Breast Implants - Options for Very Small Slightly Saggy Breasts

Hi there, I have very small (slightly saggy AA) breasts. I want to have breast implants (cup size C) but would like opinions on size etc. I really don't want to have a breast uplift - I hope its not necessary as I have only slight sagging. I have 3 children / breast fed my eldest but didn't with my youngest two (twins). Could you also please advise whether I would need an uplift? I really don't want one and to be honest don't feel I require it, nipples above crease etc. Thank you.Any information/advice would be greatly appreciated. Many thanks in advance.

Doctor Answers 14

Breast Augmentation vs Breast Lift

When the nipple is in a good position and the breast is deflated breast augmentation can be performed without a breast lift (mastopexy) procedure.  In the deflated breast it is beneficial to place the implants beneath the muscle to reduce palpable, visible implant rippling.

Philadelphia Plastic Surgeon
5.0 out of 5 stars 17 reviews

Candidate for Breast augmentation/lift

Based on the photos you provided, you appear to be a good candidate for brest augmentation. I agree, a breast lift is not necessary. Clear communication with your plastic surgeon is important in achieving the desired goals of the patient.  I like to communicate with patients with “goal” pictures.  During surgery, I use temporary sizers to determine the size/profile that will give the patient the look she is looking for. Trying to predict the size of the implant preoperatively is not ideal.  I think it is too much responsibility for the patient to choose the size of the implant.  Ideally, the surgeon would make that determination once he/she is in the operating room with sizers in and examining the patient in the upright and supine position.  There are many variables that come into play when choosing the correct implant size (how much breast tissue the patient currently has, the shape of the chest wall (concave vs. convex), etc.. 
 On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a certified physician is always the best way to get the most accurate information.  

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

When is a lift needed with breast augmentation?

A breast lift (mastopexy) is recommended by plastic surgeons when the skin envelope is larger than  the volume of the breast.  If a lift is not done when indicated, extra skin may drape abnormally over the lower pole of the breast and the nipple may be too low on the breast mound.  From your photographs, I am sure that a lift could be avoided if you chose a large enough implant.  It would be a mistake to pick a size you are uncomfortable with simply to avoid a lift.  I would recommend you try on sizers with your surgeon's help to decide the approximate size you would be most comfortable with. You want to make sure that your idea of an appropriate size is in keeping with your surgeon's recommendation. A small peri-areolar lift (sometimes called a mini-lift) might enhance your result if you select a smaller size implant.  Occasionally I let a woman choose to have an augmentation  and wait a few months to see whether or not a lift is required. This two step process works for some, though it is obviously better to complete the plan at one procedure. This is a decision that is important for you, so talk with your plastic surgeon and keep an open mind about the options.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 116 reviews

Breast augmentation -getting it right the first time

YOur posted photos show flattened out breasts with nipples above the level of the under breast skin folds. There does not appear to be any excess skin so it is unlikely that you would need any lifting procedure. Since the upper half of the breasts has very little tissue an under the muscle position is probably your best bet even is you use silicone instead of saline. The breasts are not symmetric in shape so perfect symmetry after surgery is not possible.

You should pick a breast implant size by trying out different sized implant samples under your bra. The surgeon would then pick the implant base diameter based on your breast measurements.

You currently have no cleavage and that cannot be created by breast implants. Most importantly your nipples point off to the sides, right more so than left. You will need nipple repositioning at the time of surgery because if you just put the implants in the nipples will diverge even more from the midline. This can usually be accomplished by removing a small crescent of skin beside the areola in the direction you want to move the nipple. Since you would need that it is probably best to place the implants through that skin incision. You can see an example case in the referenced web page.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast lift or Augmentation

I agree with my colleagues, I do not think you will need a lift. I personally favor silicone gel implants placed under the muscle. Remember that implants only add volume and will not actually lift or significantly alter shape.

Please discuss your options carefully with a board certified plastic surgeon. I believe you will be happy with your results.

William H. Gorman, MD
Austin Plastic Surgeon
4.1 out of 5 stars 20 reviews

Breast implants would improve your appearance

From your photos and your description of yourself, I believe that you would benefit from breast augmentation using either saline or silicone breast implants.  I would recommend a fairly generous size in the order of 330 to 390 cc.  I think that with the amount of sagging you have, you do not need a lift at this time.  I recommend consulting a board certified plastic surgeon in your area.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Breast implant options

It does not appear that you will need a breast lift, as implants alone should fill out your breasts, and your breasts are not excessively hanging over and your nipples are indeed above the level of your inframammary crease. Be aware, however, that your breasts are far apart and will remain so, and your ribcage is tipped laterally, so this will affect the implant position and how they will face somewhat outward as your breasts face now. You should do well with silicone gel implants placed below the muscle, just be aware of the constraints of your anatomy as mentioned.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

Breast Implants Sizing

Although a in-person consultation is always necessary before making any strong recommendations, it appears as though a silicone implant (exact size to be determined) would best suit you.  This would provide the most natural look and feel given that your breast skin and substance has been thinned out from the three pregnancies.  Best of luck...RAS

Ryan Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast implant sizing is important

Based on your photos, I would recommend a breast augmentation using a silicone implant in the dual-plane position using an infra-mammary approach. Seek a board certified plastic surgeon for recommendations.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Dual Plane Breast Augmentation

It's not unusual for plastic surgeons to encounter patients who have breast hypoplasia associated with mild breast sag. These patients want larger breasts, but don't want the scarring that's frequently seen with breast lift surgery.

Under these circumstances, dual plane breast augmentation offers significant advantages. The procedure creates a pocket beneath the pectoralis muscle as well as a separation between the muscle and the overlying breast tissue. This results in the implant having muscle coverage superiorly and breast tissue covering the implant inferiorly.

This configuration allows the breast tissue to cover the implants in a more natural way. It avoids the need for a breast lift and avoids a snoop dog deformity. In addition, patients continue to have the advantages of sub muscular implant placement including a decreased risk of capsular contracture.

It's important to realize that everyone's idea of a C cup is different. For this reason, we utilize the 3D Vectra imaging system and external sizers before surgery. We find that this approach minimizes confusion regarding implant size.

If you're considering breast augmentation and have mild breast sag, you may be an excellent candidate for this procedure. Under these circumstances, it's important to consult a board certified plastic surgeon.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 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.