Is Breast Lift Necessary for Deflated C Cups?

Question

I am 34 year old and briefly breastfed my two sons (ages: 7y/o & 5 mo.) I have consulted with three different PS about Breast augmentation to regain fullness in my breasts.First one said I needed a full Breast Lift, second said just Breast implants needed, and third said a Benelli lift. I used to be a 34D before pregnancy and stayed a 36C after. Now, I'm a deflated 36C.While breastfeeding I was a nice full 36C not much growth just plump. I am hoping to have a 36D, would that be too big? With lift or not? Thank you.

David Stoker, MD · Answer

You are a candidate for breast implants, with or without a lift, depending on the size and shape of implants you use.  I believe you will progress to a lift in future years if you choose not to do it at this time.

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients
to lose breast volume and develop breast sag following pregnancy. It’s apparent
from your history that you have lost significant breast volume following breast
feeding and would like to have your breast volume restored to its pre-pregnancy
level.

When patients lose
breast volume, they often develop associated breast sag. In this situation, the
amount of breast sag varies from patient to patient. Selecting a therapeutic
option for breast sag under these circumstances can be very difficult.

In some mild cases,
a biplaner breast augmentation may be adequate to correct this problem. In
other cases, the sag may be more severe and a more aggressive lift may be
necessary.

Picking the right
option can be difficult for any particular patient. In your case, three
surgeons have made three different recommendations. Without a physical
examination it’s hard to say. Your pictures aren’t particularly helpful.
Consultation with a board certified plastic surgeon who is recognized as an
expert in complex breast surgery is appropriate and will help minimize your
confusion.

Adam Tattelbaum, MD · Answer

Thank you for your question and for your photograph. Unfortunately, the photograph is a little bit limited but I will share some thinking with you nonetheless. I agree with one of the other doctors listed below that you are in the grey zone with respect to needing a lift. From the photograph you appear to have a generous amount of natural breast tissue. Natural breast tissue will always respond to gravity with or without an implant, even with a breast lift. But I actually think that a little bit of droop gives a more natural look. In a patient such as yourself in the grey zone for a lift I will usually ask that patient to allow me the option of a lift if I feel it is necessary. I place the implants first focusing on the symmetry of the upper pole of the breast. Filling out the upper pole will certainly give some degree of elevation. If the patient has given me the option I will then proceed with either a full lift, crescent, vertical, or a Periareolar lift if I feel that the implant has not given enough elevation. If you are uncomfortable with your plastic surgeon having the option of making the decision for you can place the implants, allow them to drop and settle and decide upon a lift together in the future. Both are reasonable options. Again, because of the volume of your natural breast tissue you will still have some degree of droop but I actually think it will make you look more natural. Best wishes.

Richard Baxter, MD · Answer

No one can give you definitive advice without personally seeing you, but from what I can see in the picture implants alone would not be a good long-term solution. In the long run, it can make things worse. Part of the decision about which type of lift is best depends upon the size of the implants, since the larger they are the more they will "re-inflate" the breasts. My guess is that the vertical pattern (lollipop scar) would work best.

Otto Joseph Placik, MD · Answer

Based on this limited view, it is my general impression, that you would benefit from a lift. There are multiple techniques for breast lifts and so that may be a more difficult decision. A Benelli may be an option but it truly depends on your measurements and degree of ptosls.

Steven M. Lynch, MD · Answer

Hi,

	  If you use implants only, you will be larger but you will definitely have a more matronly look as your nipples are low.

	  In my practice, I would suggest you lift the nipples to a more centralized position and do a vertical scar to decrease the envelope of the breasts.  This would compress the breast tissue.  If you would not accept the vertical scar, then a benelli would be an alternative but the bottoming of your breasts would NOT be improved with the benelli.

	  One of the problems with implants only can be the double bubble effect.  The implants stay higher and the breast tissue comes off the implants.  Therefore, the UNIT of the breast tissue and implants is not achieve as it would be with a mastopexy with implants.

	  Talk to your surgeon and come to some conclusion that will achieve your goals and realistic results.

Tom J. Pousti, MD · Answer

Thank you for the  question and picture.

	In  person examination and careful communication will be a critical  step towards achieving your goals. However,  a few general words of advice may be helpful.

	Based on experience, I would suggest that your 1st concern should be obtaining the best results possible (scarring concerns should be secondary).  Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met. 

	In other words, if you select your surgeon based on  the offer of a &ldquo;limited scar&rdquo; procedure you may be disappointed with the results.
	It will be very important to communicate your overall 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" or "top heavy" 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.
	If you decide to use implants ( for example to achieve more superior breast pole volume)  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.

Marcel Daniels, MD · Answer

Breast lifts are generally needed when the nipples are at or below your breast crease and it is tough to say from the picture you posted. Putting a small implant on top of the muscle may give you a temporary fix but may increase the likelihood of needing a lift down the line. 
A modified form of breast augmentation with a more aggressive release of the pectoralis muscle might work but without seeing you in person it is difficult to say. In some cases it is more predictable and precise to do the surgery in two stages, first the implant than secondarily the lift.

Michael A. Jazayeri, MD · Answer

Hi Luna,
Based on your photos, I would say a lift is recommended for both breasts.  Remember, once an implant is placed, the nipple has to be at the center of the implant, otherwise the result will look unnatural.  I need to examine you to determine which type of lift would be the best option for you.

Michelle Copeland, MD, DMD · Answer

Mothers may find that pregnancy and breastfeeding contribute to loss of volume and firmness. If you're looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants. A breast lift raises droopy breasts from one to several inches and excess skin is removed. If you just want to go bigger, the only way to do that is with implants. The great thing about these techniques is that they can now be down with minimal scarring and performed as an outpatient procedure without the need for general anesthesia.

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