This is probably the most common question asked by my cosmetic breast patients with any droopiness or ptosis of their breasts. There is no absolute or correct answer. It depends on your (the patient's) expectations and desires. Just remember the implant needs to be centered directly behind the nipple, so wherever your breasts/nipple sit currently this is approximately where you can expect the implant to be positioned/settle. Breast implants alone simply add volume to your breasts. They do not lift or shape your breasts. If you are happy with the look of your breasts and just want them to be a bit fuller then a breast augmentation alone may work. In my practice, my patient's generally expect superior pole fullness/cleavage and a youthful, perky breast appearance without wearing a push-up bra so I tend to offer more lifts. Most of these patients are initially hesitant about the scarring, when in fact they should be more concerned about breast shape, contour and nipple position. I educated them that scars mature and fade over 6-12 months, when breast shape, contour and nipple position generally don't improve and, may in fact, worsen over time. In my experience you could certainly have an augmentation alone and end up with a "natural" or "matronly" result. You may be perfectly happy and satisfied with your result. However, many of my patients who chose this route then will come back with a horizontal tan line across their chests (above the top of their implants) from a sundress or tube top, asking why when they wear a sundress or top without a bra, their breasts sit low, or do not have superior fullness. I re-explain that the implant must be centered behind their nipple and that generating this superior fullness would require a larger implant combined with a lift. Some elect to have the lift, and others chose to push their breasts up in a bra to generate superior fullness and cleavage. Finally, attempting to avoid a lift by using an extremely large, high or extra high profile implant is a nothing more than a short term Band-Aid, and does not address the root cause/problem (i.e. stretched/lax and excess skin/tissue). This does nothing but postpones the lift for a short period of time and will only lead to further tissue stretch and thinning requiring an even larger lift to fix. Ultimately, this approach generates a much more complex (and expensive) surgical problem just months to a few short years down the road, so I never encourage patients to go with this approach. Some of you may then ask why some surgeons you've seen offer this approach to droopy breasts, typically without discussing the other abovementioned options and each options pros and cons. The truth is that it's far easier and quicker for a surgeon to place a large implant without regard for the durability, or lack thereof, than perform a more technically challenging, and longer, lift procedure.
I would agree with your surgeon that you could have the procedure without a lift: your nipples point straight ahead and are well centered. However, you do have breast tissue falling below the fold, and loss of projection. A breast lift would make the breasts appear higher on the chest wall, with a improved less flattened shape, but at the tradeoff of scars.
Based on your pictures, it appears that you would benefit the most from a lift and implants. However, you would need an in-person consultation to know for sure. One nice feature which we offer is VECTRA 3D imaging during your consultation to help you visualize different options including lift only, implants only or lift plus implants. From looking at you pictures, I would caution that if you only have implants that you may be the appearance of either low setting implants or, if the implants are placed in the proper position, then it may appear as breast tissue falling of your implants. That is why I feel it would be best for both implants and a lift in your case.
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".
Dr. Emmanuel Mallol Cotes.-
Breast lift is considered necessary when the nipple is below the level of the breast fold (center of the nipple) and you might do well with just an implant alone. When considering breast lift, you should also consider the trade off of the scar on the breast, as glandular breast ptosis will require a vertical breast scar.
Given your goal of larger and higher you would do this best with a lift and implants. That being said, I would suggest just putting implants in and give it 6 months to see if you are happy with the results or if a lift would be appropriate. The lift will make things higher but this is not a permanent condition and you will get some recurrence. The lift also increases the scarring. The only thing you lose with staging is time and probably some additional money but you may save yourself scarring and a needless operation.
You should consult with an experienced Plastic Surgeon certified by the American Board of Plastic Surgery who has some type of implant sizing system and even the Vectra 3D imaging system.
Hello and thank you for your question. You are starting from a very good place pre-operatively and should have a great result. You are on the borderline between needing a lift or getting by with implants alone. To fully answer your question, you really need an in-person evaluation. The most important aspect is to find a surgeon you are comfortable with. With good surgical technique, you could have an outstanding result. 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
Thank you for your question and you photos. Depending on the shape of the breast that you're looking for...you can get away with an implant alone or an implant with a lift.
if you choose implants larger than 400 cc and your surgeon performs a dual plane dissection, you should be OK with implants alone. However you may require a lift in the future as your body continues to change. You can certainly make an argument to perform a small lift with your augmentation at present time. It's best to discuss your concerns with your plastic surgeon or get a second opinion. Best of luck!
Dr. Dhaval M.Patel
Hoffman Estates, South Barrington, Oak Brook, Chicago
Thank you for your question. Based on your photos a dual plane breast augmentation may be all that you need. It sounds as though your plastic surgeon this cover the options and is planning the appropriate procedures for you. For more information on lift with implants please read the link below:
I believe that you could get a good
result with implants alone. Oftentimes, an augmentation can give the illusion
of a lift. After a minimum of 9 months, when the implants have settled, you'll
have a better idea whether or not you think your breasts are perky enough. You
can always get a lift later if you feel that you need one. For more
information on this and similar topics, I recommend a plastic surgery Q&A
book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."