Breast lift choices - everyone has a different opinion! Reduction, fat grafting, implants, what would be best for me? (Photos)

Thanks for your question. Your surgical plan would depend on what you'd want your results to be. You seem to be a candidate for 1) a breast reduction, which is similar to a lift except more tissue is removed to make the breasts smaller and corrects the droop 2) a breast lift, which focuses on correcting the droop, and 3) a breast lift with implants, which corrects the droop, adds upper pole fullness and helps you keep/increase the size of your breasts. I recommend you schedule a consult for a proper evaluation. Be sure to always consult with a board certified plastic surgeon. Take care, Dr. Salama, Board Certified Plastic Surgeon.

Dear kg2v,


my preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos, I would recommend and augmentation with a mastopexy (lift). These can be staged. However, both are necessary to address the problems at hand: droop and upper pole hollowing.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Hello, thank you for your questions. First of all, I’d like to say that all of these options are valid and reasonable. The key question to ask yourself is whether you would be happy with smaller breasts.If your answer is a clear no, then a breast lift with implants may be the best choice, as it will give you lifted, fuller, and perkier breasts.If you are unsure about your desired size, you can start with a breast lift alone. This option will give you a natural lift using your own tissue. If you are happy with the smaller, lifted result, then no further surgery is needed. However, if you later decide you’d prefer a fuller size, implants can be added approximately six months after the initial surgery.I hope this helps clarify your options.

If you are satisfied with the volume of your breasts in a bra then you do not need additional fat or implants. You would benefit from a breast lift using 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 or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Congrats on your weight loss ! After 25 years of working mainly with weight loss patients, I can safely say this is one of the more challenging procedures to get consistent and long-lasting results.

Lifting the breast with a vertical mammoplasty (lollipop or tennis-racket shaped scar) and rearranging your tissues to provide more fullness is the simplest operation and you never have an implant to worry about later. Problem is it doesn't give great fullness bat the top.

IN GENERAL using an implant and adding weight to a breast that has undergone weight gain/loss cycles results in sagging (or bottoming out) very soon after surgery. A small implant to provide upper pole fullness is the best option.

I prefer to do the lift and implant in one procedure. If we get early sagging, removing and tightening the skin some more and possible using mesh is my second procedure.

Fat grafting, in my opinion and experience, is of zero help in restoring any meaningful breast fullness and can result is issues interpreting mammograms later on.

Much depends on your breast tissues and skin, so an in-person exam is best.

Hi, thank you for sharing your question. The answer to the question will depend on how much volume and projection you want as well as how much long term upper pole fullness you want. Also, whether you want the surgery in one stage or two.

From your photos, it looks like you still have a good amount of natural breast tissue. Because of this, doing a lift with an implant at the same time could carry a higher risk of developing “waterfall deformity”, where the natural tissue droops over the implant over time.
For that reason, my recommendation would be to first do a lift without an implant or reduction. This will allow the breast tissue to settle and give you a clear idea of the shape and volume after the lift. If you still want more fullness after healing (usually a few months later), an implant can be added at that stage for a safer and more predictable result.
Best,Dr. Süleyman Köken

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast 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 is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You need an aggressive breast lift.
This entails removing a substantial percentage of the skin of your breast.
A lift by itself is a fairly safe, straightforward procedure. When combined with implant augmentation, the procedure has higher risk for complications, including tissue necrosis with potentially disaster is outcomes. And paragraph The more aggressive the lift is the more risk is added by
Removing tissue or doing a breast production has even more risk of wound healing problems.
The safest in my opinion would be to do a lift, followed by implant augmentation at a later day to pay the
I’m guessing there’s a fairly high chance that you’re going to end up with a revision procedure because of the amount of skin that needs to be removed.
A lift by itself is going to leave your breast flat, but the nipple position will be better To get projection, you need an implant.
Fat transfer is not going to give you projection.
Fat transfer makes what you have just slightly bigger.
A fat transfer is not at all a good procedure for you.
If you don’t want your breast to look like pancakes then you’re going to need an implant to push the breast tissue forward.
Grafting fat doesn’t do that.
Grafting fat is no better than your own tissue in creating projection and your own tissue isn’t projecting at all and it’s not going to even if you lifted higher on your chest wall.
Do I advantages and disadvantages of doing combined procedures.
It is slightly higher risk in terms of complications to do a lift and implant at the same time.
It is however, done frequently and I’m guessing most patients have this done as a combined single operation.
It is however, safer to do it as two procedures.
As I mentioned, there’s a pretty good chance you’re going to need a touchup procedure.
This obviously depends on who does the procedure and to what degree you are accepting of the outcome.
The thing to note is that the degree of lifting and the amount of tissue that needs to be removed to do that is far more than a typical breast lift. Based on some historical textbook recommendations, some plastic surgeons may even opt for removing the nipple and putting it back on as a graft.
This is sometimes done for patients who have a breast reduction, whose breast hangs down quite low.
The reason that you’re getting different opinions is because there is no one best way of doing this.
Situations are complex you’re more likely to get more opinions about what to do.
For simple problems you’re more likely to get the same response from each provider.
In the end, provider selection is probably the most important variable credit.
During each in person consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar body characteristics to your own.
Bring pictures of yourself to use as a reference during the consultation.
If providers don’t have any good examples of previous patients who looked similar to what you do and they may not have sufficient experience.
You should also ask each provider what the most common indication for revision surgery is for this procedure, what their revision rate is and what their revision policy is.
In reality a breast lift with an augmentation has at least a one and three chance of needing a revision.
This may be years down the line, but revision rates are high for this combined procedure.
In your case because of the amount of extra skin, the chance of needing a revision is even higher.
I’m not trying to scare you saying that you’re going to need more procedures, but you should know that the chance of needing a revision is there.
Look for the surgeons will have the most experience and seem to have the best track record Carrie
Also look for those that seem to put a premium on the safety.
Best,
Mats Hagstrom MD