Advice for Breast Augmentation Redo After Pregnancy?

Question

I currently have 350 HP breast implants, but I had a baby and the now sag. My nipple is just above the crease and I have about 1-2 inches of breast underneath.The bottom portion is full but I have no upper fullness. I never did, even after the first augmentation. My plastic surgeon says using a larger implant (500-600 HP) will fill the breast back up and make them high and tight like I want. He says no to any type of lift (I'm Black, so maybe he's worried about scarring). Is this a sensible solution? What would you suggest for a patient like myself? A Breast lift or have Breast implants? I am a big girl 34-27-46, 5'6".  Thanks.

Armando Soto, MD, FACS · Answer

Hi there-
In my experience, changes that occur in the shape of a woman's breast as a result of pregnancy and/or breast feeding are not easily correctible through replacement of the implant alone, especially if you don't necessarily want to be significantly larger than your current size. Replacing your implant, even with one of a different shape or style, is only going to make you larger... subtle changes in the shape may occur, but over time, the breast shape will sag even more, because nothing was done to correct the relationship between the quality/quantity of skin present.
Re-shaping your breasts is going to be an important part of achieving the breast shape you desire. The scars can be a problem, and there is no question that a specific strategy should be adhered to when doing these procedures on African-American patients (in other words, it is not reasonable in my mind to do everything the same way you would on someone with very fair skin and expect the same outcome), but as long as this is done, the scars can be as thin and inconspicuous as in caucasian patients.
The shape of the breasts is paramount- choose an operative strategy likely to give you the shape you want. Good luck!

Jed H. Horowitz, MD, FACS · Answer

You may benefit from a breast lift. A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy.
With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. 
Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct heightmay also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Ricardo L. Rodriguez, MD · Answer

Ask yourself, "Am I happy with the size of my breasts when they are lifted up in a bra?"
If you are, you don't need a larger implant, you just need to have the implants placed higher on your chest wall.
BTW you can do this with a periareolar lift which will leave minimal scars. A repair of the capsule in the bottom part of the bra will insure higher placement of your implant.
If you are not happy with the size when you are in a bra, you need a bigger size implant, to address the size issue, and a lift to ensure higher implant and nipple position.

Otto Joseph Placik, MD · Answer

Puitting a larger implant will make it bigger and tighter in the short term but set you up for sagging in the long term.
It sounds as if you are recieiving conflicting advice and that makes it difficult to make a decision.
From your picture, it appears that you have relatively litttle sagging according to our classifications. I would be reluctant to adivse you to do anything at this time if you are looking to have them high and tight. This is especially true because you state that your first augmentation did not achieve this goal
If that is your goal, one option is to consider a reduction and a lift to elevate the existing breast tissue and then place a similar sized implant without necessarily increasing the size of your breasts. Be prepared for the scars.

Raffy Karamanoukian, MD, FACS · Answer

The choice for breast lift or mastopexy is dependent on the degree of skin laxity and the position of the nipple. Larger implants will temporarily improve the position of the implant if done appropriately, but this will inevitably result in further droopiness of the breast and nipple. I would suggest a breast lift with or without exchange of your implants.

Robert Frank, MD · Answer

I've put 500 cc implants in patients like you and had them thrilled with the result. It requires that you feel OK about being in a D or DD cup. There are parts of your story that are still missing. If you're 6 ft tall for example, you're able to handle a larger implant than if you a 4'11". I would not recommend a lift of any type and would consider the new implant ONLY if you were persistantly troubled by the appearance of your breasts.

George Marosan, MD · Answer

I'm not sure how long after your pregnancy this photo was taken, or if you are breast feeding or your breast size is back to your pre pregnancy size. If your nipple is just above the crease, that is the ideal position. Moving it higher will make them "look" to the ceiling and will give the impression that your breast implants buttomed out. Looking at your side view photo, your nipples are at the most projecting part of the breasts, which is the ideal position and you have a nice slope to the upper pole of the breasts. Going to larger implants will make you look unnatural, and within 2 years we would be having a discussion about breast lift surgery. It seems to me that you have stretch marks on your breast skin, another reason why I would not recommend larger implants for you. I would not do any surgery unless your implants feel firm secondary to a contracture.

Nina S. Naidu, MD, FACS · Answer

Hi,
As you can see from the many and varied responses to your question, there are several solutions to your problem.  The best solution really depends on what you are looking for.  
If you like the size you are now when you wear a bra (which naturally lifts the breasts), then a breast lift with your current implants is the best option.  This will bring the tissue higher on your chest.  
If you want to go larger, then breast augmentation is indicated.  However, you will probably also need a small lift with larger implants as your skin has stretched and sagged a bit with your pregnancy.  Large implants do provide some lift alone, but it may not be enough.  
Finally, it is not unreasonable to leave your breasts alone, as on the view you sent they actually do not appear to be that low.  Once you decide what your priority is with your breast shape and size, communicate with your surgeon to find an option on which you can both agree.  
Good luck.

Parham Ganchi, PhD, MD · Answer

You have naturally shaped breasts that do NOT have drooping of the nipple (as you mention yourself). As such, doing a lift will only buy you scars without any significant improvement in the long run. Using larger implants will also get you no improvement in the long run. You may look fuller in the upper breast right after surgery but this will only drop and look the same as you are now but bigger. I'm not sure why you have high profile implants as they tend to fill the upper breast less. A medium profile implant (or even low profile) may have filled out the upper breast better.

Christopher L. Hess, MD · Answer

Your picture exemplifies nicely shaped breasts.  The normal position for the nipple is on level with the breast crease.  Your nipple is slightly above which is excellent.  I see that you have lost some upper pole fullness.  If you didn't have that before the last surgery I'm not sure why your surgeon used a high profile implant.  These implants have a lot of projection with little base diameter which does little for the upper pole fullness.
If you're planning on having more children than hold off on surgery.  If not I would suggest either moderate profile or low profile implants and perhaps a periareolar mastopexy.

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