Do I Need a Lift or Just Implants? 3-Kid Mom with Vitiligo Scars (Photos)

Thank you for your question. I think you are valid for comparing your options. Based on your photos, you would be a great candidate for a breast lift with augmentation. A breast lift will bring up your nipple position and give a more natural appearance to your breasts, whereas the implants will provide you with more volume and upper pole fullness. If you are concerned with how you scar, you can proceed with a augmentation alone, with understanding that it is a possibility that your nipples may only lift a little bit or be in the same spot.

Do I need a breast lift? You might not need one. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., US

Thanks for your question!You’re absolutely right to look into both options. In your case, a breast augmentation alone wouldn’t give you the lifted, natural result you’re hoping for — you would need a breast lift as well. If you’d like a fuller upper pole, an implant combined with the lift would be ideal.
The type of incision depends on your surgeon’s preference and your specific anatomy. In my practice, I usually perform an anchor (inverted-T) lift, but since your skin laxity doesn’t seem too pronounced, the scar would be relatively short.
Regarding your vitiligo, it’s important to know that new scars — whether from surgery, trauma, or even mild irritation — can sometimes trigger the Koebner phenomenon, meaning new depigmented (white) areas may appear along the incision lines.This doesn’t mean the scar will heal poorly, but it may lose pigment permanently in those areas.

Based on the degree of ptosis (nipple position) and elongation/stretching of the breast, an augmentation alone is unlikely to give a result that you are happy with. The lift is needed to reset the shape and position of the breast on the chest wall with the implant providing the improved fullness (especially in the upper pole) similar to the example photo you provided. What type of lift is largely dependent on your individual measurements and goals. You should meet with a well trained plastic surgeon who will review your anatomy and goals and discuss the implant selection and lift that would be needed for your specific case.
Sean M. Fisher, MD Aesthetic Plastic Surgeon Seattle, WA