I am scheduled for breast augmentation and TT in a couple of weeks. I am 5'7 and weight about 150. I breast fed two children and it really shows. I asked my ps about a lift w/implants vs just implants and she acted like I could go either way. I had always heard if your nipples were below your crease then you should get a lift. I would rather go with just implants but if I'm going under I want to get it done right. I would love your expertise.
Nipples Below Crease: Breast Lift and Implants or Implants for Me?
Doctor Answers 31
When is a lift necessary with implants?
There is no simple rule such as, "if your nipples are below the crease you need a lift." It depends upon the tightness of the skin, the size and shape of the implants, and your goals from surgery. With larger implants, the skin envelope is filled out more and there is some rotation of the nipples into the correct position. Depending on the implant size, this can be quite an improvement. For many women this is enough. If you desire more of a lift, it can always be done later. If the implant size you are choosing is small, then a lift may be required. However, keep in mind that augmentation and lifting in the same operation increases the risk of both operations. Essentially, you are performing two contradictory operations -> enlarging the breast with implants, and decreasing the skin envelope and moving the nipple with the lift. This operation (augmentation mastopexy) has the highest revision rate in breast surgery. A conservative approach in borderline cases is to perform the augmentation first, then if necessary come back for a lift. I recommend trusting your plastic surgeon as she has performed a physical exam and carefully gone through your goals.
Breast lift or Augment?
Based on your photo you have pseudoptosis or glandular ptosis (your nipple is at the infra mammary crease but a portion of the breast hangs below it). In that situation I would agree with your surgeons opinion, you could use either approach.
In my own practice, simply adding volume to the breast with an augment will markedly improve the shape and appearance of the breast without the need for any additional scarring from a breast lift.
It doesn't look like you need a mastopexy
From your photos, I would agree with your PS. You could have a perfectly good result without undergoing a mastopexy. It just depends on whether or not you want the nipple position to be higher on the breast mound. If you don't have the lift, the implants will settle over time and look fine; keep in mind that it may take more time than a higher positioned nipple because the implant has a slightly longer distance to travel. If you are not really thrilled with the idea of having a mastopexy, be confident that your result will look great without one. Good luck!
Lawrence Tong MD FACS FRCSC
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Breast Lift with or without Implants
The simultaneous use of implants with breast lifts deserves careful reflection.
First, you need to clearly define and communicate your goals and expectations.
Adding volume to your breast with an implant will create a limited degree of lifting which may or may not suffice to fullfill your aesthetic goals. The obvious advantage here is only a small implant placement scar.
If you desire more substantial lift, you will have to consider the trade-off of breast lift scars.
In my patients, after having carefully listened to their expectations, I maintain flexibility in surgery: First, I use an intraooperative sizing process to determine an anatomically optimal implant volume. If this implant volume creates a sufficient lift and provides an aesthetic result that I believe will please the patient, the breast surgery is complete. If not, an appropiate type of breast lift is considered and added at that time.
In aesthetic borderline cases, I would stop at the implant stage and let the patient be the judge over the next several months before committing her to the scars of a breast lift.
Lift plus Implants or Implants alone are both reasonable options.
If you place a pencil beneath your breasts at your IMC (inframammary crease), I suspect your nipples will actually be at or slightly above the line made by the pencil. This makes you what I term a "borderline" case. Since the answers by my colleagues indicate that there is no clear-cut consensus, and either approach will likely yield good (but different) results, more information is needed (and of course, a physical examination gives any surgeon an advantage in making a good recommendation). If you are OK with larger implants, better filling of the skin brassiere can be achieved, and more fullness accomplished in the entire breast. The implants can be expected to "drop" somewhat, and this will give a better lower pole fullness that helps to achieve a better nipple/areola-to-breast-mound relationship. BTW, with implants alone, no skin is added or taken away between your nipples and collar bones, so any "lifting" is only on the basis of better "filling" of the lower part of the breast, giving the appearance of "lifted" nipple position!
If a woman wants only slightly larger breasts with this type of anatomy, there may be too much of a "rock in the sock" appearance, and the increased scarring and cost of a breast lift will be needed to achieve the goals of "slightly larger but normal perkier look." In addition to more cost and scarring, you may have a slightly higher chance of loss of nipple/areola sensation, and you can never "take the scars back" if you don't like their appearance.
Thus, a reasonable approach, in appropriately-informed women with your anatomy, is augmentation alone and let things heal, soften, and settle properly. If you like how your breasts look, great--you've avoided scars and additional cost. If you want bigger, or smaller, or "perkier," then you can add a lift later, at additional cost, scars, and time off work. Discuss this with your surgeon, or obtain additional consultations. Ultimately, the choice is yours! Best wishes!
Lift vs implants
An implant alone should do the job.
Judging from your photos I would recommend you go with an implant alone. The amount of lift that you would achieve from any lift procedure would not justify the additional scarring. I would also recommend that your implant be placed above the muscle. Your implant can be positioned in this location because you appear to have enough breast tissue to adequately camouflage the implant without the need for muscle coverage. Placing the implant above the muscle will also in itself provide a slight lift.
You may be able to avoid a breast lift.
We take several factors into consideration when deciding whether or not to do a lift such as the degree of skin laxity, poition of the nipple, size of the implant among others. Looking at your pictures it appears that you have lost some volume of the breast and this does contribute to looser skin. However, the nipple is relatively well positioned on the front of the breast. For older women this is age appropriate. You can have a natural result with an implant alone.
Discuss this carefully with your plastic surgeon. Discuss the size you would like and how high do want the nipple to be. In cases such as yours, I often suggest putting in only implants to avoid the scars from a breast lift. You can always come back and have a lift later. Remember, as you age the skin tends to stretch and you may develop more hanging later.
Nipples at or below crease- Implants or lift and implants
Your surgeon is right, you could go either way. When the decision is borderline, I feel that it's better to perform less surgery and see how things heal. In your case, the periareolar lift could be done in the future under local anesthesia if necessary.
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.