Breast Implant for Uneven and Saggy Breasts?

I am almost 59 years old, 5'7", weight 140.  Fairly good figure, just saggy, with small, uneven breasts. I would like to look good naked! First thought I would get saline implants, but after talking with others who have had implants and doing some research, am wondering about silicone. Would this help resolve the size issue, and the droopiness?

Doctor Answers 14

Many variables to breast enhancement recommendations

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There are many variables that are taken into account when making a recommendation for breast enhancement surgery. It really requires a face to face evaluation with a board certified plastic surgeon to determine what these variables are. It may be helpful to obtain information and opinions from other patients that have had breast surgery, as you have done. But remember, NO ONE is YOU. Your specific body/breast characteristics are yours alone and only a consultation with a plastic surgeon will determine your best options. I suggest two or a few different consultations, as opinions may vary slightly. Good luck!

Breast Augmentation - Saline or Silicone

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Most surgeons agree that silicone gel breast implants, in general, tend to feel more natural than saline breast implants. However, the degree to which this difference is significant varies a great deal with regard to two issues: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. The more natural feel of a silicone gel implant will be much more important to patients who are slender and fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue to conceal the implant. The difference will be less noticeable to a patient who is more full-figured and has wears a B cup bra.
Smaller saline implants in my opinion, better simulate natural breast tissue than larger implants. If the goal of breast augmentation surgery is to produce a natural-appearing breast profile, and by 'natural-appearing' I mean that it matches the rest of a woman's figure and does not look like surgery, I think that most patients are best served by an implant smaller than 300cc in volume. Saline implants in this size range, in my experience, tend to produce results that not only look natural but also feel natural.
Depending on the degree of sagging, you are experiencing, an implant alone might be able to provide the result you desire. A consultation with a plastic surgery with expertise with breast implants and breasts lifts can help you with your decision

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Many different choices for saggy uneven breasts

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Dear Cielo,

When you describe sagging, it sounds like you will need a lift as well as the implants. The incisions and implants can be chosen in a way to lift up the breast, remove excess skin and fill them out in way that can make them much more equal in appearance. This can be accomplished with saline or silicone implants, but the silicone implants have a more natural feel. It is extremely important to seek out a board certified plastic surgeon to go over all of these possibilities with you. Good luck.

Dr. Cuber

Breast lift and silicone implants may be best

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I would agree with most of the previous answers. Clearly, you need an evaluation by a qualified Plastic Surgeon. When the skin thins and the breast tissue becomes ptotic or droopy, a lift is not satisfactory.

An augmentation with a silicone implant recreates the fullness of the breast. It provides a structure to rebuild a natural-shaped breast. Once the silicone implant is in place behind the muscle, the lift can occur to reconstruct the breast shape you desire. You will have more scarring around the nipple and down to the base of the breast. This will fade and improve over time, but will always be present. It is a tradeoff, but well worth it as confirmed by almost all of our breast lift patients.

Good luck with your search.

You really need a consultation

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You really need to go to a plastic surgeon for a consultation. If you have droopy breasts, then you may actually need a breast lift as well as implants. If you provide a picture, we may be able to give you more specific advice.

Go to the best breast plastic surgeon in your area

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Yours will not be as simple a procedure as a breast augmentation in a 25 year old with excellent breast form already. You may well need a combined lift and augmentation and there are many ways to do this depending on your personal starting point as well as the experience of the surgeon. The implant adds volume and does not lift you. Whether you choose saline or gel depends only on how much the feel matters to you with the "feel" preference going to gel.

Meet with a few well qualified plastic surgeons to solicit their opinions and see with whom you click. Then proceed with the plan and enjoy your new figure.

Evaluation first key to addressing sagging breasts

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Asymmetry of the breast is actually the norm. Very few, if any women, have perfectly shaped and symmetrical breasts. It is only an issue if the asymmetry is large enough to be noticed, and cause the woman concern. Otherwise, it is not of medical concern.

Sagging, droopiness, or ptosis can be caused by a couple of things, and each will be treated differently. If the nipple has dropped below the crease where the underwire of the bra would sit, it is likely that you would need a breast lift. This is called breast ptosis or "true" ptosis, and is due to the fact that the nipple is attached to the skin which has stretched out, and the breast gland itself has usually shrunk after child rearing, or significant weight loss.

The other type of sagging is called pseudo or glandular ptosis. In this instance, the nipple position is good, but the breast gland slumps in the lower portion of the skin envelope. This is due to loss of support of of the gland, which allows it to move from the upper pole (more youthful position), to the lower pole. In most cases, this can be corrected with appropriate implants.

Asymmetry can be correctd by using larger implants in the smaller side, or putting more saline in the implant in the smaller side. Alternatively, and routinely, liposuction may be used or the mastopexy may be applied asymmetrically in conjunction with the implants to improve symmetry.

Your choice of saline or silcone implants should not be made based on the asymmetry or sagging, but rather bassed on the feel vs. the risks and the appearance of each implant.

Hope this helps.

The right operation is really more important than which implant you use.

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To cielo,

Hi! In general, I recommend Mentor round smooth walled silicone gel implants (either moderate PLUS profile or high profile) for most patients. They tend to look and feel more natural, and they are safe. But saline implants can give fine results also for women who are afraid of silicone.

The more important question for you is what exactly is the best operation? You may need a combination lift-augmentation with different size implants for each breast. And then there are two different possible types of lift. I use a circular scar around the nipple if you only have a little sagging, or a lollypop scar if you have more sagging.

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

Silicone Implants are better

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The US is just now emerging from an FDA imposed "Dark Ages" of breast surgery. In the real world (not the USA), saline implants only represent about 5% of the breast surgery.

Saline Implants are less expensive by about $1,000, and must be used under the muscle to avoid severe wrinkles, However, under the muscle placement will cause the implants to set about three finger breadths apart, and can cause visible movement of the breast with arm motion. Saline implants can be used for ages 18-21. Temporary implant, very likely that one or both will need to be replaced by 10 years. Fine volume adjustment is possible.

Silicone implants are more expensive by about $1000. They can be used on top of the muscle and placed closer together (one finger breadth). There is less discomfort with the surgery, and the implants will not move with arm movement. They are much less likely to need replacement during the life of the implant. Patients must be 22 (I don't have any idea why, ask the FDA). No adjustment of the implant is possible, and implants have fixed volumes and dimensions.

For you personally, I think silicone implants offer a softer and more natural result for adult women. Only very mild sagging of the breast can be corrected by the implant alone. You will probably require a lifting operation at the same time.

Breast implants require compromises

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There is no perfect operation for the breasts when using implants. Each type, size, and style of implants have diferent side effects, characteristics and risks. In general, the more your final breast size is composed of the implants, the more it will reflect the characteristics of the implant. For this reason, the most natural feel will usually require silicone implants with their attendant risks.

If your breasts are uneven in size, you might consider improving the symmetry with an appropriate amount of reduction on the larger side resulting in an augmentation-reduction-mastopexy. If you can have similar implants on each side, it will give you the best chance of symmetry. Asymmetric sagging probably will require customization of a lift.

If you have a relatively good amount of natural breast tissue and do not want to be that much larger, saline implants can feel relatively nature if they remain relatively small and hidden behind your natural breast. You should pick a surgeon that will help you plan your surgery careful, answer all your questions regarding the risks and benefit of all your options, and be flexible in trying to achieve what you desire.

Robin T.W. Yuan, MD
Beverly Hills 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.