Breat Augmentation Methodology Advantages and Disadvantages

After losing 186 pounds, I have no breasts at all. I want something other than what I have now which slightly resembles loose socks with small balls in the toes hanging to just above my waist. I am wondering about the difference in implant procedures.I know of one method that involves cutting beneath the breast, removing the nipple, placing the implant & reattching the nipple.Recently I have heard about a procedure that goes in through an incision near the underarm area. What are the advantages and disadvantages in comparison and which would I benefit from the most?

Doctor Answers 11

Massive weight loss and implants

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With massive weight loss usually a combination of breast augmentation and a breast lift with tightening of the skin envelope is required.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You need a lift and augmentation

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Losing the weight is great for you , but it does leave you with cosmetic problems. For what you describe, you most likely need a breast lift (anchor scar) and an implant. Make sure, you see and experience board certified plastic surgeon as this can be a difficult and tricky procedure.

Some physicians two stage this and some do it at one operation. Beware of a trans-axillary augmentation, as it usually leaves you with a implant that is too high and your breast hanging down.

You need to have your nipple raised and the envelope filled with an implant.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

An augmentation with a lift is probably your best bet

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Given your description, I think an augmentation with a breast lift, either as one or two procedures, is your best bet. I congratulate you on losing the weight-- that in and of itself is an incredible accomplishment, so now we need to get you looking and feeling your best. In most cases like yours, a breast lift will improve the shape of the breasts and an augmentation their size. This will usually require an anchor-pattern incision (incision around the areola, straight down the breast, and then underneath it in the crease). Also, this may need to be done in two stages to avoid healing difficulties, but this should be determined by your surgeon at your consultation.

Best of luck and I'm sure you'll have a very nice result!

Dr. Salemy

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Breast enhancement after weight loss

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Congratulations on your weight loss success. You will probably want to speak with several surgeons to plan for haw to address various areas that you may wish to improve.

As far as your breast questions, I will say that you are probably going to want something more than "breast augmentation" alone. The most likely solution would be a two-stage procedure. Stage one would be mastopexy / breast lift in which a large amount of loose skin would be removed, your remaining natural breast tissue re-suspended up on the chest, and the nipple & areola positioned in the appropriate new location. The nipple is usually moved up without separating and reattaching it. Stage two would be to add an implant (the actual augmentation) if you and your surgeon felt it was needed.

A few surgeons have suggested operations in which excess skin and fat from the lateral chest or upper abdomen was used to provide breast fullness and reshape the "donor" areas too (auto-augmentation). Those are not common operations.

The underarm (axillary) approach is possible for breast augmentation, but not well suited for patients with low nipples or lax skin on the ribs.

Sutton Graham II, MD
Greenville Plastic Surgeon

Augmentation Mastopexy after Massive Weight loss

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You have to distinguish between Breast Lift (mastopexy) and Breast Augmentation.

The latter simply enlarges the breast while the former helps to restore the shape.

It is very likely you will need a lift.

Here are your options and the decisions you need to make:

  1. Do you want a lift and the resulting scars? This will reduce the extra skin and elevate the position of the nipple.
  2. Do you want to reduce the size of the breast?
  3. Do you want to enlarge the breast?
  • IF YES: Do you want to do it with your own tissue or with an implant?
  • IF you want or need an implant, do you want the implant placed at the time of the breast lift, which carries increased risks, or at a later date with the incovenience of a second surgery?

I think that if you proceed with the aforementioned questions, you may be better able to make a better decision. There is no one right answer for you, but there are many options and you will need to learn more about each one prior to making a decision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

You need a Breast Lift and its scar pattern

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From your description of your breasts, you need a breast lift (mastopexy) and probably implants too. Your breast lift will require a scar around the nipple, down to the crease, and probably across the crease as well. I am sure if you talk to a Plastic Surgeon, he/she will be able to show you where the incisions/scars need to be.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

You need to get more education.

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You have more going on than the appearance of the breasts, and so let me help with that.

First, so you understand, I have a professional passion for treating massive weight loss patients (mwlp+. I congratulate you on your accomplishment- atta girl!

If you lost the weight without surgery, that is incredible, and puts you in a different catetory than if you had a bypass. If you had the latter, my experience is that you are physiologically delicate, dehydrated, and malnourished as it pertains to healing. Therefore, you need to be treated by someone who understands this and knows how to treat all the bumps in the road that might come your way.

The next thing to understand is that the time and weight along with gravity has stretched your tissues and weakened the support tissues. Therefore, the tissues are more likely to stretch or sag compared to a non mwl patient. It is therefore reasonable to expect that you may need a followup procedure at sometime to thighten things up.

That all being said, the rock in the sock description, along with the breasts being at your waist is a sure indicator that you need a breast lift or mastopexy. The degree of sagging or ptosis you describe will more or less limit you to the "Wise" pattern (anchor) lift. The scar resides around the areola, down to the breast crease and in the breast crease. It sort of looks like a lolly pop on a smiley face. Typically, the nipple is NOT removed from the gland, but rather is left attached and moved into position so that blood and nerve supply are maintained. Please view on mastopexy on a massive weight loss patient (it is graphic however!)

A breast lift will bring the nipple to a better position and shape the breasts. It is not great at maintaining upper pole fullness and firmness.

The next question is about an implant. You will likely desire one to complete the cosmetic rehabilitation of your breasts. I would urge you to consider this ~9 months to a year after a lift. This will give you a chance to see if you like your breasts, and therefore obviate the need for implants, or conversly, if you decide on implants, any touch up procedures can be done at the same time.

Hope this helps, and I would love to hear feedback on my video!!!


You may have limited options

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Depending on how large an implant you may desire/require AND the amount of excess skin you have will detrmine options for implant placement. It sounds as if you would benefit mostly from an augmentation mastopexy(lift). This will increase the breast volume while removing the excess skin, while reshaping the breast mound into a more desired shape.

With this appraoch, the implants are easilt placed through the skin incision patterns determined by the method chosen for the lift.

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 21 reviews

You probably refer to a transxaillary approach

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Congratulations on losing 186 pounds! Now that your weight is stable, removing the extra skin and reshaping your body is your next step. For breast enhancement after major weight loss, one has to remove a lot of the extra skin and reshape the breasts. Sometimes this also involves the addition of an implant.

You refer to a procedure with an incision in the underarm. There are two possibilities:

1. an implant placed through an axiallary incision

2. a type of extnded breast lift that continues across the back just below the underarm and uses some of that tissue by repositioning it and placing it within the breast cavity.

An implant alone will not give you enough correction once you have lost 186 pounds. You undoubtedly need the skin envelope reduced by a mastopexy. When there is that much excess skin, we do the procedure in two stages . The mastopexy (or breast lift) is done first and can be combined with an arm-tuck or other modest body-contouring procedure.

At a second stage, we add the implant. We find that doing the implant and mastopexy at the same time leads to a "touch up procedure" most of the time to either tighten the skin again or reposition the implant. We feel most comfortable reducing the skin envelope by mastopexy, seeing what results that gets the patient and then adding the implant at a later time.

Body contouring after weight loss is not a one time surgery. Be sure to pick an experienced surgeon and to have a long discussion. Come up with a plan of several stages that will lead you to the body you now deserve! Congratulations again on your weight loss.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

You will need a lift

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Because of the excess skin, you will need a lift or shaping operation and this means a fair amount of scars around the nipple and on the breast. Techniques vary with individual surgeons as to how to move the nipple higher but removing is often a technique reserved for extreme cases of sagging or as a bail out procedure in the event of poor perfusion of blood using other techniques. Since you will have multiple incisions, an implant can easily be place through any of these incisions. Genrally, because ofthe lack of adequate breast tissue, silicone gel implants will feel more natural if they do not get hard over time.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.