Breast Lift and Augmentation for a 40yr Old, 5'4 and 130lbs

I fit into a 34c but am saggy. I've seen 3 surgeons:

  • Doc1:Full anchor bl+175-200cc saline
  • Doc2:Short scar bl+250-275cc silicone
  • Doc3:Aerola reduction+400-425cc silicone

I've decided on Doc2 as I am most comfortable with him. But I still need re-assurance w size.I felt the 200cc sizer was too small and the 225cc perfect. Doc recomended 250 left (which also needs reduction for balance) and 275 on right. I want the fullness of a full C but not too much projection. Appreciate your input

Doctor Answers 23

Which Breast Lift Technique To Use?

Without seeing your photos, it would be hard to offer any advice about which technique to use. That being said, you should choose a board certified (American Board of Plastic Surgery) who has documented experience in this procedure. Ask to see before and after photos. If it would help, you should ask to speak to a patient of the doctor to ask questions about the procedure, post-op course and results. Finally, you should feel comfortable with the surgeon you choose. Elective surgery is a big decision not to be taken lightly. Good luck.

Minneapolis Plastic Surgeon
4.8 out of 5 stars 175 reviews

Breast augmentation/lifting

Much of the final “look” achieved after breast augmentation/lifting 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 “look” 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’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’ 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 “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” 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 “I wish I was bigger”.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews


It seems like you have done your homework and visited with several surgeons. Be confident in your choice and enjoy the changes that surgery can accomplish. Best of luck to you.

Marc Schneider, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 25 reviews

Breast lift (Mastopexy)

All three docs may be offering a reasonable solution.  Which one fit you best is difficult to say without seeing your pictures.  However, when choosing your doc, make sure that he/she is a board certified plastic surgeon and that he/she was able to show you before and after pics of what to expect.  
Finally, as to the question of the size of the implant, you should have had an opportunity to try different implant sizers to see which one you really like.  Any reasonable size can be used and your surgeon would then adjust their technique around the implant.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 458 reviews

Keep the goal in mind for breast lift augmentation

You have three consultations with three very different recommendations that are all over the map. The most important consideration with breast lift and augmentation is a clear vision of the goal or 'look' of the procedure. Communication is the key and is confusing to me how after careful consultation one suggests an anchor lift with a 200cc implant, and another a round block lift with a 400cc implant. If your message is not clear and consistent the result is up to chance.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Short scar mastopexy versus anchor pattern scar

Hi Alchemista,

I am glad you are doing your research and asking questions BEFORE you make a final decision.  Without photos and knowing the implant styles it is a little hard to be precise with answer.  Also, we need to know what bra size you are now.  However, in general I agree to NO to #3.  Peri-areolar only lifts are rarely successful and given the other 2 docs recommend more extensive surgery, my guess is that they are right.  Personally I don't like saline implants that much but it depends on why doc #1 is recommending them.  The selection of saline is often totally driven by patient preference.  Most docs who do a lot of breast surgery prefer silicone as long as the patient understands that if they leak, the surgery to remove them is slightly more involved than the surgery to remove a deflated saline.  As far as the degree of scar between #1 and #2 here are my thoughts.  I generally use a short scar, ie lollipop, scar pattern but I tell the patient that if there is too much skin in the lower half of the breast at the end of surgery, I will add a scar in the inframmmary crease which will allow me to get rid of this excess skin.  It is important that there is not excess skin in the lower half of the breast.  I sometimes commit to an anchor pattern right away and this depends on your pre-operative evaulation.  I would like to know the reason why each one is making their recommendations.  Regarding size of implant, you will not be able to tell a 25cc difference.  Remember that the implant will look slightly smaller in the body compared to when you tried it on in the office, so if 225cc looked perfect in the office, 250cc should loook pretty perfect after surgery.  Hope this helps.  Good luck and congratulations on thinking about all of this before surgery!

Tracy M. Pfeifer, MD

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 27 reviews

Breast augmention and breast lift together

It is great that you have sought out several different opinions.  Breast augmentation and lift together is extremely complex with a fairly high rate of complications when done together (this is a national statistic). In general, if you really want to "play it safe" then simply do the two procedures separately.  As much as any women may not ideally want two procedures, sometimes it is the safest way to go.  Filling the breast out with added volume from an implant and tightening the skin envelope with a lift work in opposite directions and there are limitations to what can be safely achieved without getting a widely dilated areola (colored area around nipple) and many other problems.  In general, if you stay fairly low with the volume of the implant (350 cc or less) you will be safe most likely.  I think your "option 2" sounds reasonable; however, in my experience, which is extensive in this area, the short scar lift with implants does not lead to as pretty a shape for the breast.  I utilize a "short scar" inframammary incision (essentially a mini anchor) and that helps "center" the implant behind the breast.  Most "lollipop" short scar techniques that I have seen have a high rate of implant malposition.  I'm sure you'll do great and you are to be congratulated on your research and learning about the procedure and seeking out multiple opinions.  Good Luck!


James F. Boynton, M.D., F.A.C.S.

James F. Boynton, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 42 reviews

Breast lift and augmentation

It sounds like you have done your research. Augmentation mastopexy is challenging procedure so it's important that you feel absolutely comfortable with your choices. The implant size is dictated by your desire for size but also by your breast dimensions. Don't hesitate to discuss implant choices again with your surgeon. Enjoy your new breasts!

Nia Banks, MD, PhD
Washington Plastic Surgeon
4.0 out of 5 stars 27 reviews

What procedures and sizes are best for breast lift and enlargement

Without providing photos, any recommendation or concurrence with one of your physicians would be pure and unhelpful conjecture. The correct answer may not even be any one of these. An examination would provide the best determination including for the implant size. 

Peri-areolar lifts rarely provide the appropriate shape; vertical lifts also have limitations. It is even possible that a modification of the anchor shaped scar may provide you with the best overall outcome.

You may want to consider seeing even a few more plastic surgeons as your recommendations are quite different presently.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast Lift and Implants - Size, Incisions, Scars, etc

Hi alchemista

There are obviously no absolute answers to what you're talking about.  However, in my experience, I would say the following:

1)  Very few patients think their implants are too large; many patients wish they had gone a little larger

2)  Most women who have a lot of sagging are not as large (cup-wise) as they say they are; instead, they need a larger bra cup to hold the excess and loose skin.  If you look at the actual breast tissue size (ie, imagine you've already removed some of the skin - sorry if the visual is rough) the breasts are smaller than the cup size bra they're wearing.

3)  It's about 150-200 cc (or 5-7 ounces) per bra cup size.  So if you're a full B and want to be a full C, you need about 250 or so.  But if you're really a smallish B and want to be a very full C, you probably need more like a 300 or 350.

4)  Certain types of breast lifts limit the size implant you can put in.  Depending on the size of your areolas and exactly where they're positioned (nothing personal, of course) there is a limit as to how large you can go if you do an anchor or short-scar lift (not much difference between the two, sometimes).

Conclusions?  No simple answers, but I'd probably go with an anchor or short scar, go a little larger than they're saying IF the implants will fit and otherwise just be happy with your result.  You can always have larger implants put in at some point in the future; the key is to get a good shape and have safe healing and recovery at this procedure.

I hope that this helps and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

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.