I would like to have a less "pancake" breast with Fullness on top. I understand that an implant alone will not move my areola, however if I chose something along the lines of a silicone 450cc high profile implant, will I achieve a "fuller" breast without a lift?
Can I Get Just Breast Implants? Or Do I HAVE to Have a Lift? (photo)
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Doctor Answers 26
Augmentation and lift candidate
For me, the benefit of the lift versus the drawback of the scars becomes the question. The nipples are supposed to be at the apex of the breast, the part that sticks out the furthest. This is typically at the level of the infra-mammary, below the breast, fold. The upper poles are depleted and hollow and need fullness. An auto-augmentation can be done where the breast lift is done like a breast reduction, commonly called a wise pattern, the outer (lateral) and inner (medial) breast is not removed like in a reduction, but released and sutured to the inferior pedicle (the area where the nipple receives its blood and nerve supply. This is truly just a lift, but will basically take "what you've got" and fill that upper deficit and make you perky again. You can get an idea of if this is enough volume for you by laying down and if that is enough volume, then there is your answer, no implant needed.
If you lay back and think, wow that is not near enough, then an implant will be necessary to get you that volume. An implant has its role in filling volume, not correcting the overall look of the breast. So if you just fix the volume and not the position of the nipple, inevitably you will not be happy with the result. The breast tissue will hang off the implant and look abnormal, thus it does need lifted onto the implant. Plastic surgeons debate frequently on which should be done first, the lift or the implant. or the safety versus the convenience of combining an augmentation and a mastopexy. This is where the comments come from about the exam and additional photos. Examining the looseness of tissues, the quality of skin, the amount of extra skin inferior (constricted lower pole) all come into play.
When I think a person would be a good candidate for the augmentation mastopexy, I like to place the implant as I normally would through an infra-mammary incision in a sub-muscular position. Usually I think it looks great lying down with the implants filling the void. Then I sit the patient up on the operating table and you can watch the breast and nipple-areola fall off the implant and hang. At this point I take a suture and "tailor tack" the extra skin from either sides together till the tissue is sitting right where I want it on the implant. This is marked, the sutures removed and the excess outer skin removed. The deeper skin remains intact with only minimally undermining of the deeper fatty subcutaneous tissue to allow for movement of the nipple areola tissue to it's new spot. I think this then allows for the lift to be done safely preserving it's nerve and blood supply. I have seen many other plastic surgeons use this technique as well. In addition many use a staged technique with good success with either the lift or the implant first depending on their techniques and experience. The most important thing is to research your plastic surgeon's credentials (always look for American Society of Plastic Surgeons membership), feel confident with your surgeons competency- which can be helped by asking the right questions (having done your research), and by an exam and discussion of your options.
Though as a plastic surgeon I am programmed to not want scars and hide them as much as possible, I really have found that a scar on the breast is much more aesthetically acceptable than a droopy miss-shaped breast. I have found this with my lifts, my augmentation lifts, and my breast reductions.
Breast implants and a breast lift
Based on this photo alone you would likely benefit from a lift at the same time as your breast augmentation. Your nipple position is too low to rely on an implant alone to elevate it. If you are very concerned about the scar involved with a breast lift-which would be a lollipop incision-you could do this in stages and do the implant first and see how it looks. Then, a few months later you could undergo the breast lift.
I could give a more specific recommendation if I were able to examine you. Please consult with a board certified plastic surgeon for more information.
Lift and augmentation
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Breast Implants with a breast lift
Breast Augmentation with Lift
Thank you for sharing your photos. With your nipple in the lowest portion of your breast, you would definitely need a lift to achieve an aesthetically pleasing breast. Here is 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 implants alone or lift required?
Based on your photograph, an implant alone is not an option. The implant will rest within your current breast tissue, thus not achieving upper pole fullness. You basically will have a larger version of your photograph with more fullness at the bottom of the breasts than at the top. One question to ask yourself, do you want to go larger or only want upper pole fullness and less of a pancake look? You could have a lift only, with no implant, and achieve the same result if you like your current size. Good luck!
Augmentation with a mastopexy.
To achieve the best aesthetically pleasing result I would recommend breast augmentation with a mastopexy.
Augmentation alone will give you nice upper fullness and good cleavage, yet it will not significantly change the location of your nipple and areola, no matter what size implant you choose. Without a good push-up bra, your breast will hang off the implant.
A mastopexy alone would give you perkier breasts, however this will not give you the upper fullness or projection I think you are looking for.
I believe augmentation with a breast lift, using a lollipop incision, would give you the best result. These incision hide and fade nicely, for a beautiful, fuller breast shape.
Can I Get Just Breast Implants? Or Do I HAVE to Have a Lift? (photo)
I will answer your question with a question: what do you want from your surgery?
If you think you would be happy with fuller but still drooping breasts, then have implants alone. You can then do your own lift with a good bra. In cases such as yours I use anatomic (tear-drop) highly-cohesive silicone gel implants placed over the muscle.
If you want your nipples facing forward and can accept the scars, then you should have a breast lift along with your implant. In such a case I strongly suggest a lollipop-style lift. This is a strong lift that will not distort your areolas. Also it increases the projection of the breast. I am not a fan of the donut-style lift (for which the scar is limited to the areola) as it often causes enlargement of the areola as well as flattening of the breast.
All the best.
Breast Augmentation - Can I Get Just Breast Implants? Or Do I HAVE to Have a Lift?
Yes you can - but the question is whether you'll be happy with implants alone, and I'm concerned that you will not. Implants are implants: they enlarge your existing breast volume with only the slightest improvement in overall shape (they do fill the upper portions of the breast and that may appear to give your nipples a lift but it only has that effect to a very small degree). Large implants will provide you with greater volume, but your nipples will (still) appear low on the mound, as they do now. Will you be happy with that? I would advise you to have a lift along with the implants; either a circumareolar lift (as has been suggested) or even a superior crescent lift, which elevates the nipple and areola about 1-2 cm...and that may be just enough. You should, of course, raise this very important issue with your own PS.
I hope that this helps, and good luck,
You will definately achieve a "fuller breast" with implants alone but your nipples will still be low. For an ideal result you would need a lift most likely. I have some patients that don't mind having a somewhat droopy "mature" appearance and get by without a lift. This is not a question that someone can answer easily over the internet. You need to see a Board Certified Plastic Surgeon with experience with breast lifting.
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.