Do I really need or should I get a lift? Would round or teardrop be better shape in cohesive? (Photos)

Question

Wide set/lift? Seeking info such as do I really need or should get lift? Would round or teardrop be better shape in cohesive. If no lift would they just be droopier? I want cleavage even if it needs push up bra to aide in that look.

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show a wide-set breast shape with some lower-pole laxity and nipple descent, so the lift question is reasonable. An implant alone can add volume and upper fullness, but it does not reliably raise the nipple or tighten loose skin. If the nipple sits at or below the breast fold on exam, a lift is usually needed for a higher, less droopy shape.

Round versus teardrop is usually less important than implant width, profile, placement, and whether the loose skin also needs tightening. Modern round cohesive implants can still look natural when sized appropriately, while shaped implants have their own tradeoffs, including possible rotation. Cleavage is also limited by your natural breast spacing and chest width; implants can improve fullness but cannot safely move the breasts very far toward the center.

If you want fewer scars and can accept some remaining lower-pole droop, an implant-only plan may be discussed. If your goal is a perkier shape without relying on a push-up bra, ask a board-certified plastic surgeon to compare implant-only versus lift-with-implant options using your measurements and goal photos.

Daniel Barrett, MD · Answer

Dear Plasticideas21,

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

Gianfranco Frojo, MD · Answer

Yes you definitely would benefit from a breast lift to properly tailor/shape the overlying skin/breast tissue.

Ramin Behmand, MD, FACS · Answer

From the side view, it looks like you might be able to forgo a lift, but the front view suggests that you would likely be happier with one. A lift would provide longer-lasting results and help maintain the breasts in a more ideal position over time. Teardrop-shaped implants need a textured surface to prevent rotation within the breast pocket, while round implants tend to be a better choice, with fewer associated issues. Dr. B.

Gary M. Horndeski, MD · Answer

Your breasts are too low and too lateral. You need a breast lift and 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. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Joe Gryskiewicz, MD, FACS · Answer

It is always best to see an experienced professional in person when making decisions. Based on looking solely at these two photos. For the best outcome it would be most beneficial to add a lift along with breast implants. Breast implants will add volume and give shape but being that your nipple placement is low and breasts are long , you will have a much better outcome lifting them as well. In your circumstance just putting implants in will overtime just make your hang lower without addressing the top upper pole fullness.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. 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 size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Sean Fisher, MD · Answer

The goal of a breast lift is to improve shape, nipple position, and symmetry- which can be the key to a great result. From the photos provided, it appears there is a fair amount of asymmetry both in terms of breast volume, but also shape and nipple position. A breast lift can improve these asymmetries before an implant could be added if the goal is for increased volume, projection, or upper pole fullness. 
Performing an augmentation without a lift is unlikely to give you a result that you are happy with. A large volume augmentation can elevate nipple position to a degree, but it is much less powerful than a lift and also would not be possible to correct the nipple position asymmetry or shape asymmetry. 
Sean Fisher Aesthetic Plastic Surgeon Seattle, WA

Connie Hiers, MD, FACS · Answer

I would suggest using smooth round implants placed behind the muscle and a lift for your best look. If you only go with implants, you will just have larger and still sagging breasts.

Camille Cash, MD · Answer

From the submitted photos  it appears you will have the best result from a lift with implants.  This would give you extra volume including upper pole fullness, correct asymmetry, and raise the position of the nipple.  The next step is to visit with a board certified plastic surgeon near you to learn more.

Do I really need or should I get a lift? Would round or teardrop be better shape in cohesive? (Photos)

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