Wondering if I would need a lift if I get breast implants? (photos)

Question

I am wondering if I would need a lift if I were to proceed with implants and if I have enough tissue where I could go for subglandular implants (under the muscle would be out of the question for my lifestyle). I am fine with the augmented look but am concerned about potential sagging and ideally they would be high profile. I would ideally like them to be closer together to have nice cleavage without needing to manipulate them too much.

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on these photos, it’s unlikely that you will need a breast lift during your augmentation surgery, especially if you are planning above the muscle.

Jake Thayer, MD · Answer

Great question. Whether to add a lift to an augmentation can be a challenging question. In your case, your right breasts do appear to have some pseudoptosis or breast descent, with the left looking slightly lower than the right. Given your concern of avoiding sagging, I would lean towards adding the lift with the augmentation. This would give you best chance (in my opinion) at achieving a nicer overall round aesthetic breast shape. Other considerations I would have would be the addition of resorbable mesh ("internal bra") if you were considering having them placed above the muscle for longer term support of the implant to avoid malposition or bottoming out down the road. Hope this helps!

Eric Swanson, MD · Answer

Basically, the deeper the cleavage you want the greater the volume. You do have a little sagging but as long as you accept this, it is fine. Implants do little in the way of lifting, but are great to fill out your upper poles the way you want.

Daniel Barrett, MD · Answer

Dear sage2400,
determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Daniel Butz, MD · Answer

A lot of patients are worried about the breast lift scars - fortunately they do tend to fade nicely and provide a much better overall breast aesthetic when performed properly. 
Based on your photos I think you would likely get a better result with a lift. AND it would likely last longer. 
If you skipped the lift they may look okay initially but you'd have a higher chance of "waterfall" deformity sooner - which is where the breast tissue hangs off the implant. 
I would seek out a few consults from board certified plastic surgeons. I prefer to do the right surgery the first time - not the easiest or the one with the smallest scars -this mentality often leads to more revisions in the long run.

Ira H. Rex III, MD · Answer

Is hard to make a judgment just looking at your photos, but I think you might be quite disappointed with just implants and no lift. You should not expect nipples to change position much, or may be even become lower with just augmentation. This would especially look awkward on your left, more saggy side. Also, your left nipple may be pointed more sideways. He should talk to a board certified plastic surgeon to discuss what would best meet your expectations.

Gary M. Horndeski, MD · Answer

You are an excellent candidate for a breast lift using 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. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Your breasts are sagging now. With only implants, you will still be low, still sag, but will be bigger. Implants cannot correct sagging breasts. I suggest a lift with implants and recommend placing them behind the muscle for better upper breast fullness, hiding the implant edge, and better long-term support.

Camille Cash, MD · Answer

Based on the photos alone it appears you would have the best outcome from and augmentation with a lift.  This would raise the nipple position and provide more volume.  With augmentation alone you may have sagging in the future and it appears one breast sits lower than the other already.  I encourage you to meet with a few board certified plastic surgeons to discuss your options and learn more about the procedures.

Mats Hagstrom, MD (license on probation) · Answer

You’re not alone in not wanting to have a breast lift.
As plastic surgeons were not thrilled about putting scars on women’s breasts either.
The reason women choose to have a breast lift is because it gives a much better aesthetic final outcome for women who need them, 
The indication is based on the relationship between your nipple and the IMF (infra mammary fold) on each side. if the nipple is at or above the IMF, you can generally get away without needing a lift.
If the nipple position is below the IMF, then some type of lift is usually needed.
I think most plastic surgeons tend to favor sub pectoral augmentation as a superior procedure for a multitude of reasons.
The main advantage to sub glandular augmentation is that it’s technically much easier.
There are other issues and variables and one option is not necessarily better than the others.
My experiences been that the best plastic surgeons, I know generally almost always recommend subdural augmentation because of the many advantages with this approach.
 Breast augmentation outcomes are generally based on three variables.
The first is patient candidacy. The second is implant selection and the third is the surgeons ability to place the implant in the correct anatomic location.
Understanding your candidacy is part of maintaining high patient satisfaction.
Patient who are less than ideal candidates need to understand their candidacy for the procedure or they may have expectations that cannot be met 
Understanding your own candidacy is best done through in person consultations with provider who have sufficient skill and experience.
Different providers will have a different ways of guiding patients through the implant selection process.
Some providers ask patients to make the final decision in regards to implant size shape and type while other providers will make the ultimate decision based on input from the patient.
Some providers do this better than others.
 my personal preference is to make the decision during surgery by using temporary sizers.
I usually have a full inventory of implants available to me during surgery.
I usually have a clear understanding of what the patient is hoping to achieve by reviewing lots of before, and after pictures of previous patients who had similar characteristics.
I bring the ideal outcome pictures with me to surgery and use those as guidance when selecting implants with the use of temporary sizers. 
There’s no right or wrong way to do this.
Different providers have different styles and as I mentioned some providers do this better than others. 
I think it’s difficult for patient to assess which surgeon is going to be a technically better provider.
One way of doing this to ask providers to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had the most similar characteristics to your own body.
Seeing impressive collections of results will at least tell the provider has experience. Generally speaking the providers who have the most experience tend to be somewhat better than those with less experience.
Experience is not the same as being skilledbut having experience tends to be a big advantage. 
Being shown a handful of pre-selected images representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider or how many of these procedures they have actually done.
 It’s also very important that you’re looking at results of previous patients who had the same candidacy for the procedure to start with.
Understanding candidacy is complex and you should take notes and judge providers based on their ability to explain your own candidacy to you.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely you are to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
 You should also ask providers regarding revisions.
Ask providers what are most common indication for doing a revision surgery is.
You should also ask them what the revision rate and revision policy is.
Since breast augmentation has a fairly high revision rate. These are very important things to understand Before having surgery.
Patients who opt for not having a lift when they in fact, need a lift may end up being disappointed.
It is not wrong to do augmentation mastopexy as a staged procedure.
For patients who are right at the edge of needing a breast lift, you can see what the outcome is with augmentation alone and then add a lift at a later date if you want to improve the outcome.
Ideally the assessment should be accurate enough that patients are guided to have the correct procedure to start with.
 Augmentation/mastopexy is a fairly complex procedure and some surgeons prefer to do them as staged operations. 
Mastopexy/augmentation should generally be done with subpectoral implant placement to minimize complications of tissue necrosis. 
In the end, provider selection is probably the most important variable.
In the hands of the right provider, you’ll have a good understanding of your candidacy and treatment options.
In the hands of the right provider implant selection is more likely to be satisfactory and the chance of needing revision surgery will be less.
Went in doubt slow down and schedule more consultations.
Best,
Mats Hagstrom MD

Wondering if I would need a lift if I get breast implants? (photos)

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