Breast Implants 3 Years After Breast Lift for Upper Volume?

Question

I underwent a breast lift 3 years ago due to 60 lb weight loss. I am satisfied with getting perky, normal-looking breasts. My drooping was really bad, 3rd degree. I now feel I am lacking upper volume on my breasts, and while I do not want a LOT more size, I would like that round, sexy shape women get with implants. I think my nipples are too high now because if I wear anything with cleavage, they peek through (embarassing). I am 5'4 and 150 lbs. I am thinking a 250 cc implant might help. Any opinions?

Otto Joseph Placik, MD · Answer

Your implants will likely settle in the lower portions of your breasts and only provide temporary upper pole fullness. You may want to consider fat grafting.

Tom J. Pousti, MD · Answer

Much of the final &ldquo;look&rdquo; achieved after breast augmentation surgery  depends on several factors:
	1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation &ldquo;look&rdquo; will be optimal.
	2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
	3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
	On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
	Other differences involve how the breast implants are filled. Saline implants are filled after they&rsquo;re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
	On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers&rsquo; saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
	4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of &ldquo;goal&rdquo; pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as &ldquo;natural&rdquo; or &ldquo;C cup&rdquo; or "fake looking" means different things to different people and therefore prove unhelpful.
	Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate. I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. By the way, the most common regret after this operation, is &ldquo;I wish I was bigger&rdquo;. I hope this helps.

Steven Wallach, MD · Answer

The photos are difficult to look at, but the nipples do look like they are pointing upward. This may be because of how they were positioned at the time of your lift or from the implants bottoming out. Hard to say from the photos.

Vincent P. Marin, MD, FACS · Answer

One of the biggest limitations with breast lift surgery is producing a fuller "upper pole" of the breast. A breast lift is produced by tightening the bottom of the breast, but this often improves the lower aspect of the breast, but not the top. As a result, I often recommend using an implant to "fill out" the upper half of the breast. Thus, there are possible solutions to help remedy your problems, but you should consult with a plastic surgeon in your area to discuss this in detail.
With respect to the nipples on the upper part of the breast, this is a difficult problem to correct. This can seem to occur if the breast has "bottomed out" and inappropriately descended below the fold. This can happen with large implants or in breast lifts where the scar has relaxed or stretched. Thus, there may a solution that can be addressed if you choose to have another surgery. Just "lowering" the nipple and areola will result in a visible scar where the nipple used to be. 
Good luck.

Sean A. Simon, MD · Answer

BB,
Your question brings up a very common scenario.  Patients frequently desire the sexy, rounder look that implants can provide when either combined with a breast lift or performed after a breast lift has been done previously.  Additionally, you described your nipple position as being too high, commonly referred to as "star gazing nipples" which can certainly be seen after breast lifts or breast reductions especially over time as the tissue inferiorly tends to bottom out, especially with certain techniques.  
Without actually seeing you, I would say that with an augmentation and probably a re-lift (excising some additional skin) you should be able to get the result you are looking for.  Congrats on the weight loss, by the way.
Dr. Sean Simon
Miami, FL

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

	Yes, Breast Implants will give a previously lifted Breast more fullness of the upper pole or top of the breast.

	See an experienced Board Certified Plastic Surgeons. If your breasts have "bottomed out" after your Breast Lift, the lower pole may need to be revised to push the Breast Gland and Implant higher.

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