I am wanting to get breast augmentation to improve shape and fullness, but I do not want to go up in size significantly.

If you don't want to go up in size then you do not need implants. If you want to improve the shape and fullness then you need a breast lift. The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them 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.

Best Wishes,

Gary Horndeski, M.D.

This is very much not normal practice and is certainly not safe. There are blood supply issues, unpredictability of the cosmetic outcome. You would be turning a cosmetic operation into a reconstructive operation. Just a bad idea

It would seem counterintuitive to remove breast tissue and replace it with an implant. Exceptions might be when done in conjunction with a breast reduction or lift. In the absence of a good examination or at least photos, it is difficult to provide a meaningful answer to your question

Dear lkb81,
it is hard to tell for sure without an examination. 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

Thank you for your inquiry! Natural breast tissue is removed during a Mastopexy (breast lift). If a Mastopexy is not needed then you can try on various sizes of implants and decide what size best fits your goals. We would love to help you reach those goals. Schedule a consultation with a Board-Certified Plastic Surgeon so we can create a surgical plan for you!

Thank you for your question. Removing breast tissue during augmentation isn’t typically standard practice unless there’s a medical reason, like removing fibrocystic tissue or in cases of breast reduction. Removing a significant amount of tissue can lead to scarring, changes in nipple sensation, and potential interference with future mammograms. If your goal is to reshape or add fullness, there are safer and more effective ways to achieve this without removing breast tissue. If you wish to avoid a lift, choosing the right implant can still give you a more lifted appearance. However, it’s essential to discuss your goals with your surgeon to find the safest and most effective way to achieve the desired results.

It’s good that you’re asking questions and looking for clarity on this topic. Having a surgeon remove breast tissue in conjunction with breast augmentation or to avoid a lift isn’t a common practice, and there are several factors to consider when it comes to your safety, your long-term results, and the health of your breasts.

Is It Safe to Remove Breast Tissue?
While removing breast tissue is typically done in procedures like breast reduction, it is not common in a straightforward breast augmentation. Removing too much breast tissue can have significant effects on your breast shape, sensation, and long-term outcomes.

Impact on Shape and Structure: Your breast tissue contributes to the shape and support of your breasts. Removing too much tissue may result in a flattened or distorted look, especially without the added structure of a lift.

Complications: Excessive removal of breast tissue can also affect the blood supply to the nipples and the skin, increasing the risk of complications like nipple necrosis or wound healing issues.

Long-Term Aesthetics: While it may temporarily help avoid a lift, removing tissue may not provide the best long-term results. As your skin ages and loses elasticity, the implants may eventually sag, especially if there’s minimal breast tissue left to support them.

Normal Practice in Breast Surgery:
It is not normal practice to remove as much breast tissue as the patient requests unless there is a specific reason, like breast reduction for health or comfort. In your case, the surgeon may have been suggesting it as a way to avoid a lift, but this is not a recommended approach if your goal is long-lasting and aesthetically pleasing results.

If You Want to Avoid a Lift:
If your primary goal is to avoid a lift, here are some safer and more commonly used approaches:

Moderate-Sized Implants: Using implants of moderate size (instead of very large implants) can add volume and fullness, which might help fill out some sagging. Implants in the range of 250-300cc might give you the added volume without exacerbating sagging. However, if the sagging is moderate to severe, an implant alone might not give the lift you're seeking.

High-Profile Implants: High-profile implants have more projection, meaning they stick out more in the center and can create the appearance of a fuller, more lifted breast. However, they don’t necessarily correct sagging, and without proper tissue support, they could cause future issues with breast drooping.

Fat Transfer: Some surgeons might suggest fat transfer to add volume without using a traditional implant. This technique uses your body’s fat, but the amount that can be transferred is usually limited, and it may not provide a dramatic lift.

What Implants to Choose if There Isn’t Much Breast Tissue:
If you have minimal breast tissue left after a reduction or if you naturally have less breast tissue, the type of implant and placement becomes critical:

Silicone Implants: Silicone implants are typically recommended for patients with little breast tissue because they provide a more natural look and feel compared to saline. They are less likely to show rippling or feel unnatural, especially in cases where there isn’t much tissue to cover the implant.

Submuscular (Under-the-Muscle) Placement: When there’s not much breast tissue, surgeons often recommend placing implants under the muscle (submuscular) to provide more tissue coverage and a more natural slope to the breast. This can help minimize the appearance of the implant and prevent visible rippling or a more "fake" look.

Smaller Implants: If you don’t have much breast tissue, going with smaller implants may help avoid complications like bottoming out, visible rippling, or future sagging. A smaller implant puts less pressure on the skin and tissues, leading to a longer-lasting result.

Lift vs. No Lift:
Lift for Longevity: If your breasts have moderate to severe sagging, doing a lift (mastopexy) along with the implants may give you the most long-lasting and aesthetically pleasing result. A lift will reposition the nipple, reshape the breast, and prevent the implants from sagging over time.
No Lift: Avoiding a lift now might give you the volume you want but could lead to future sagging, especially if you have minimal breast tissue. If the skin stretches further over time, you may eventually need a lift anyway.
Final Thoughts:
While it’s understandable that you might want to avoid a lift, removing too much breast tissue is generally not the best or safest approach. You might get a temporary benefit, but long-term, it could affect your results. Silicone implants, under-the-muscle placement, and a moderate size are generally good options if you don’t have much breast tissue, but you should carefully weigh whether skipping the lift now could lead to needing it later.

I would recommend having another conversation with your surgeon about safer ways to achieve your goals, or perhaps even seeking a second opinion to discuss options more in line with your aesthetic and health needs.

Thanks for your question!
You do not need to go large, you can have a smaller implant placed. Schedule a consultation with a board certified plastic to discuss your options and goals. Best wishes!

Hello,

Thank you for the question.

Based on what you are describing, you appear to be a great candidate for breast augmentation procedure which will give you a fuller cleavage that you desire.

Implant size discussion and implant selection is one of the most important steps during your consultation with plastic surgeon. The decision-making process depends on patient’s desires, as well as breast and soft tissue dimensions.

There are very small implant sizes currently that can give you a very small increase in size, and there may be no need to remove any breast tissue.

I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Hello. It is not uncommon to perform breast tissue removal at the time of implant placement. This is typically done to reduce volume along the lower portion of the breast during a breast lift (mastopexy). This is a very effective technique to improve breast shape. I hope this helps.