Breast Lift with or Without Implants if I Don't Want to Be Any Bigger Cup Size?

Question

I am scheduled for a breast lift without implants. My dr says I have a lot of breast tissue to work with. I am a 36 dd and I don't want to be any bigger but want a good shape with upper pole roundness. Can I accomplish a good shape without an implant? He is planning on a vertical incision. Any advice will be very helpful.

Ary Krau, MD, FACS · Answer

Hi islandgirl05,

	     I am glad to hear  that your PS is planning on performing a vertical mastopexy where there will not be a horizontal incision.  This type of lift is a bit more challenging to perform and not done by all plastic surgeons.

	     My concern is your final size and shape.  To perform this type of lift properly, a certain amount of your breast tissue will need to be removed.  The amount  required to be excised depends on the starting shape of your breast.  Therefore, you need to realize that you will be a bit smaller than your starting size. Additionally, you mentioned that you would like to end up with upper pole roundness after surgery.  It has been my experience that this is not possible without the use of implants.  Regardless of how tight the lift is performed, the upper part of the breast eventually flattens out.  An implant placed behind the muscle will be supported by the muscle and can give fullness and roundness to the upper part of the breast.  The implant will not, necessarily,make the breast bigger, as a small implant will suffice compared to the breast volume obligatorily removed by the lift itself.

	Good Luck,

	Ary Krau MD FACS

Andrew Smith, MD, FACS · Answer

At your size, it sounds like you should be able to achieve fullness without implants but it's very hard to say without photos. Some women choose a small implant to make sure they achieve the upper pole roundness that you are describing because typically, it's difficult to achieve that look without implants. If you are concerned, you should have another discussion with your Board Certified Plastic Surgeon but keep in mind, you can always add implants later if your results are not what you were hoping for but that would be an additional cost.

Kenneth Hughes, MD · Answer

A breast lift can improve the look of your breasts and create the superior pole fullness you want. An implant is not necessary. Find the plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year. Kenneth Hughes, MD Los Angeles, CA

Sacha Obaid, MD · Answer

You definitely can have a nice result from a breast lift without implants. The question of how much roundness you can expect on top really depends upon what you are starting with and unfortunately without a picture I cannot tell you that. Good luck.

Raj S. Ambay, MD · Answer

Thanks for your question. You would be a great candidate for a lift. If you like your general size then a lift would be the procedure of choice and you would loose very little volume. The best way to evaluate ptosis (sag) is by physical exam but a picture can give a preliminary idea. The best picture is a side profile. In general breast lifts are done to not only raise the nipple but also to make the areolar/nipple complex smaller and raise the breast tissue to a more natural youthful position. Of course, the key to a great breast lift is patient selection and technique selection. Areolar lifts are generally good for women with good skin quality, breast tissue reasonably placed and a nipple/areola that are sagging no more than 2 cm. Once the breasts sag past that point, it is necessary to perform a lollipop lift which not only repositions the sagging breast tissues but also the nipple and areola. The final and most aggressive lift is an anchor lift which places both a vertical and horizontal incision. Again the determinant is the degree of sagging, skin quality and amount of breast tissue. Last, if there is a deficiency in breast tissue, an augmentation can be done either together with the lift or as separate procedures. Make sure you visit with a board certified plastic surgeon get get specifics on your situation.

Robert L. Kraft, MD, FACS · Answer

Generally, at your size, you do not need implants but photos would be useful. The lift technique is important in a patient who is already a DD.  In terms of shape, upper pole volume is dependent on your starting point.

John Q. Cook, MD · Answer

If you have DD breasts there should be adequate volume for you to have a nice result from a breast lift procedure.  Technique is important.  Techniques that lift the breast just by removing skin tend to settle and lose volume in the upper pole.  Some people want a great degree of fullness in the upper portions of the breast, in which case implants might help. 

	As with all plastic surgery, a natural result is best.

Steven Wallach, MD · Answer

I think an exam in person would help determine whether or not your goals could be accomplished.  Hard to say without photos as well.

Jourdan Gottlieb, MD · Answer

Without photos it is hard to give a useful response to your question. At your current size, I would in general much prefer to use only your own tissue and not add implants. There should be enough tissue to fashion a nice breast shape. A vertical mastopexy is probably the way to go, though hard to say without a picture.

	All the best.

Tom J. Pousti, MD · Answer

Thank you for the question, but I think that you will do much better if you spend more time with your plastic surgeon as opposed to online consultants. Have your plastic surgeon demonstrate, in front of a full-length mirror, what is realistically possible with the breast lifting operation (only) in your case. Also, you may want to demonstrate to him/her what you mean by “upper pole roundness” and confirm that your goals are achievable, without the use of breast implants.

	 Also, for your peace of mind, you may wish to ask your plastic surgeon to demonstrate examples of previous patients who have achieved the types of results you are looking for.

	 Online consultants,  despite good intentions, will not be able to provide you with precise enough advice.

	 Best wishes.

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