do I need a lift or can o get good results with 350cc saline implant? (photos)

I would like to schedule my surgery within 2 month and I have seen one dr. Who was not very clear whether I need a lift or not. I don't want any extra scars however I want it to be done right. Please help!

Doctor Answers 11

Do I need a lift or can o get good results with 350cc saline implant?

Do you need an uplift? Its difficult to tell from photos, but it appears your nipples are just above your inframammory crease. Generally,  this means you don't  need an uplift.  Also measurements from the top of your sternum to your nipple would be very helpful to determine your need for an upift (mastopexy).

Judging from your photos,I  would go for the 350 ml implants without the mastopexty. Your PS should give you the last word on this, however.

Thank you for your question and good luck with your surgery. 

Do I need a lift or can o get good results with 350cc saline implant?

Thank you for your question.  There's a chance that you may need a small limited lift / mastopexy in addition to your 350cc implants.  In my practice, I place the implants in first to fill the breast skin envelope with volume before committing to any scar.  I then sit up my patients and determine if there is excess skin that requires a lift / mastopexy.  Be sure to consult with an experienced board certified plastic surgeon.  Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 15 reviews

Lift and implants

You do appear deflated a bit, and your breasts are a bit saggy. You probably need a small lift. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Your expectations will help to chose the right procedure

Your breast tissue is sagging below the infra-mammary fold and you would get better results with lift and moderate size implants.If you do not want lift and do not mind to be much bigger and lower sitting breast tissue, then you have large implants alone. Please send some desired look and would help us to give you better answer. 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 110 reviews

Do I need a breast lift?

Thank you for the question and pictures. Your pictures clearly demonstrate breast ptosis. As you state, you will benefit from breast augmentation/lifting surgery. Breast lifting/reduction surgery does involve removal of skin; therefore, there are scars associated with the operation.
Most patients (If properly selected and who are doing the operations at the right time of their lives) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.

You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly. Some general thoughts may be helpful to you as you learn more:

Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation.

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.
The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air, while at the same time removing some of the balloons rubber surface. I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery.I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.

Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. 

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural, proportionate look” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this, and the attached link (dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes.

A couple points...

I would encourage you to consider gel implants and a device that is properly chosen to fit your body's measurements and achieve your goals.  Depending on the implant selected, a 350 cc saline device might not be right for you.  I would also encourage you to open dialogue with your surgeon about what your goals are and specifically show your surgeon pictures of what you desire.  After seeing your goals, I think you will get a better and more clear plan.  In my opinion, I think you would be best served with textured gel implants under the muscle and a lift procedure to optimize your outcome.  The scars heal beautifully and tend to not be a concern, but are something every woman worries about ahead of time- you are not alone.  Hope this helps!


To lift or not

From your photos it appears that a lift will give you the optimal result but tightening your skin envelope and also repositioning your nipple to the most protection point of your breast after the implant is placed. If you are not wanting scars then you may want to hold off on a lift. You can always have a lift at a later date. Most commonly in my practice patients elect to have both procedures done simultaneously to avoid an extra surgery. Good luck!!

Gaurav Bharti, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 99 reviews

Breast augmentation and lift, some advices:

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 400ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 149 reviews

Do I need a lift

Thank you for your quesetion.  I would recommend a lift with the augmentation to tighten your somewhat loose skin.  To be sure, consult with one or more board certified plastic surgeons in your area to discuss your options.

Do I need a lift or can o get good results with 350cc saline implant?

Hello dear, thanks for your question and provided infromation as well... The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift, with augmentation such as silicone implants, you will be a very good candidate for this procedure, hugs!

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 332 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.