26, no kids, 400cc, under muscle, do I definitely need a lift? Or just implants? (Photos)

Hello, thank you for your question. If your are going to go sub muscular, you may want to consider the breast lift as well because the muscle supports the implant and it may sit higher on your chest wall than your natural breast tissue. Without a lift you may not be happy with the appearance as there will be a noted change from where the implant sits to your natural breast tissue we call this a snoopy appearance. Speak to your plastic surgeon.

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 or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

I would recommend placing appropriate sized implants and performing a lift. The level of ptosis (grade 1-3) is a poor classification system that is very vague and arbitrary with significant variability between surgeons. The ideal process would include tissue based planning to determine the need for a lift, which I believe is required in your case.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style 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 size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

You will never look like your wish pics without a lift. Although the concern about higher costs are real, fear of scarring is not warranted. The shape of a breast, not the well healed scar on it, is the most important determinant for patient satisfaction. A big implant is not a lifting agent and will leave you bigger than you want with suboptimal breast aesthetics.

You can just go with implants, but you will not look like your wish photos because of the sagging you now have. Your breasts also sit somewhat low on your chest and you will never have high sitting breasts. If you are planning to have children soon, then just go with the augmentation. Pregnancy and breast feeding do change breasts.

I have developed a technique which lifts the breasts internally with absorbable mesh .This is combined with a sub-areolar lift
I prefer placing implants above the muscle

A lift is needed when the breast sits below its natural attachment on the chest wall.
The bottom of the breast is the inframammary fold or breast crease. If most of your breast is hanging below the inframammary fold, then your breast will hang off the implant, because the implant will sit above the fold.
Most plastic surgeons will recommend adding a lift if the nipple position is below the inframammary fold. To make an assessment we need to see the position of the inframammary fold in relationship to your nipple position. Without seeing where the inframammary fold is, we can’t really make an accurate determination.
In the end, patient may be on the verge of needing a lift, in which case you should ask yourself how important having an ideal breast contour is in relationship to the drawbacks of having a breast lift.
Nobody wants to have a breast lift, but some women need them in order to get a good outcome.
Best,
Mats Hagstrom, MD