Mastoplexy with grade 1 ptosis or just implants? (photos)

Question

I'm 33yo, 5"6", 32B, 12.5cm bwr hoping to get natural looking (less upper pole fullness) results about 1 or 2 cups larger. At consult, I liked the 3d imaging of implants with lift (360cc shaped 13cm width moderate) . My problem is that most of the before photos for lifts/implants are of women with much larger breasts or more droop. Will the mastoplexy really improve my results that much, or will I be adding scars without a significant payout?

Austin Hayes, MD · Answer

Thank you for your question. In general, if your nipple is located at or above the crease below your breast then a lift is typically not needed. In addition to nipple position, measurements are also used to determine when to add a lift. It's important to know the breast implants do not lift the nipple to any significant degree, so you can't escape the lift by using a breast implant. Breast sagging is a spectrum and women with mild/moderate sagging can sometimes go either way. In this situation, I typically recommend breast augmentation as an initial procedure, waiting six months, and then only performing a breast lift if it is truly needed. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide which procedures are right for you.

Carolina Restrepo, MD · Answer

Thank you for your question. From your photos and desired results, it looks like you would be best served with a combination of breast lift with augmentation.  The parameters of both the breast lift and the position of the breast implants should be designed to keep the implants relatively low while lifting the breast tissue and nipple to sit directly over the implants.  Many techniques exist in breast surgery, and combined lifting with augmentation is especially tricky.  The key is working with an expert, board certified plastic surgeon to get the best plan for you.

Brian C. Reuben, MD · Answer

Thank you for your question and photos.  Without a doubt, you will have a better shape and look to the breasts if you have a lift.  Without a lift, you will have skin and breast tissue cascading or falling over the top of the implant, giving the breast a "sad" or droopy look.  The scars are the trade off for a better shape.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a great candidate for a breast lift with an implant.  This can be planned to give you a natural appearing result.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.  The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Itzhak Nir, MD, FACS · Answer

From your photos I recommend you have smallish implants placed for some increased fullness and a circum-areolar mastopexy. This will give you the look and shape that you want.

J. Garrett Harper, MD · Answer

You are young and my advice is to get it right now.  I feel that if you didn't get a lift, you wouldn't get the best result and you would be unsatisfied.  A mastopexy-augmentation with gel devices placed under the muscle and a superior pedicled lift would get you a gorgeous result that would last.  Find a surgeon that gets gorgeous results with this surgery and trust that doing it right the first time is the best plan of action.  You should get an amazing result.  Hope that helps.-JGH

Sean Kelishadi, MD · Answer

Hello and thanks for reaching out to us! Based on your photos, I think you would benefit most from a breast lift with implants. When I discuss with my patients about breast lifting techniques and also use of implants, I break down the different topics into parts.The easy way to decipher what each procedure produces is that implants increase breast volume and add upper pole fullness. Implants are placed in either a subglandular or subpectoral pocket centered over the left and right chest breast footprint. When you have ptosis/sagging, where the nipple-areola complex is at the fold or lower, your breast will continue to hang off of your chest onto your upper abdomen even after implants. In fact, in patients with such sagging who undergo an augmentation without a lift, their breast tissue hangs off of the implant that is sitting on their chest, creating a shape like Snoopy's nose, hence called a "snoopy" deformity. Implants can not give a therapeutic lift and taking shortcuts will only lead to suboptimal results. In some borderline cases of ptosis, breast augmentation can be performed and if there is unsatisfactory sagging, then a lift can be performed later at a second stage, but in your case, an in person examination will be most instrumental in going over your lifting options in conjunction with implants. Two lifting techniques that are very good ones in the right patient and I use are based on the following:1) if it is mainly the nipple position that needs lifting, I like the circumareolar approach (also called a donut lift) vs

2) if a large portion of the breast tissue/weight needs to be lifted, a circumvertical (also called lollipop) and sometimes a full anchor incision is needed as the circumareolar approach in my mind is not strong enough to hold the weight of the breast and results in stretching of the areola and drooping over time.Costs vary based on surgeon experience, region of the country, and amount of time needed to perform your operation. I recommend you start by finding a board certified plastic surgeon with expertise in aesthetic breast surgery. Most high end practices can offer you a preliminary virtual consultation, and they also have various credit and financing options to help make surgery with the best surgeon for you more affordable.I hope this helps you!Sincerely,Dr. Sean Kelishadi

2) if a large portion of the breast tissue/weight needs to be lifted, a circumvertical (also called lollipop) and sometimes a full anchor incision is needed as the circumareolar approach in my mind is not strong enough to hold the weight of the breast and results in stretching of the areola and drooping over time.Costs vary based on surgeon experience, region of the country, and amount of time needed to perform your operation.  I recommend you start by finding a board certified plastic surgeon with expertise in aesthetic breast surgery.  Most high end practices can offer you a preliminary virtual consultation, and they also have various credit and financing options to help make surgery with the best surgeon for you more affordable.I hope this helps you!Sincerely,Dr. Sean Kelishadi

Melinda Haws, MD, FACS · Answer

On my website I have women very similar to you who have done just implants as well as ones who have done the implants with a lift.  It all depends on what you want for your final result. And it depends on your in person examination. Seek opinions of other surgeons or ask your surgeon to give you an idea of what you would look like without the lift with his before and after pictures.  All women are different and we don't all want the same things afterwards.  While it would mean two surgeries if you weren't satisfied , it is entirely possible to do the implants first and then return for the lift if you don't like it.  If you chose the lift, I personally would do a vertical mastopexy.  The vertical scare is typically quite good.  Best of luck

Steven Wallach, MD · Answer

If you want implants, then it might be possible to only perform a circumareolar lift as well. You would have to be evaluated in present see if this was appropriate for you.

Daniel Krochmal, MD, FACS · Answer

Thank you for your question.Based on the photographs, the addition of a mastopexy would likely improve your result, and adding the scars would likely be worth it.  If you are very undecided about the scars, you do have the option of only doing the implants, seeing how you like your shape, and then deciding to do the mastopexy later if you aren't happy (but that's a second surgical recovery and more cost).  The most important thing is that you find a surgeon you trust and like their before/afters of other patients who are similar to you.Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

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