Breast Sagging of 24 Cm, I Photoshoped my Desired Shape with Benelli? (photo)

Question

My breast are small and their sagging is 24 cm. I am 5' 10" tall and weight 134 lbs. I would like to do breast augmentation with Benelli lift, to avoid the lolipop scars of full mastopexy. On the photo below you can see my current breast appearance (left) and how I photoshoped my desired shape (right). I moved the center of the nipples only 1 cm up, as I have already learned that the donut cut cannot lift the breasts signinficantly. Is it doable? What do you recommend? Thank you!

Kevin Brenner, MD, FACS · Answer

Although you have done an excellent job altering your photos in photoshop, the reality is that soft tissue do necessarily behave in the same way. It appears that the degree of sagging, combined with the large size of your areola may preclude the use of a Benelli lift in your. Of course, this will greatly depend on the size and type of implant that you ultimately choose.

Edwin C. Pound, III, MD · Answer

First, beware of photoshopping or computer imaging results.  You can do lots of things on computers that you may or may not be able to re-create using real tissue. 

	There are two goals in a breast lift - 1. to elevate the nipple/areola, and 2. to tighten up the tissue under the breast to allow for a higher, perkier look to the breast.  A Benelli (aka, donut) lift only accomplishes the first goal.  It does not tighten up the tissue under the breast.  Whenever I do a Benelli lift, I feel that I get better results if I do it in conjunction with the insertion of a breast implant to fill out the excess skin.  If you do not want a breast implant then I am thinking that a Benelli lift may not give you the result that you see in your photoshopped picture.  You will probably need a lollipop lift.  Even with an implant this may be necessary.  Only an examining plastic surgeon can make that determination.

Kenneth Hughes, MD · Answer

You appear to have elements of deflation, ptosis, and constriction.  The deflation can be improved with the implant and the constriction to some degree.  The ptosis may be too great for the Benelli alone.  However, a larger implant with a high profile may give a better opportunity to avoid a vertical or full breast lift. 

	          The breasts may not have the degree of medial fullness as well, as is depicted in the inferior pole in the photoshop pic.  All of these elements along with chest wall width need to be taken into account during consultation and exam. Good luck.

Jeffrey Zwiren, MD · Answer

The Benelli or doughnut mastopexy has the highest level of patient dissatisfaction. The force vectors are all in the wrong direction and it tends to flatten out the breast loosing the conical shape to the end of the breast. It raises the nipple but does nothing to support the inferior breast. In many cases the areolar widens out in an abnormal fashion. If you are only removing areolar skin then I think that it works otherwise a vertical mastopexy is the correct decision.

Norman Bakshandeh Day, MD, FACS · Answer

You are very good with your computer skills. Unfortunately what can be accomplished on a computer is not always transferable to real life. The same applies to computer imaging

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	Although your efforts with computer imaging are to be commended,  you should be aware that the results of actual surgery may vary significantly from what can be accomplished on the computer screen.

	Personally, without direct examination, I'm not able to provide you with a precise answer to your question;  it is not clear to me based on the limited photographs whether you will be okay with a circumareolar (Benelli)  or whether additional breast lifting will be necessary to achieve aesthetically pleasing results.

	My best suggestion would be to meet with well experienced board-certified plastic surgeons who can demonstrate significant experience helping patients in your situation. Be careful about selecting an operation simply because it will result in fewer scars.

	 Best wishes.

Darryl J. Blinski, MD · Answer

Photoshopping is a tool that can be manipulated to achieve an unrealistic appearance. The years of training and operative experience of a boarded Plastic Surgeon is the best photoshop! In my opinion you will need a l-shaped or full lifting. Best to seek ONLY in person evaluations from boarded PSS in your city.

Kamran Khoobehi, MD · Answer

Your areola size and shape, position of the nipple and shape of your breast will require to have full lift for the best result. The decision about the procedure will depend on your expectations,your breast tissue quality and your surgeons experience.Please get more than one consultation

Jourdan Gottlieb, MD · Answer

Thank you for your question, for the photo, and for the simulation.

	The actual answer to your question will depend upon an exam in the setting of an in person consultation. 

	Although a Benelli lift can accomplish 1 cm of elevation, I cannot tell from this photo alone that once cm elevation is enough. Much depends upon the location of the breast fold. The lower edge of the (reduced in size) areola should be even with or above the fold, and in spite of the nice altered image, I think the nipple and areola may well need enough elevation such that the Benelli lift will in inadequate, and that a vertical lift would be a better choice.

	When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.

	Best wishes.

Scott L. Replogle, MD (retired) · Answer

I would add to the responses that the measurement of 24cm is relatively meaningless and is definitely relative to patient characteristics just as cc's of volume are. The critical measurement is where the nipple sits in relation to the inframammary crease behind it which can't be judged in the picture. 

	If the nipple isn't too low relative to the inframammary crease, then an implant will fill out the breast including the lower pole and give the illusion of a lift. If the nipple position is too low relative to the crease then a lift procedure is indicated with or without an added implant behind it. 

	In general, a donut or Benelli type lift is not a true lift of the breast and appears to be adequate or helpful when the breast didn't really need a lift. A properly done lift of the nipple-areola and gland of the breast is best done with a vertical or lollipop type incision. 

	I agree that a direct exam is necessary and that computer simulation is not reasonable to "choose" a result that is surgically realistic.

Breast Sagging of 24 Cm, I Photoshoped my Desired Shape with Benelli? (photo)

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