600-800cc Breast Implants Now, and Lift One Year from Now?

I have stage 3 ptosis (@ 3.5) I am 5'6", 137 pounds, 21% body fat. I have 5 children. I am an avid weight lifter, runner (30miles a week) and am a combat instructor. When I was nursing my children my breasts were a DD cup. I am now a deflated C/D. My husband and I both enjoyed my breast size and shape when I was nursing. We are not interested in super perky breasts or high nipple placement. My surgeon is recommending 600-800cc subfascial implants now with a lift @ year later based on the results I want. Thoughts?

Doctor Answers 19

Breast implants and lift later

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You have given excellent details and the photo helps so much.  What to do depends entirely on your goals.  Anatomically, you need a full lift to elevate the nipple and re-shape and tighten the breast.  This is because you have too much skin for the breast to sit up in a youthful, toned position.  Based on how slender and how active you are, I would think this might be all you need.  You would have a small, athletic, sporty look.

Using 600-800 cc implants in my opinion would distort you beyond repair and would make your activities very difficult to perform.  Trying to gather up the extra skin with huge implants rather than just doing the lift gets so many people into big troubles.  

Unless you want to be HUGE, skip those giant implants.  Maybe a lift alone, maybe a lift with a more moderate implant... 

Combine Lift With Implants

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I agree with other comments posted: 600-800cc implants seem inappropriately large and separating the procedures seems unnecessary.

The lift is desirable because of your nipple position and breast laxity. Neither would be corrected with implants. "Blowing up the balloon" with large implants will create excessively large, still very droopy breasts.

Reshaping your breast and elevating your nipple-areola complex and breast back up onto the chest will play an important role in helping you achieve an aesthetically pleasing result.

Finding the right size implant for you is very important, but the way to do so is fairly straightforward. In your preoperative consultation, using trial sizers and/or 3-dimensional imaging will help you find the implant size that fits your chest and gives you the balance and proportionality you seek.

Some of my respected colleagues prefer breast implants and lift to be separate procedures; many of us plastic surgeons will perform the two procedures at the same time. This is an area where experts disagre

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

You need to have lift first

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You need to have lift and implant. There are you two ways to do this and plastic surgery comunity is divided on the best approach.

The safest approach is to have the lift first and implant 3 months later.

The fastest approach is combined lift and implant

I would recommened lift first and implant later based on the long term result,decreased risk of nipple loss and less tension on the scar.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Breast lift and Augmentation

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 I agree completely with most of the previous responses. Because of your lifestyle, you absolutely do not want to have an implant larger than about a 350 cc. This should be quite large enough, if not too large, since you need the implant over the muscle because of your muscle building and other activities. You also should have the lift and augmentation done at the same time. There is no reason not to if the surgeon knows what he/she is doing and sits you up after the augmentation to adjust the nipple position.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

It can be done that way but not the best

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You do not need to do the lift at the same time but in a patient with ptosis(droopiness) as severe as yours, I would do the 2 surgeries concurrently.  Without the lift, your shape will not be good and you will likely be disappointed.  I would also recommend under the muscle placement and smaller implants.  600-800 cc's are way too large for your frame- think heidi montag's new size, she looked more beautiful with a smaller size - and you would look out of proportion and unnatural.  Good luck...

David Shuter, MD
Jupiter Plastic Surgeon

Breast implants and breast lift should be done together.

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1) Based on your picture and on my pretty big experience in Manhattan, here's what I think:

2) First and foremost, you need a breast lift. If you only have breast implants, you won't just have droopy breasts. You will have a major deformity, with your breasts hanging below the implants.

3) For somebody with your build and lifestyle, I think it is a big mistake to use implants larger than 400 cc's. Huge implants age very poorly, stretch your tissues, and will interfere with your activities. And 400 cc's will get you to a DD.

4) The two operations are best done together to get optimal shape. That's how we do it, with good results, and very few complications. The lift should leave you with lollipop scars. Anchor scars are not indicated.

5) Hope this is helpful. I am afraid I sound dogmatic, but I have seen your situation mishandled lots of times.

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

Breast augmentation and lift, which one first?

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You have a very physical lifestyle and are in excellent shape. If you want to stage your breast surgery, I would do a lift first with an augmentation to follow. Things to consider:

1. 600-800 cc implants are really big.

2. Breast implants do not lift breasts.

3. Most surgeons certified by the American Board of Plastic Surgery can do a breast lift and augmentation at the same time.

When I consult with a very athletic woman who wants large breasts, I counsel them that breasts bounce when larger, can be uncomfortable when running, and can get in the way of a golf or tennis swing. How did you feel when running with the DD's you had when you were nursing?

I can only imagine that your surgeon is suggesting this large size implant because he or she is expecting to fill out your stretched out breast skin with a large implant. Although we would like them to, implants do not raise the nipple. They will also act as an additional weight on already stretched out skin.

If you do want to stage these procedures, a lift to a full C cup with a nice shape might be something that you find works well for your body. If not, an augmentation can be done later. 600-800 cc implants will make you much bigger than a DD, but something smaller will give you more volume with less of a risk of compromising your physical lifestyle

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 56 reviews

Breast lift and breast implant - which first?

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Based on your description and photo, I believe you need both a lift and implants to give you the best result.  Although some surgeons would disagree, doing them together in your case would be fine.  I think doing an implant without a lift for you would be a mistake.  You would likely have perky implants (600-800 cc is too big for you in my opinion), but with loose nipples and breast tissue hanging off them.  If anything do the lift first then wait and do the implants later.

If you need a breast lift with your implants, have it

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From the appearance of your breasts in the photo, placement of these very large implants will likely create large, sagging breasts. Certainly, they will impede your athletic endeavors. Large implants will not lift the breasts, but could make your nipples point downward and stretch the tissues further. If the plan is to stage breast augmentation with a mastopexy, usually the mastopexy is performed first.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 17 reviews

Breast augmentation now with a lift later can work

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When there is doubt about the need for a breast lift, or concerns about the acceptability of the scar, it is a very reasonable option to complete a breast augmentation and complete a lift say, one year later if needed. The grade III ptosis that you describe means that the nipple is dependent, off the lower portion of the breast pointing downward. You should know that with augmentation alone, the implant will tend to push the nipple lower and accentuate the droop. Still this may not discourage you and augmentation alone may be the correct choice. On a final note, the implants that you mention, 600-800cc, are very large for the chest size in your photo and are at the upper limit for 'standard' breast implant sizes. They are not what one might suggest in a person with such physical demands as a combat instructor. Beware.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.