Looking for natural result proportional to my thin body - do I need a breast lift?

Dear lesssy,

determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

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

The asymmetry in your breasts will be the most challenging aspect. The left breast has more ptosis, a larger areola and a higher infra-mammary fold. I like the implant range you have considered as it will help with volume, look natural, and be proportionate. The most conservative course would be augmentation first, then see how the implants settle and how you feel about them, and then make a decision on a breast lift. Thank you.

Your nipples sit below your breast fold. For this reason, a breast lift would be recommended. A periareolar lift may not be sufficient.

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

Yes, you need a breast lift. 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.

Judging by the photos I would likely recommend a donut or periareolar mastopexy to help address the asymmetry that you have have. As far as sizing goes, that his always difficult to comment on photos alone as there is a lot that goes into sizing our patients, in particular assessing the skin envelope and have measurements performed.

One recommendation that I have is to make sure you see a board certified plastic surgeon that has a great deal of experience in breast surgery. Hope that helps.

From the photos you have some asymmetry. One nipple is lower with a larger areola. There is some size asymmetry too. You could proceed with augmentation alone but it is important to note that the asymmetries you have now will still be present but you will have more volume to the breasts. The implants you are considering should give you a nice, natural enhancement.

Yes, you need a lift, especially for the more sagging breast. I would suggest placing the implants behind the muscle and using smooth round implants for better long-term results. Don't go with large heavy implants for your tissue will not support the weight.

Dear lesssy,
While you don't have classic nipple ptosis (maybe grade I on the left), you do have visible asymmetry in your nipple positions, areolar size and breast shape. A dual plane breast augmentation with a larger size breast implant ~300cc will probably give you a nice result. Without areola "correction" your asymmetries might become even more visible. Good luck!

The indication for a breast lift in conjunction with implant augmentation is based on the relationship between the nipple and the IMF. (Infra mammary fold)
On your pictures, we can’t see the IMF because the breast is hanging over it.
If you were to take a skin marking pen and draw a straight line from the IMF over your sternum, then we could easily see the nipple to the IMF.
If the nipple is below the Breast implant augmentation.
If the nipple is at or above the IMF, then you can have breast implants without a lift.
All the left breast sits higher on the chest wall than the right side.
The position of the breast on the chest wall is determined by where the IMF is.
If you check on yourself, you’ll feel or see That the IMF sits higher on the left side this means that if the nipple isn’t an ideal position, the left nipple should technically sit higher than the right side because the left breast sits higher.
This tells me you have more breast droopiness on the left side.
I Think you mentioned this in your comment. My best guess is that your nipple does sit below the IMF, especially on the left side so a breast lift is going to be indicated.
I’m not a big fan of the Arellano only breast lift A.k.a. donut lift a.k.a. Benelli lift.
Too many patients end up with undesirable side effects from the procedure which includes why didn’t scars, a flat and stretched out areola. Once a patient commits to this procedure, converting it to a more proper breast lift later as revision surgery becomes more difficult.
I think a lollipop incision is going to be far better or perhaps a wise pattern or anchor.
Implant selection is a really important part of the process.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
Implant selection includes size shape and type.
There’s a lot to discuss.
You should have a clear understanding of the implication of having either saline or silicone especially the implication in the future with implant failure, which will inevitably happen if you keep the implants long enough.
In the end, provider selection is the most important variable.
In the hands of the right plastic surgeon, you’ll be guided to have the correct procedure without any hesitation.
The advance of the right plastic surgeon you’ll be guided through the implant selection process in the best possible way minimizing the chance of needing Surgery or being unhappy with the outcome.
Some plastic surgeons will ask patient to make the final decision regarding the implant size. Other plastic surgeons will make the decision based on input from the patient.
My personal approach is to work with before, and after pictures of previous patients who had very similar body characteristics.
I ask the patient to pick out multiple examples of what they think our ideal outcomes on the patients who had similar body characteristics.
I bring these pictures with me to the operating room and use them as a reference during surgery.
During the procedure used temporary what size implant will give the desired outcome.
I have a complete set of implants available during surgery at my disposal.
I found this to be the most accurate way to deliver results consistent with the patient wishes.
In my opinion working with pictures and images is the most accurate way of conveying ideal results.
As I mentioned each provider, it will have their own way of doing this.
There’s no right or wrong way to do it.
Some plastic surgeons do it better than others.
In my opinion, the surgeon is in a slightly better position to make the decision regarding implant size based on having years of experience with the patient often having zero experience.
Putting an implant in your bra is in my opinion an inaccurate way of judging implant size. perhaps it works for those who use that method.
I’m not claiming my way is better, but it is what has worked the best for me.
In regards to implant augmentation, the outcomes are generally based on three variables.
The first is the patient’s candidacy for the procedure.
Candidacy includes variables like breast position on the chest wall, breast shape, and breast divergence.
In your case, your breast sit slightly wide on your chest wall, have moderate droopiness, and your right breast has slightly more divergence than your left breast.
Breast divergence becomes amplified with the projection of the implant.
I don’t think your divergence is dramatic, but recognize that you’re right breast will point out towards the side more than your left breast.
Plastic surgeons can’t move the breast on the chest wall and we can’t change the angle of the breast either.
The second variable is implant selection.
I’ve mentioned that above.
The third variable is the surgeons ability to put the implant in the correct and atomic location.
This is irrelevant of if the surgeon puts the implant above or below the pectoralis muscle.
If the implant is put too high, then the patient will have a high riding implant that may require a revision procedure.
If the implant is placed too low or the IMF is opened too much than the patient may develop bottoming out overtime.
In general statement, anytime, excessively large implants are used the chance of undesirable side effects, complications and need for revision surgery will go up.
The implant sizes you mentioned seem very moderate and I don’t think you’re going to have trouble by staying with that size.
as long as the implants diameter is reasonably natural breast diameter, you should be fine, and this will minimize the chance of needing revision surgery in the future.
Obviously adding a breast lift as it said a variables.
The biggest mistake I see breast lift technique that minimizes scars leading to complications and revision surgery that could’ve been avoided by simply doing the breast lift in a more proper way, even if that requires a slightly longer scar.
As I mentioned, the most important variable is provider selection.
Finding the right plastic surgeon is neither easy or straightforward.
Consider the following recommendations for provider selection.
The biggest mistake I see patient is having one consultation which more or less eliminates the ability to choose a better provider.
Bring pictures of yourself to use as referenced during the consultation.
The surgeon is going to examine you, but you need to have pictures of yourself to use as reference, especially when reviewing before and after pictures.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have very similar body and breast characteristics of your own. this is where having pictures of yourself comes in handy.
It’s really important that you see the outcomes of patients who have the same degree of breast droopiness, breast size, etc., etc. An experienced plastic surgeon should’ve access 100s of before, and after pictures to choose from.
Having a weak collection before, and after pictures is probably the biggest red flag.
Your an experienced plastic surgeon should’ve access 100s of before, and after pictures to choose from.
Having a week collection of before, and after pictures is probably the biggest red flag.
Your goal should never be to see what the best results of the providers career looks like.
Your goal should always be to get a good understanding of what average results look like and especially the surgeons chance of getting undesirable outcomes or how many patients need revision procedures.
In the hands of the right provider you should have access to more before and after pictures then you have time to look at it during the consultation.
Most patients don’t have a lot of experience consulting with plastic surgeons.
By having multiple consultations, you’ll become more familiar with each aspect of the procedure and how cosmetic surgery consult should be performed.
You’ll get an idea of which surgeons are detail oriented and cover all the important aspects.
Take notes of the consultation, especially how thorough the provider is and the quality and quantity of before and after pictures.
Ask each provider what your most common indication for revision surgery is, what their revision rate is for this procedure and what their revision policy is.
recognize that revisions are fairly common after Breast augmentation with a breast lift. revision rates for this procedure are probably around 30%.
This means one out of three patients are likely to need a revision at some point within the first few years after surgery.
It is the surgeons responsibility to make an accurate assessment of the patient and accurately convey the aspects of surgery. The patient needs to know.
It is the patient’s responsibility to vet the provider in regards to their skill and experience.
Never assume that somebody is good at something without seeing evidence of the fact.
Simply being bored certified in plastic surgery with a handful of good reviews, and a few years of experience does not mean somebody has mastered any single plastic surgery procedure.
The more the more likely you are to find the better provider for your needs.
Avoid virtual consultations whenever possible.
When in doubt, slow down and schedule more consultations.
Good luck,
Mats Hagstrom MD