Implant for pseudo ptosis mammae (photo)

Question

I'm asian.h155 cm w 48 kg I've had 2 kids I have striae in mammae I want to lift & volume up my breast bit i don't want breast lift because of the scars I went to plastic surgeon,he gave me 2 options: - implant 450-500cc silicone high profile, because so many excess skin (dual plane method) - breast lift with anchor method + implant 250cc-300 cc(because i'm asian,scar will be more visible) If i implant without lift. How many cm my breast can lift?

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos, I would recommend a lift in conjunction with an augmentation. Implants will not lift regardless of volume. It is impractical to select implants oversized for your frame to avoid the scars of a lift.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Daniel Barrett, MD · Answer

Dear Awesome327259,

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, its actually breast tissue thats being brought together to support the breast and hence improves longevity.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

From the pictures posted, if desired,   a lift would be necessary. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

You are a terrible candidate for implants. I recommend 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

You need a lift. Anything else besides a lift will only give you more sagging. Since you are sagging now, please do not go with large and heavy implants.  Your stretched out tissue, even lifted, will not hold up heavy implants. I would suggest something between 150-200 cc's to add a cup increase only.

Mats Hagstrom, MD (license on probation) · Answer

Procedure selections should be based on having a clear understanding of what the primary underlying ideology or problem is.
As you probably know pseudoptosis is the lack of volume in the upper half of the breast in regardless of nipple position.
Breast ptosis is the relationship of your nipple to the IMF (infra mammary fold).
If your nipple sits below the IMF, then you need a breast lift with the augmentation.
We can’t see the IMF because your breast is hanging over it.
To understand the relationship between your nipple and IMF you need either an examination or you need to draw a line with a skin marker across the front of your chest. That way, we can see the level of the IMF in relationship to the nipple position.
Note, the left IMF is almost always a bit higher than the right side.
This is true for all people, men and women.
Once you understand, the relationship between the nipple and IMF, then the decision of needing a breast lift becomes clear.
There’s really no way to get around this.
If your nipple sits below where the implant is going to sit, then your nipple is going to hang off the implant.
Different plastic surgeons will have different ways of guiding patients through the implant selection process.
Do you really want 500 mL implants? At 48 kg those seem like they would be pretty big implants adding an entire kilo to your body weight.
Some plastic surgeons ask patients to choose the final implant size. Other plastic surgeons make the decision based on input from the patient.
I personally make the decision during surgery with the use of temporary sizers.
I get an understanding of what the patient is trying to achieve by reviewing lots of before and after pictures.
I bring those pictures with me to surgery so I have a clear understanding of what we’re trying to achieve.
 I typically have a full selection of implants available during surgery.
Personally, I don’t think you should change the size of the implant to avoid a lift.
If you need a lift, you need a lift.
Unless you want 500 mL implants don’t get that size.
I’m not a fan of the dual plane augmentation. 
My approach is always to leave as much of the implant covered by the pectoralis as possible, without the implant writing too high.
I want to implant weight to be supported by the pectoralis muscle so it can’t bottom out. This is tricky because if the pectoralis muscle isn’t partially transacted, then the implant will ride too high.
If the muscle is opened (cut) too much, especially if the IMF is opened then long-term complications are more likely.
Different plastic surgeons have different opinions and different approaches.
If it works, it works.
Ask each provider if they’ve had patients who’ve had implants that bottom out. 
Finding the right provider is in the end, the most important variable.
Finding the right plastic surgeon is much more difficult than most people think.
My best recommendation is to have multiple consultations before selecting a provider.
It’s time intensive, but in my opinion, it’s a solid investment Your long-term quality outcome.
If the procedure isn’t done right, the first time the chance of having a long-term quality outcome goes down significantly.
Recognize that breast augmentation has a pretty high revision rate.
It’s much higher than most people think.
If a lift is added than the revision rate cost up even higher.
 You should for sure ask each plastic surgeon what their revision policy is. You can ask them what their revision rate is, but almost all plastic surgeons will say that the revision rate is much lower than the national average.
(Somebody isn’t telling the truth.)
Quality breast augmentations are based on three variables.
The first is patient candidacy. The second is implant selection. The third is the surgeons ability to put the implant in the correct anatomic location.
Whenever there are problems after breast augmentation surgery, we can almost always trace those problems back to one or more of the three above stated variables.
In regards to your propensity to form visible scars, you should ask yourself if you think you heal well, poorly or average?
Almost everyone has some scars somewhere.
I usually always do a scar history before doing surgery.
I generally ask patients to show me any scar on their body and I use this, as a guide to understand what type of scarring the patient is likely to have.
Being Asian doesn’t mean you’re going to have worse scars.
Some Asians are prone to hypertrophic scar formation, but not everyone.
Scars also healed differently on different parts of the body so this needs to be taken into consideration as well.
My best recommendation to you is to focus your efforts on the variable that matters the most, and that is provider selection.
I generally always recommend patients have multiple consultations before selecting their surgeon.
Selecting your provider should come before considering scheduling surgery.
If you’re not sure, then slow down the train and schedule a few more consultations.
Best,
Mats Hagstrom MD

Implant for pseudo ptosis mammae (photo)

Answers (6)

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