Can I remove natural breast tissue and replace with an implant to change the shape and size of my breasts? (Photos)

Dear natalyalovitt,

Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position.

Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. 

My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift).

Most importantly, it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, it is actually breast tissue that is being brought together to support the breast and hence improves longevity.

On the other hand, many women have overdevelopment of breast tissue and require reductions. Some of the questions you need to ask yourself are if you are willing to have scars from the surgery, take the risk of losing nipple sensation and other complications in addition to possible problems breast feeding if you plan to have children in the future.



It is best that you visit a board certified plastic surgeon to discuss your options further. Only after a thorough examination you will get more information and recommendations.





Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Thanks for your question.
It wouldn't be advisable to remove all of your breast tissue and replace it with an implant unless you have a very high risk of breast cancer and you wanted to undergo prophylactic mastectomy for that reason. If you remove all of the breast tissue, the sensation in your breasts will be severely reduced.
There are periareolar (incision around the areolar) mastopexy techniques that are suitable for you. I'd go and speak to a board certified plastic surgeon about your options.
Good luck!

Hello and thank you for your question and photos. Schedule an in-person consultation with a board-certified plastic surgeon in your area, have a full examination, and discuss your goals with them in detail. If you want more upper-pole fullness and a higher breast profile, these goals can be achieved through a breast augmentation and breast lift that will not require removal breast tissue which can have potentially undesirable consequences. Your surgeon can recommend the best and safest course of treatment to get you the results you want. During your visit, ask your surgeon to share before and after photos of past successful surgeries that are similar to yours so you can ensure he can deliver the results you want. Good luck!

Thank you for sharing the photos.  I think if your primary goal is to reduce and improve the shape of your breasts, there are two general ways of achieving this:
One method would to be to have a less traditional breast reduction technique that involves re-distributing your excess breast tissue at the bottom to the top and re-positioning your upper breast tissues higher on your chest wall (an internal breast lift).  The advantage of this technique would be avoiding implants altogether - all the tissues would be your own - although the gain in upper pole fullness will not be as dramatic as with using an implant. 
The second method would also involve re-positioning your upper breast tissues higher on your chest wall (an internal breast lift), but instead of saving the excess breast tissue at the bottom, a small implant is used to provide fullness in the upper aspect of your breasts.  This could be placed either under the breast or the muscle.  The advantage of this technique would be a significant improvement in upper pole fullness and breast shape, but now you would have an implant and also inherit the risks related to it (e.g. capsular contracture, infection, rupture, etc.).  In addition, because you are 20, using a silicone implant would be off-label according to the FDA (you need to be 22).
In both techniques, the scarring would be the same.  There would be a scar going around your areola, down the breast, then extending horizontally across the bottom of the breast in both directions.  You would be able to reduce the size of your areola and also re-position slightly higher.  It is possible to try to avoid or limit the horizontal scar but I think in your case, trying to keep it to a vertical/lollipop scar will lead to puckering/dog ears (areas of excess skin and tissue) at the bottom of your breasts which you will need to manage definitively with a horizontally-patterned skin excision anyways.
My last comment is that with either technique, there will be some internal re-arrangement of your breast tissues, and therefore the risk of compromising your ability to breastfeed is always there, albeit small.  This may or may not be an important consideration for you.
Anyways, hope this helps.  As always, seek proper consultation before treatment, and best of luck!

it looks like you just need a lift with your BA on the right side, and on the left just a BA. I don't think you need to remove any breast tissue, especially at your age.
david berman md