Breast Implant Placement to Correct Asymmetry and Sagging?

Over or under breast augmentation to correct asymmetry and sagging? Lift?

Doctor Answers 11

Breast Implants and a Lift

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To address this properly you need implants as well as a breast lift in my opinion. From the looks of the other opinions, the other docs seem to agree.

Orange Plastic Surgeon

Lift and augmentation

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You would definitely need a breast lift. If you want more volume, then an implant can be placed as well.  The implants is usually placed first and then the lift is performed over the implant.  You can have a great result.

Yours is more difficult than the usual situation

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You have a varaint of tubular breasts which are harder to fix than those that just need a simple lift and implant. I personally would always place the implant under the muscle and then do the lift on your left side followed by the lift on your right side which is larger and needs tissue removed to better match the left. In the hands of an experienced surgeon you should get a very nice improvement.

Augmentation Mastopexy

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I routinely do under the muscle to prevent capsular contracture.  If the mastopexy is done correctly then under the muscle is just fine.  I'm not a fan of over the muscle as I don't think it will improve on the result and adds the risk of capsular contracture.

Over or Under: advantages for breast asymmetry????

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I frequently perform a combination of these two procedures to use the advantages of both. This is called the biplanar technique.

I use the subglandular (over the muscle) technique to perform radial relaxing incisions and release the constricted breast parenchyma. I then place the implant under the muscle.

I know this makes it even more confusing but that is why it is important yo choose a surgeon who can explain the risks, alternatives, and benefits of the different approaches to help you make an informed decision.

Breast asymmetry and sagginess

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Based only on what is seen in this photo, I think you would benefit from a sub-muscular breast augmentation and lift primarily on the right side but you could also have a peri-areolar lift on the left to decrease the areolar diameter and give a small lift. Your beasts, like many women, are asymmetric and will never be perfectly symmetric. I would advise you to schedule a consultation with a board-certified plastic surgeon so your surgical options can be reviewed with you. Best of luck.

Dr Edwards

Over the muscle.

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Hi! If you are just having a breast augmentation, the breast implants should definitely be placed over the muscle to improve shape and symmetry.

In New York City, we would recommend a small breast lift as well. The lift will give you better long term shape, and it will make your areolas smaller (they are too large). But you would have a circular scar all around your nipples. So it is a trade off.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Above the muscle without question.

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Whenever I wish to lift the breast, I always go over the muscle to release the entire breast and allow it to reposition. With some indication of tubular breast, it is especially important to release the undersurface of the breast and allow it to spread out over the chest, or, in your case, an implant. As far as the asymmetry goes, your breasts need measuring to determine the amount of difference. One then chooses implants of different sizes to try and even the size difference. What you will need as far as a lift goes will depend on the amount of enlargement you want. It appears that you do not have a significant amount of droop. Sometimes this can be corrected by an implant alone. To be sure of correcting any droop, your ideal procedure may be a periareolar mastopexy. This would also correct what appears to be an asymmetry between the sizes of the areolae. Of course, all this will be dependant on a careful, in person, physical examination.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Breast implant alone will not improve tubular breast appearance

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The asymetry and tubular shape of the right breast and to a lessor degree the left require a lifting type of procedure to improve the shape of your breasts and improve symetry. Once this is achieved then an implant can be done to improve breast size and fullness.

A two stage procedure using a soft tissue expander type of breast implant will give you the flexibility to expand the breasts and improve the shape.

Tubular or constricted breasts

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You have characteristics of tubular breasts with asymmetry and an enlarged areolar. Ideally, you would want to achieve symmetry and a more ideal shape with a lift of your and your surgeon's choosing (i.e. periareolar vs. vertical scar) and then decide on the augmentation of the lifted breasts. This could be done simultaneously although it is probably safer if done with a submuscular implant. If you decide on a subglandular implant, especially a relatively large one, a two stage procedure is safer.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.