Getting small implants - do I need a breastlift too? (photos)

Before my 1st preg, I was a full D. While I was lactating, they easily tripled in size. After I breastfed my 1st, they reduced to smaller than they were pre-preg, but my areolas stayed large due to the stretching. After another preg, they've now reduced to smaller than they were when I was a teen. I don't feel they're terribly saggy, but my nipples and the loss of volume at the top really bother me. Is it possible to have my nipples repositioned and sized without a full breastlift & the scars?

Doctor Answers 8

Small implants and lift

the pictures are limited, but it appears you have typical postpartum deflation of your breasts. Based upon your complaints(which are the same as many other woman in your position), you desire your nipples to be in a better position along with increased volume. If you want upper pole volume, you need to have an implant or fat grafting(or some combination of the two). If you want your nipples in a better position, you need a lift, likely more than a benelli(just around the areola) lift.

Really hard to tell from pictures

Implants can give you a lifting "effect",  but really a lifting operation depends on measurements and your end goals.  The most important thing to do is to have the implants placed where they need to be long-term.  That sets the foundation for everything else.  I would then encourage you to accept whatever lift will get you the prettiest results both now and in the long term.  One of my mentors in Paris had a philosophy and she would say "Never sacrifice shape for an incision".  I think she is SO right.  With appropriate suturing and incisional care after surgery, your incisions will almost be unrecognizable.  Don't let the fear of an ugly scar deter you from the correct surgery because scars can look beautiful in the right hands and with the right care.  Hope this helps.-JGH

J. Garrett Harper, MD
Charlotte Plastic Surgeon
4.9 out of 5 stars 36 reviews

Lift and implants

I think that you could benefit from a lift and implants.  Best to be evaluated in person. Good luck with your decision to move forward.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Aug and small lift

You could have your aug through a periareolar incision and then have a small, periareolar lift which would also take off some of the excess areola.  This type of surgery has a higher complication rate than say, a typical aug or typical lift, such as, capsular contracture, nipple widening, not lifting enough, recurrent ptosis.  That being said, it can be done.

Cain R. Linville, MD
Houston Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast augmentation with possible lift

It is hard to evaluate just from your photos. Breast augmentation with give you the added volume you seek. Your nipples will get a small lift effect from your implants.  On certain cases a breast lift is required to get the desired position and shape of the breast. This is best determined during an in person examination. Good luck. 

Gaurav Bharti, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 115 reviews

Getting small breast implants - do I need a breastlift too?

Thank you for submitting your question and photographs.You should be able to achieve a very nice result with a combination of small breast implants placed under the muscle and a breast lift.  It may be possible that a periareolar lift alone with submuscular dual plane breast augmentation Tatian may give you an excellent result.  However a formal breast examination is required to give you a better idea if a  periareolar lift alone or a lollipop lift may be needed.  Please choose your plastic surgeon wisely, find one who is board certified in plastic surgery and very experienced and breast lift surgery.  For more information please read below:

Breast surgery

Hello and thank you for your question. Based on these photographs it is difficult to determine if you would do best with a breast lift with implants or breast implants alone with a dual plane technique.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.  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

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 123 reviews

Getting small implants - do I need a breastlift too?

Thank you for the question and pictures.   Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone.

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. 

Generally speaking, 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%. 

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. 

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.

  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.   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. I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 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.