. Nipple position sits at or below the level of the breast crease (inframammary fold)
3. Significant amount of loose skin and breast tissue, which hangs over the crease leading to a hollow appearance in the upper pole of the breast.
Candidates for Breast Augmentation (Primary Breast Size Concern):
1. Patient is happy with nipple position and amount of skin in relation to crease.
2. Desires increase in volume of breast to increase bra cup size and provide more cleavage and fullness to upper and lower pole of breast.
In many cases, patients have concerns of both size and shape, therefore requiring a breast augmentation with a breast lift to achieve desired results. I hope this helps.
Breast Augmentation with Lift
Augmentation mastopexy is designed to correct the two most common changes that occur in breast appearance following pregnancy: loss of breast volume, and stretching out of breast skin. While there are some moms who can get an acceptable cosmetic result from augmentation alone or from mastopexy alone, many moms have a combination of breast volume loss and skin excess that requires simultaneous augmentation and mastopexy (breast lift). I frequently perform this surgery in concert with an abdominoplasty (tummy tuck), and this combined breast and tummy rejuvenation surgery is sometimes referred to as a 'mommy makeover'.
Augmentation mastopexy is also commonly performed for major weight loss patients, including those who have had bariatric surgery including gastric banding and gastric bypass. Obesity followed by major weight loss usually produces breast changes that are very similar to those seen after successive pregnancies, and often the effect on breast skin is quite severe. Additionally, as a North Carolina breast implants surgeon, I regularly see patients with significant breast ptosis (the medical term for 'droopiness', pronounced TOE-sis) in young adulthood, without any history of pregnancy or major weight loss. Some breasts are just naturally droopy, and I have performed mastopexy and augmentation mastopexy for patients as young as 21 years.
This surgery is a potentially challenging one which requires thoughtful preoperative evaluation and planning, and careful attention to detail in the operating room. Many surgeons have traditionally performed breast augmentation and mastopexy surgery in stages, usually mastopexy first followed by augmentation at a later date. In the recent past more and more surgeons have adopted a non-staged, single surgery approach to augmentation and mastopexy, and that is what I propose for the vast majority of patients who I see in consultation that need both procedures. I believe that the results of simultaneous augmentation mastopexy are as good or better than a staged approach in most cases, and of course patients quite naturally prefer a single trip to the operating room if at all possible.
The answer to your question depends upon what your overall goals are. The size and shape of implants (particularly high profile) are often enough to fill out the "deflated" breast skin. However, if the goal is for high, perky breasts, a lift may be a necessary component. Given the photos that you provided and your goals of not appearing too "fake", I believe it is unnecessary for you to need a lift. The position of your nipples currently are at the level of your inframammary fold and the deflation you describe appears from your photos to be minimal. Of course, for a better evaluation, an true physical examination is necessary. I would recommend a second opinion.
Breast augmentation and lift
I agree with most of the authors here that you probably need at least a little lift as well as augmentation, and it is surgeons' preference whether to stage them in two procedures, or attempt them simultaneously (as I often do), while accepting that there is a certain revision rate that exists by virture of the complexity of augmentation and mastopexy (lifting) when done together. You may get a satisfactory result with augmentation alone, assuming you are okay with the implants sagging a little bit, and as long as your nipples don't point downward once the augmentation is done.
I think you should seek out at least a few opinions from other practices, including solo board-certified plastic surgeons and small groups like mine, before you decide to have surgery at the first clinic where you have gone. There may be different approaches to postoperative care and management of complications that may serve your specific needs that small practices can provide with good continuity of care. After you get a few opinions, you can decide which surgeon's or clinic's approach you are comfortable with.
Breast Lift or No Breast Lift?
It is really best to assess your situation in person and with some measurements. From the photos, it does look like you may benefit from a lift. There are different types of breast lifting (some with minimal scarring, some with more scarring) and the final decision should be made by you and your surgeon depending on the goals you want to achieve. I ask my patients to bring in photos of what they want to achieve after surgery and that helps me in my discussion with the patient whether I would recommend a breast lift or just the augmentation alone. Do your homework, look at LOTS of photos to see what you want and take them into your surgeon. I also suggest taking photos of breasts that you think are too droopy for your surgeon to see (that will give us an idea of what you don't want). Breast lifting is a difficult procedure so make sure your surgeon is a board certified plastic surgeon and has lots of experience with this surgery.
Should I Get a Breast Augmentation with Lift or is Augmentation Enough?
Based upon your photos I would recommend a donut lift + large (400 cc HP) implants. PLEASE seek more private practice PS opinions than just one from a clinic. If you need referrals to North Miami boarded PSs please call me. Examples are: DRs Storch, Rubenstein, Krau, Kane, Raffey, Kalman, Gibstein, Jacobs, Gingold, Freiman are a few private practice boarded PSs in North Miami. Best of luck.
Simultaneous Augmentation and Breast Lift
Looking at the photographs, it apperas to me that there is some ptosis. If augmentation alone is done the breasts will end up looking saggier. A full lift creates anchor shaped scars. A short scar lift which creates scars around the areola and vertcal scar will produce the moderate lift and makes the breasts look perkier.
Breast augmentation vs Breast augmentation/lift
Most patients that have sagging of their breasts in their early twenties before children will have worsening of the sagging with age and with childbearing. An implant alone will improve the superior fullness of the breasts but will not improve the ptosis, or drooping. Both the deep breast tissue and the skin are tightened during most breast lifts. This results in more superior fullness and 'perkiness' to the breasts, therefore a more youthful appearance.