Breast augmentation next month but still undecided what incision is best for me. Lollipop, areola or under the breast? (Photos)

I gained a lot of weight during pregnancy and now that Ive loss a lot of weight it left me with saggy breast. Im fully decided on having it fix and wan to have a full C. ( 350-400cc) Im just worried about scarring. One doctor told me that ill benefit with lollipop incsion with high profile silicone. Another doctor told me under the breast and the last appointment I had today was using a tear drop implant and insicion just below the areola. Im really confused now. Help!!

Doctor Answers 13

Breast augmentation next month - what kind of lift?

Thank you for asking about your breast augmentation and lift.
  • Hope this explanation helps you through the confusion....
  • Two surgeons are suggesting just implants - one via an areolar incision, one via the crease incision.
  • The preference today is the crease because fewer germs are in this area but both crease and areolar incisions are acceptable.
  • One surgeon is suggesting a vertical lift with your implants - 
  • I agree with her/him - you have lost weight and your skin is loose. Only a lift fixes that.
  • HOWEVER - you don't have to have the lift now. You can have the implants now - and have a lift in six months if you see the need for a lift, which I expect you will.
  • As to the kind of implant - tear drop implants give a sloping look that is popular in Europe. Most American women want the upper fullness of the round implant. Since your breasts are flat on the top, a round implant makes sense to me but both are good options.
  • You are getting different opinions because there is no right or wrong - we have so many good implants and techniques today to offer you, that all are good options.
  • Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Best Incision for Breast Augmentation

What you are experiencing is the natural difference of opinion that occurs between surgeons. There are different incision options and different implant options. Oftentimes good result can be obtained from a number of different techniques. Just get yourself educated and decide which approach seems to fit your goals the most. I personally try to work with patients to understand their goals and their concerns. Most women want to avoid excessive or noticeable scarring so we would have a discussion about the advisability of lifting the breast or not. There are some women who either obviously do, or do not need a lift. However, there are many women in the 'gray' area where a decision to lift or not can be more difficult to make.If a patient is not as concerned about the additional scars then usually we will do the lift. If not, we can perform the augmentation only and perform a lift later only if the patient wants it. As for implants, the majority of surgeon use round moderate profile implants. High profile and shaped implants have their benefits but also their own drawbacks. Your surgeons should be able to explain all this to you but ultimately you must do your own homework. Keep seeing surgeons until you are comfortable with making the decision that is right for you.  Best of Luck    Dr Harrell

Lift or no lift?



In my opinion you would need  a vertical lift with implants. 
One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask, “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 47 reviews

Breast augmentation next month but still undecided what incision is best for me. Lollipop, areola or under the breast?

Without knowing how loose your skin is, it is hard to be specific. However, you may be able to avoid a breast lift scar by using the dual plane technique. In most cases, an incision under the breast is best, especially if placing a large implant. See link below for examples. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 67 reviews

Which incision is best for my breasts?

It appears from your photos that you have sagging breasts that are unlikely to be corrected by an implant alone.  You will probably need a lift and a lollipop incision is a good choice. By starting with the circumareolar component and breast augmentation, your surgeon can determine if the vertical part of the lollipop incision is needed .  Good luck.

John Zavell, MD, FACS
Toledo Plastic Surgeon
4.9 out of 5 stars 35 reviews

Incision confusion

Without the benefit of an in-person exam, your right breast looks a little larger and more ptotic than your left. Any of the incision approaches you mentioned are options. The lollipop one would best help to control for the differences in the skin between the right and left sides (the pictures you show suggest that right has more skin and that the left is tighter between the nipple and the lower fold of the breast). But if you are trying to avoid the scar, I would probably go with the tear drop implant with an incision in the lower breast fold. With any of these approaches there is a chance that you may need a touch-up or revision procedure later. Thanks for your question.

Breast augmentation next month but still undecided what incision is best for me. Lollipop, areola or under the breast

from your photos is is my opinion that a lollipop incision with the implant is likely what I would do. I think the implant can be placed through part of the lollipop incisions.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Lift

You likely need a lift with the augmentation. I will often do this with a circumareola or lollipop type of incision. Best of luck.

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

Breast augmentation and lift candidate, 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.
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".
Respectfully,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 203 reviews

Breast augmentation next month but still undecided.

We suggest you are not ready for breast augmentation next month and need to take time to understand what your goals are and what the benefit and trade off is with each differing recommendation. It is very hard to discuss the location of the augmentation scar for you have not fully condiered the need for the lift, and if the lift scar will be acceptable to you.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 41 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.