Breast Lift vs. Breast Augmentation or Both: Decisions in Breast Surgery
The following question will help clarify whether you need a breast lift vs a breast augmentation and lift.
- Do you want to look better in the nude or in clothes?
If you want to look better in clothes, a breast lift will generally not provide any benefit. A breast lift will reposition the nipple-areola to provide improvement in breast shape without a bra. This is usually a volume issue and can be addressed with an implant, otherwise a good pushup bra will do.
If you want to look better in the nude, then this is more an issue of nipple position and shape. This is generally where a breast lift comes into play.
If you want both, then a breast lift and augmentation is needed.
Breast Augmentation After Breast Lift
Sorry to hear that you did not get the results you wanted.
The breast lift is usually the best choice for lifting a droopy breast. Right sfter surgery, the breast will be very full and round on top. However, the surgery lifts the breast, but cannot change the tone of the tissue and the ability of the body to maintain the tightness and shape.
Some settling occurs.
At times, we use implants at the time of a breast lift to add volume; sometimes we use the implants to contribute to shaping.
Your situation sounds like one where using an implsnt might be helpful to maintaining the upper chest fullness.
As surgeons, we do our best to evaluate and offer the best procedure to achieve desired results. It is impossible to predict precisely how any individual will heal (or how much their breasts may settle). It is not possible to guarantee a result from surgery.
My advice is to be frank with your surgeon about your concerns and give him/her the opportunity to help you.
A mastopexy will leave a full breast even without an implant.
A properly perfomed mastopexy should leave the breast looking full even without an implant. Breast implants make breasts larger. If the patient is satisfied with her size, an implant is contraindicated.
You should definitely relay your concerns with your surgeon, but don't be too angry with him. While it is difficult to know your exact situation without having seen you preop, I think it is certainly reasonable to assume that if you started as a DD, you would have had enough volume after a lift only and not required an implant. That being said, having the implant placed now is very straightforward and some would argue that it is safer as a two stage procedure.
I think if you speak with your surgeon, he will do everything possible to make you happy, and this may even involve reducing or eliminating his surgical fee.
Communication is always important
When a patient naturally has a significant amount of breast volume (i.e. a "DD"), a breast lift can often be successfully performed WITHOUT an implant. This seems to be what your surgeon had in mind when he suggested the mastopexy without an implant. I agree with the other surgeons who have said that we cannot always predict the outcomes of the surgery--and in your case, it seems that you would have had better results by using an implant.
I encourage you to express your frustrations and concerns with your surgeon and together you can reach a reasonable solution and surgical plan. Money is a concern for EVERYONE in these tough economic times, so be honest with your surgeon about not wanting to spend more money and see what he can do for you.
I'm sorry you're so unhappy and I wish you the best.
Breast lift and augmentation are commonly done as a staged procedure
Unfortunately, it sounds like there may have been a communication breakdown and/or misunderstanding between you and your doctor. While it is hard to give you specifics since none of us were there for your preoperative discussions, it is common to perform breast lift/augmentation as a staged procedure (2 surgeries). Additionally, if you would have had the augmentation and lift at the same time, then your initial surgery would have included an additional surgical procedure fee for placing the implants, longer operating room costs/fees for the time taken to place the implants, and the actual implants costs. You really need to factor all of this in to your calculations when discussing the price for your upcoming surgery. Since you did not pay any of these fees before, it is not unreasonable for you to pay them now - if you do want the impalnts. It is not like you paid for them and did not receive the service - that would be an entirely different situation. However, I encourage you to discuss your concerns with your surgeon and I am hopeful that you will both be able to find an amicable solution.
David Shafer, MD
New York City
I am sorry for your dissatisfaction. While I would let your surgeon know your concerns, DD is usually ample and he/she probably was using that in his/her mental process. Each surgeon has a different policy in ensuring a happy patient so he/she may charge you a reduced fee for the surgery if you approach properly.
It is hard to achieve upper pole fullness with a breast lift or a reduction. That characteristic is unique to breast implants. You can achieve the look you desire with implants, but you will be bigger in size. It is unfortunate that was not conveyed to you before the initial procedure, but all is not lost. A second procedure may be exactly what you needed from the start. Maybe you can work out a compromise with your surgeon, you pay for implants, he does not charge a surgeon's fee and you split the cost of the OR and anesthesia.
Breast implants after a breast lift
A breast lift can improve your nipple position and the overall shape of your breast, while making it slightly smaller. Depending on the amount and quality (firmness) of your breast tissue, it is sometimes difficult to achieve satisfactory fullness of the upper portion of your breast with a breast lift alone. It is not completely unusual for some patients to want or need an implant placed after (one year later) they have recovered from a breast lift. Sometimes these patients end up having nicer results than patients who have implants and a lift done at the same time.
This is difficult to answer without seeing your photos, so I would recommend that you consult with a board certified plastic surgeon to review your options.
Breast augmentation after breast lift
I'm sorry to hear that you were not satisfied with your outcome.
Ideal breast size is a very personal matter. What may be too large for one is too small for another.
In my opinion, deciding if a patient needs implants or just a lift is pretty simple. If she is happy with her breast size prior to a lift, wearing an unpadded bra, then implants are not necessary. If she would like to be larger then I would recommended implants.