Will getting a Breast Lift first help me achieve my desired look? (photos)

Question

I’ve always had saggier breast due to weight loss, I am now 23. I went in for a consultation and was told if I get a breast lift (anchor) + implants in at the same time that it would just droop back down. My dream and desired look is to have my old breast size back to a D-DD or at least a light top fullness. I’m definitely comfortable if my dream can’t come true. If i go thru a lift first and then eventually implants put in, Could I get my desired look? Close to 5’2.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding what to do with sagging breasts after weight loss. A thorough history and consultation will be in order. I would specifically want to know how much weight you lose and if you have numerous stretch marks throughout your breast. It appears from your photos that you do not have significant stretch marks. Nonetheless, your weight loss is of concern. Weight loss tells the plastic surgeon how elastic your skin is. If you had lost over 100 lbs, the elasticity of your skin has been stretched almost to the max.

Nonetheless, I would suggest a mastopexy. This would be an anchor mastopexy with an incision around the areola, down the front of the breast, and underneath the breast. This will definitely lift the breast. At the same time, I would also suggest a smooth-walled implant. This can be placed either on top or under the pectoralis major muscle. If there is a concern for skin drop after the surgery, as your previous consultation mentioned, then I would suggest a dermal mesh be placed. There are several companies now which provide internal mesh which helps to support the implant. Over several months this mesh dissolves and is replaced by your own naturally formed scar tissue within your breast. This leads to a solid lift for years to come and the implant and lift will not significantly drop. I would seek consultation from several other plastic surgeons before you give up on breast surgery. In my opinion, I would go for it. Specifically, I would suggest an anchor mastopexy, breast augmentation with silicone implants, an insertion of mesh. Thank you for your question regarding what to do with sagging breasts after weight loss.

Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Kaveh Alizadeh, MD, MSc, FACS · Answer

Hi Graceful 431279,
In looking at your situation, I think you are a fantastic candidate for breast lift only with superior pole autoaugmentation. You certainly have enough breast tissue to fill out the upper pole and by just moving your breast tissue up you will have a perky C+/D- breast size. We have also been adding fat grafting as an adjunct to fill out the cleavage if desired as well as an internal lower pole support in form of a sling as well to secure the breast position.  At Cosmoplastic Surgery, we have used the "Naturabra" technique that allows for your own breast tissue to act as an internal bra that supports the lifted breast while filling out the superior pole. We just reported our results of the past 18 years of over 700 breast lift cases at the 100th anniversary meeting of the American Association of Plastic Surgeons in San Diego in April 2022.

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements and different size implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Donald R. Revis Jr, MD · Answer

Good afternoon,
I don't see why you couldn't have your dream boobs either way- either by doing the surgery all at once or staging it as a lift first followed by implants later. It is really up to the surgeon and their comfort level/approach. In my practice, if you wanted rather large implants then we probably would stage it, but if you wanted a regular sized implant I would probably do them together.

Wayne I. Yamahata, MD · Answer

As I evaluate your photos, personally i would favor doing the breast lift and implants at the same time. Although there is some risk of needing a second surgery for a revision, in many if not most cases, this would not be necessary.  If you stage the procedures and do these separately, this commits you to two operations.

Richard Baxter, MD · Answer

There are two schools of thought on the wisdom of doing implants and a lift at the same time. Doing them together has a higher percentage of revisions than most other procedures, because there are a lot of things that have to work together and settle evenly during healing. On the other hand, if you do the lift first and implants later, that could be seen as a 100% revision rate! Although I recommend doing them together most of the time for that reason, your degree of sagging is more than average. Do the lift first and see how you like it - you may decide you don't need implants.

Scott W. Vann, MD, FACS · Answer

Generally in patients like you, I do the lift and augmentation at the same time. However, I recommend to not get too large an implant so to lessen the chance of recurrence of sagging. If you do it in two stages and have a few months between cases you could maybe go with a little larger implant, but if you go too big you still risk recurrence. You might want to seek more in person consults. Good luck.

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

You went to a plastic surgeon who seems not interested in the case. You do need a lift and possibly an implant by someone familiar with these procedures.

Gregory Lakin, MD · Answer

You could get a full breast lift with anchor scar and a small breast implant to added upper pole fullness at the same time. There is always a risk the may sag later in life but using a smaller implant will reduce the risk. Good luck!

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