Wanting a breast enlargement. Do I also need a lift? (Photo)

Question

Wanting a breast enlargement but not sure if I need a lift or not.

Enrique Quiros Lim, MD · Answer

Hi,After reviewing your photos I can tell that you have good breast footprint, and you will have good result with breast augmentation with implants in terms of breast volume increase. In my opinion the BEST result will be achieved with a breast augmentation with implants and a small periareolar lift, so that way you can elevate minimally the nipple position (so they will be symmetrical in position) and reduce the size of the areola.Hope this will be helpful.Dr. Enrique Quiros Lim

Semih Yildiz, MD, FEPOBRAS · Answer

The photos suggest mild to moderate breast ptosis with some lower-pole skin laxity. An implant can add volume, but it does not reliably lift the nipple or tighten loose skin; in some cases a larger implant can make the breast look heavier over time.

Whether you need a lift depends on measurements in person: nipple position relative to the breast fold, the amount of skin excess, tissue thickness, and the look you want. If you are comfortable with a natural, slightly lower breast shape, a carefully chosen implant alone may be possible. If you want a higher nipple position, tighter lower pole, and a more lifted shape, a breast lift with implants is usually more predictable.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question! On the photos I see mild ptosis and asymmetry and think you will be able to get a great result with breast augmentation alone, especially if the implants are not too large for your frame. (the weight of larger implants will cause a greater degree of sagging/ptosis faster). With the pre-existence of mild ptosis, you are, however, at risk of needing a revision that incorporates a lift sooner than later, so there may be a benefit in doing a very small lift (crescent/circumareolar/lollipop) now at the time of primary augmentation vs a "larger lift" (more incisions/scars) 5-10 years down the road. This would be best determined in an in-person consultation with a board certified plastic surgeon.

Leila Kasrai, MD, FRCSC · Answer

Your nipples are located below your breast fold, therefore a lift would be recommended. Without one, the implants would sit a bit too low on your chest to give you any fullness in the upper portion.

Georges J. Samaha, MD · Answer

Hi, 
You have grade 1 breast ptosis. That is when your nipple and areola are around your breast fold. You do NOT need a full anchor scar lift. Depending on how big of an implant you would like you might need a vertical mastopexy to lift up your nipple and areola. 
I would do a dual plane submuscular breast augmentation first. Sit you up during the surgery, and look at breast symmetry as well as nipple/areola position. If needed, only then I would do the lift through an incision around your nipple. It take a little longer to do this step wise approach, but great plastic surgeons all do it. Most skip this step.
Hope this helps.

Jeffrey Lisiecki, MD · Answer

Great question, and likely you do not need a lift, especially if you want to go on the larger side with your augmentation.  Implant placement in a dual plane or subfascial position would also help improve the shape without needing a lift.

Brian K. Reedy, MD · Answer

Thanks for your question! Some of that answer depends on your goals, but if you are looking for the best result, I do think you should consider a lift. It will get you better cleavage, get the nipple and areola above the fold and give you the most youthful appearance. Good luck!

Chul Hwan Seul, MD, PhD · Answer

When considering implants with a volume less than 250cc, a breast lift procedure may not be required, and only enlargement may suffice. However, if a larger implant is selected, there's a significant likelihood of the breast shape appearing abnormal if solely an enlargement is undertaken. In such cases, it is advisable to combine enlargement with periareolar mastopexy for a more balanced and aesthetically pleasing result.

Jeffrey M. Darrow, MD · Answer

From your photographs, it appears that you have ptosis (hanging of the breast issue) of your breasts.  It also appears that your nipple is either just barely at or slightly below the fold level underneath your breast.  Ideally the nipple level should be above the level of the breast fold.  When you add a breast implant to the breast, it adds weight to the breast, and the breast will hang more.  If you want the most youthful, lifted appearance to your breasts, adding a breast lift will do that.  Your trade-off would be that you would have an incision line on the front of your breast. Discuss this in detail with your plastic surgeon. Best wishes.

Daniel Barrett, MD · Answer

Dear Newme1806,
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.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Wanting a breast enlargement. Do I also need a lift? (Photo)

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