Which Breast Procedure is Right for Me? Is Minimal Scar Intervention a Possibility? (photo)

I have lost 80 pounds in the last 3 years and am noticing asymmetry and ptosis of my breasts. I wear a 36DDD bra. I am wondering which breast procedure would give me the best aesthetic result with the least amount of scarring. I am looking for a provider in the Orange County area - are you or someone you would recommend who can help me in this area?

Doctor Answers 11

Breast lift and or implants

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It depends what you are looking for. You can reduce the larger breast and lift them both, or add an implant to the smaller one and lift them both.  Or implants in both with a larger one in the smaller breast.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Options for Breast Lift.

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Thanks so much for your question.  Let's start by saying congratulations on the weight loss.  80 lbs is a phenomenal amount of weight so you should be very proud of yourself.  I do notice the assymetry that you mentioned in your question.  I also notice that, especially on the right hand side, your areola is larger than normal.  I mention this because it can be delt with if you decide to go forward with surgery.  A peri-areolar lift is only able to lift the breast  about 4cm.  If you want a higher, more augmented position for you breast, you will need to have at least a lolipop incision or even possibly a standard lift.  A lot also depends on your breast tissue quality and also the final breast size you desire.  These can't be fully appreciated without an examination.   Hope this helps.

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 47 reviews

Which Breast Procedure is Right for Me? Is Minimal Scar Intervention a Possibility?

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It is hard to answer this without knowing what your goals are, especially in terms of size. If the smalller breast is a good goal size, you should consider a breast reduction of the larger side. That procedure is most likely of the alternatives to result in a close to symmetric outcome in one stage.

If the larger breast is the goal size, an implant in the smaller breast is in order, and possibly a procedure on the larger side to even out the areolar size and position.

RealSelf has listings of breast surgeons in your area. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Minimal scar breast lift

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The best minimal scar technique is The Ultimate Breast Lift.  This technique uses a circumareola incision and inframammary incision to reduce the size of large breasts, reposition them higher on the chest wall, increase upper pole fullness and cleavage.  The breast weight is transferred to the underlying muscle to maintain long term stability.  This technique maintains nipple sensation, the ability to breast feed and avoids the ugly vertical scars of the Wise pattern or lollipop incision.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Length of mastopexy scar depends on anatomy of the breast and the aesthetic goal.

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The breasts in the photograph present a number of surgical options. Breast augmentation alone could be performed that would make the breasts look attractive. Of course the patient would want to have larger breasts in the first place. Various types of mastopexy is within without implants also fall within the scope of possibilities.

Best procedure for asymmetric ptosis

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There is no best procedure but if you want symmetrical volumes, you have to consider a reduction on your larger side.  And if you want your nipples lifted, you  have to have a mastopexy.  Benelli mastopexies will have less scarring but tend to flatten projection and if the sutures holding the skin around the areola fail, you will have stretched out scars.  Vertical lifts improve projection and is what most of my patients want.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Intervention with the least Scarring

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I think you will not be happy with a circumareolar (aka periareolar or Benelli) type lift.  Yes, it has the least scarring, but it will do very little 'lifting' in breasts like yours.  In the right breast (small, light, with minimal glandular ptosis), it will lift the areola into a more pleasing position when an implant is also utilized.  In the wrong breast (large, true ptosis, long distance to move the areola into a good position, no implant utilized), you will not get a nice result: persistent ptosis, persistent low lying areola, irregularly shaped and large areola, thickened scarring, pleating of the skin around the areola, and abnormal flattening of the breast mound.  The circumareolar lift is the number one named procedure in malpractice lawsuits in California involving cosmetic breast surgery.  Having said all that, it is a great procedure in the right person, and I perform it frequently.

Your breasts are too asymmetric in shape and size to be treated with this lift, and you would likely not be happy with your shape or symmetry unless a full mastopexy was performed, with all the attendant scaring (which would probably be minor in appearance after healing).  I have found that women are much more attuned to breast shape and lift then scar appearance after the procedure, even when they were more concerned about scarring before.  It is exceedingly rare that a patient tells me that scars are an issue, but many wish that their breasts were just 'a little higher' after they have healed and settled!

Regarding symmetry, I have never seen a unilateral implant give symmetry to patient.  Yes, I've seen the occasional photo that looks good in one angle, but seen in other angles or in person there are changes that occur that make the unilateral implant a poor choice for virtually everyone.  In fact, even asymmetric implant sizes can cause additional, unintended asymmetries.  If a formal lift is being performed, the most natural way to achieve symmetry in shape and size is with the lift, performing also some reduction to the larger breast.  The implants are there for volume and upper pole shaping only, and equal sized implants are used to avoid introducing any new asymmetries.

I hope this hasn't been too long winded or confusing!  Remember, either put in two implants, or none at all.  Similarly, either have the right lift performed, or don't do the surgery until you are ready!

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Which Breast Procedure is Right for Me? Is Minimal Scar Intervention a Possibility?

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           A small implant in the smaller breast and a lift on both breasts in circumareolar fashion would limit scarring and produce a nice result.   Find a plastic surgeon with ELITE credentials who performs hundreds of breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Reduction of the large one or augmentation of the smaller one

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hi. the results in breast surgery always depends on what a plastic surgeons as to work with.  to minimize scars you´ll have to increase volumen to the breast, this way youll fill the saggines of the breast.  if you want to reduce size, this will result in more scars, the reason is that to adjust the skin bra to your breast tissue the surgeon has to make a Tailor made option to assure you a better result.   always trying to achieve the minor scaring.    

Considering breast surgery for asymmetry after loosing weight

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If you are trying to avoid using a breast implant you could have a bilateral vertical breast lift with a small breast reduction on the larger side.  If you are interested in exploring your options it would be best for you to see an experienced plastic surgeon in your area.  If you are looking for a surgeon ask trusted friends and family or your family physician for a referral.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

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.