Will I need a lift as well as a breast revision to replace implant? What is the best option for me? (photos)

Question

I had a previous breast augmentation with Saline implants almost 18 years ago. I have had 2 more kids since the breast implants and recently felt like they are drooping and how do I know I need a lift. Is it possible to get pocket work done without a full lift. What options do I have for the best outcome. ?

Richard Baxter, MD · Answer

You have what is called "waterfall ptosis," which is sagging of the breast tissue with the implants staying in position. (The opposite is bottoming out, when the implants drop but nipple position stays.) This can only be corrected with a breast lift.

Wayne I. Yamahata, MD · Answer

Your photos suggest that a breast lift would be required to enhance your breast contours. Seek a consultation with a board certified plastic surgeon to discuss options for the type of lift that would best suit your goals.

Jonathan Heistein, MD · Answer

Hi.  I think your breasts would look more youthful and perky if you have a breast lift.  Unfortunately, there are scars required for this procedure, but if you don't do it, then you can fix your sagging appearance.  The option that gives a scar around the areola, donut mastopexy, would not work for you since it would not lift you enough and it would make the front of your breast look flattened.  The full mastopexy would do a better job of fixing the sagging.  Best of luck!

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You are an excellent candidate for a procedure I developed termed "Reductive Augmentation" in which we perform implant exchange with a higher-profile silicone implant, lateral and inferior capsulorrhaphy-internal bra, and revision mastopexy. I published in 2017 you can view it on my website under publications.  You are absolutely not a candidate for a donut mastopexy.  Best wishes to you.

Gary M. Horndeski, MD · Answer

The technique I recommend is explantation with lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated 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 if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

Your nipples are clearly too low on your chest. You would require a lift to correct it along with the scars that entails. There is no way to lift your breasts without scars.

Daniel Barrett, MD · Answer

Dear Esther Elizabeth,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donald R. Revis Jr, MD · Answer

Good evening,
You are an excellent candidate for a donut mastopexy to lift your nipple position and tighten your skin, and an implant exchange. I would also perform the Original Internal Bra, my strong permanent internal suturing technique, to lift and support your implants over the long term. I first developed this technique over 20 years ago, and today it remains the most common revision procedure I perform, at least 5-6 times a week- it works and it lasts!

Connie Hiers, MD, FACS · Answer

The implants could be lowered to settle down in the breasts, but you may find that you are sagging. Measurements are needed to see if a lift is needed, but I suspect you will need a lift.

Douglas Taranow, DO, FACOS · Answer

Esther,
You are a great candidate for a breast lift procedure (mastopexy).  The two options are a periareolar (around the nipple) mastopexy or a lollipop mastopexy.  The periareolar lift does not tighten the breast nor raise the nipple/areola as high as the lollipop, however, there is less scars.
You must have a lift as your implants are in the correct position but your breast tissue has drooped and now hangs over the bottom of the implants.  Since the implants are 18 years old, you may also consider replacing them at the same time.  No one knows how long they will last.
Dr. Taranow