40, female, 5/10, 12.5 stone - implant or lipo/axillary excision to look more proportional & natural? (Photos)

Question

Hi, I’m 40 year old female, 5’ 10 and 12.5st. I hate my boobs - it’s not just the breast though, I have a lot of fat/breast tissue/loose skin under my arms and around my sides. I had a consultation with a surgeon who said I should get a 380cc implant and it would help improve the bra rolls by 50%. I just want a more balanced look - am i better going for vaser lipo and/or excision or would the implant improve the overall look/shape enough to look more proportional and natural? Thanks

Harry T. Haramis, MD, FACS · Answer

In my experience, Vaser ultrasound liposuction of the lateral chest and axillae will enhance the breast shape with implants, removing stubborn areas to better define the breast edge, border, aesthetics.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Daniel Barrett, MD · Answer

Dear Trustworthy326818,
it is hard to tell for sure without an examination. Implants will not improve extra tissue in the armpits but it will improve breast shape. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

You would benefit from a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

I would recommend breast implants for volume. If excess fat is present in the bra roll areas, then add liposuction at the same time. Implants will not remove excess bra fat.

Camille Cash, MD · Answer

The implants will for the most part shape your breasts.  It may help somewhat with the sides, but if that is a big concern of yours you may want to consider liposuction to the area.  Do not select a larger implant than you want in an attempt to take up excess skin at the sides of the chest.  I've included a video on implant selection that I hope you find helpful.

Pawel Szychta, MD, PhD, DSc · Answer

Hi.I understand that you're seeking a more balanced and proportional look and are considering whether breast implants or procedures like liposuction and excision would best achieve your goals. It's important to explore all options to make an informed decision that aligns with your desired outcome.1.Breast ImplantsVolume Enhancement: Implants can increase the size and improve the shape of your breasts, potentially balancing your proportions if you feel your breasts are smaller compared to the rest of your body.While implants primarily enhance the breasts, they may slightly improve the appearance of nearby areas by filling out the skin and reducing the prominence of certain folds or rolls. However, the improvement in areas like bra rolls may be limited.Your surgeon suggested that implants could improve bra rolls by about 50%, which indicates some benefit but not complete resolution.2.Liposuction and Excision (e.g., VASER Liposuction)Liposuction can effectively reduce excess fat in specific areas such as under the arms and around the sides, directly addressing bra rolls and fatty tissue.Some liposuction techniques, like VASER, can promote skin tightening, which might help with loose skin. In cases where there is significant loose skin or breast tissue, surgical excision might be necessary in addition to liposuction to achieve a smoother contour.
 Often, a combination of procedures yields the best results. For instance, breast augmentation combined with liposuction can enhance breast size while sculpting surrounding areas for a more harmonious look.Depending on your goals and the surgeon's recommendation, procedures can be done simultaneously or staged over time.
Choosing between implants and liposuction&mdash;or opting for a combination&mdash;depends on your personal goals, anatomy, and the professional advice of your surgeon. It's essential to communicate openly about what you hope to achieve so that your surgeon can tailor a plan suited to your needs.
Remember, the goal is to enhance your confidence and comfort with your body. Taking the time to consider all factors and professional guidance will help you make the best decision for yourself.

Mats Hagstrom, MD (license on probation) · Answer

The shoulder has more range of motion than any other joint in the body.
To have that range of motion, there has to be a certain degree of skin redundancy with the army in a down position.
The skin redundancy is often perceived as being an issue with fat distribution, which it is not.
That said well done Liposuction can help the back roll Armpit and excess tissue on the side of the breast significantly.
To differentiate between subcutaneous, fat and skin laxity put your arms straight up in the air and feel the thickness of the fat layer with the other hand.
Look carefully in the mirror, how the contour changes as you put your arm down.
This degree of change is still going to remain after you have Liposuction.
Skin removal in this area is unforgiving unless it’s a direct excision in the armpit alone.
Breast augmentation is not going to have a significant impact on skin redundancy related to the range of motion of your shoulder joint in the surrounding areas.
I’m not sure what your surgeons experience has been but you can ask them to show you before and after pictures and see for yourself.
Well done, Liposuction is by far your best option, but if you only treat the back brow roll and under arm area, the chance of being disappointed is real.
If patients come in asking only for these areas to be treated, I often am reluctant to schedule surgery because they will not have anyone single area that gives them a good solid improvement.
If someone however, comes in for liposuction of their abdomen, then I will almost always encourage them to treat the back and under arm area in conjunction since leaving that right next to the treated areas does not look good. 
Delivering consistent quality Liposuction results is far more difficult than most people realize.
The number of plastic surgeons who approach mastery of this kind of work is small.
I cannot emphasize this point enough.
Finding a plastic surgeon who is excellent at Liposuction is not at all easy or straightforward.
Look for plastic surgeons to focus on Liposuction exclusively or those who are enthusiastic about the procedure and can show you hundreds of before and after pictures.
Finding the right plastic surgeon, especially for procedures like Liposuction may require interviewing quite a few providers.
Poorly Liposuction, I can leave people permanently disfigured.
Get a breast augmentation if you want bigger boobs.
Do not do it to fix the skin redundancy related to your shoulder joint.
When we’re young, the skin has enough elasticity that the redundancy around the shoulder joint has minimal impact.
In middle age, as we lose skinny elasticity areas begin to bulge, causing significant change in contour which can be upsetting and undesirable.
The primary problem is related loss of skin elasticity, or increased skin laxity typically due to weight fluctuations.
These areas don’t have great treatment options traded
Liposuction can help but doesn’t treat the primary problem.
Best,
Mats Hagstrom MD

40, female, 5/10, 12.5 stone - implant or lipo/axillary excision to look more proportional & natural? (Photos)

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