Advice for Breast Augmentation Redo After Pregnancy?

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.

Doctor Answers 14

Do nothing

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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.

Wayne Plastic Surgeon
4.8 out of 5 stars 172 reviews

A breast lift is your best bet.

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You are experiencing what many women do after pregancy. Larger breasts commonly become somewhat looser after pregnancy. The reason for this is usually that the increased size and weight of the breast during the pregnancy streches out the breast tissues. The best approach is to treat the underlying problem -- the loose tissue of the breast. This is done with a breast lift or mastopexy.

The problem with placing larger implants is that you will have even heavier breasts. And, ultimately, this will lead to larger, sagging (or loose) breasts. So you will still not have the shape you want, and you may well be larger than you want to be.

Scars from breast lifts are always a concern. In time, most of these scars will fade well, and all should be covered by clothing or bathing suits. Even if the scars are a bit more noticeable than you want, the breast lift is still a better way to go.

One other thought: if you are going to have additional children, hold off on the surgery. Subsequent pregancies my have the same result in terms of changes in your breasts. Best to have child bearing behind you before working on your breasts.

David B. Reath, MD
Knoxville Plastic Surgeon
4.9 out of 5 stars 111 reviews

Breast augmentation versus lift after pregnancy

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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.

Adverse change in breast shape after pregnancy

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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!

Change the styple of implant

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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.

Revision breast augmentation and lift

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Breast lift is required for sagging breast after pregnancy

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Since you did not achieve the fullness that you wanted after your first breast augmentation, a larger implant after the breast has sagged further following pregnancy will not achieve fulness and may make the descent of your nipple look worse.

In addition, adding volume and weight to the sagging breast may increase the sag.

A dermal mastopexy or breast lift is frequently done on African American patients with excellent results.

The procedure is just more complex than placing an implant and is more work for the surgeon.

I would encourage you to seek additional consultation with other Board Certified plastic surgeons who specialize in breast surgery and are willing to do the best procedure for you-the patient. See before and after of combined breast augmentation and breast lift following pregnancy.

See before and after breast lift and augmentation.

Lone dissenter

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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.

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 43 reviews

Would not advise larger implants.

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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.

Larger breast implants are not a good idea.

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Trust me, very large breast implants do not age well. Your size looks fine.

Hard to be sure without seeing your front view, but you probably get the look you want with a "doughnut" breast lift, where the scar is just around the nipple. Most African Americans make fine scars.

Don't do anything for at least 4 months after your delivery!

George J. Beraka, MD (retired)
Manhattan 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.