Breast Augmentation a Year Post-Breast Lift?

I had a Breast Lift over a year ago while my husband was in Iraq, and was told I won't need a Breast Augmentation. I was a 36DD and am now a 36D, and I was told I had enough fullness.

Now, a year later, I am not happy because I am flat on the top part of my breasts and still have to adjust them in my bra often throughout the day. My doctor says now I will need an augmentation. Is this normal, and do I really need it? Why is it fair that I should have to pay for the full surgery now when I asked a year ago, and was told I won't need it? My husband and I are upset about me not being happy. We have spent a lot of money, I have tons of scars, and I'm feeling uncomfortable.



Doctor Answers 24

Breast Lift vs. Breast Augmentation or Both: Decisions in Breast Surgery

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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.

Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Breast Augmentation After Breast Lift

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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.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

A mastopexy will leave a full breast even without an implant.

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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.

Talk to your surgeon

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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.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Communication is always important

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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.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Breast lift and augmentation are commonly done as a staged procedure

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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


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Only an augmentation will give you that volume in the upper part of the breast.  It is a totally different surgery and you will incur new costs.  Because you are a returning patient, your doctor may give you somewhat of a discount.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews


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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.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Upper pole fullness

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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.

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast implants after a breast lift

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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.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.