Best Combo of Procedures (Mastopexy, Reduction, Augmentation) for Poor Skin Quality? (photo)

I wear a 32E bra, 27.5 inches round the ribcage. I would like a lift and reduction to no larger than a 32C, but have terrible skin quality and need major lifting. My nipple to notch is ~21-22 cm. 1) Which procedures can I expect to need (lift, reduction, implant,) and which techniques are available to me? 2) Do implants placed under the muscle affect muscle strength and ability to build? 3) How small is optimal for long-lasting results with such poor-quality skin?

Doctor Answers 12

Best procedure for my E cup breasts. / El mejor procedimiento para mi copa E de senos

Your breasts will have a very nice result from a breast reduction with a lift. Some people in your position will also opt to have a breast implant inserted at the same time.  The upside is fullness in the upper portion of the breasts and enhanced cleavage.  The downside of aug/reduction is there is a slightly higher complication rate.  This is very manageable by most surgeons.  Also the more the breasts weigh the quicker they will droop again.  Obviously not to the same extent as before.


Good luck, and thank you for your question.



Anire Okpaku MD


Sus senos van a lucir muy bien despues de una reduccion con levantamiento. Algunas personas en su situacion escogeriam tener implantes al mismo tiempo. El lado positivo es que le va rellenar la parte superior del seno y realzar el escote. El lado negativo de un aumento con reduction es que hay un pequeno indice de complicacion el cual es bastante  manejable por la mayoria de los cirujanos. Acuerdese de que mientras mas le pesen los senos mas grande es el chance de que vuelvan a caerse. Obviamente no en la misma extension de antes.

Suerte y gracias por su pregunta


Anire Okpaku MD

Miami Plastic Surgeon
4.5 out of 5 stars 29 reviews

Breast lift alone might be all that you need


A breast lift shapes and respositions your current breast tissue.  If you can make your breasts look close to what you would like them to look like by positioning them using your hands than a breast lift alone might be all that you need.  In a breast lift no breast volume will be removed but often your bra cup size will be less than before surgery this is in part because women who have fairly droopy breasts tend to wear larger bra cup sizes.  A breast reduction can be performed at the same time but this does not appear to be needed based on the photos alone.  Below is a link from one of my breast lift patients before and after photos.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Best procedure for very saggy breasts

The short answer is you need to have a consultation with one or more plastic surgeons certified by the American Board of Plastic Surgery and discuss with them frankly what your goals are and what is likely from each of the procedures given your individual anatomy. You will then be able to choose what is best for you. It is difficult to tell exactly how much breast tissue you have from pictures and that will determine whether or not you need an implant as well as a lift. For patients of mine that have severe sagging similar to yours, I often recommend the lift which leaves an anchor scar as the first procedure and then several months later when the swelling has resolved evaluating the need for an implant. I think it makes it more likely to achieve a final result that is what the patient wants than to try to do it all at once. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon
3.6 out of 5 stars 13 reviews

Best Breast Surgery for Me?

Thank you for the question and pictures.

Much of what will be recommended to you, will depend on your goals.  I think this is best communicated with the help of goal pictures. Certainly breast lifting will be necessary to improve the position of the breasts on your chest wall. Many patients in your situation opt to have breast augmentation as well to increase the volume/fullness in the cleavage area as well as the superior poles of the breast.

Another consideration in your case, given the significant loss of skin elasticity/strength is whether to do the combination procedure in a single or a 2 staged fashion.Whether the breast lift and augmentation should be done the same time  is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.
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.
In my opinion, the decision  to do the operation in a single or two  staged fashion becomes a judgment call made by a surgeon after direct examination of the patient.  For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).
Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery.

Ultimately, I think you will be best off selecting the plastic surgeon who you feel will most likely be able to achieve the results you are looking for and follow his/her recommendations (after you have clearly communicated goals).
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Best Combo of Procedures (Mastopexy, Reduction, Augmentation) for Poor Skin Quality?

You would achieve a significant improvement from a full "anchor" or "inverted T" breast lift.  You would achieve a better breast position with less overhang, a smaller areola, and higher and better-positioned nipple/areolas.  Removing all of that excess skin would improve your skin tone (though not removing your stretch marks but at least "filling them out" better as the skin is tightened).  If you definitely wanted to be smaller, then a breast reduction with lift could be performed with essentially the same scar pattern. Sometimes when there is so much extra skin, a patient wears a larger cup size just to support the breast which is so loose.  An examination could give you a better idea of what size you would be after a lift alone versus a reduction with lift.  Implants would only serve to give you more upper pole fullness, but this will increase your risk of complications if performed at the same time and may lead to more surgeries in the future if your skin re-stretches over time and your breasts start to hang off of the implant, which is certainly more of a risk in patients with damaged skin and poor skin tone.  Mild skin re-stretching after a lift is expected, but is less of a problem if there are not implants present that can accentuate the problem.  The best course would be to either have the lift or reduction with left first, and consider implants later if you want more upper pole fullness.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

Full breast lift

In my opinion, you would get a great result from a full T scar central pedicle breast lift which will elevate the breast and the nipple back up where they belong and remove the excess skin and tighten the breast.  An implant is only indicated if you want to be bigger or to have more upper pole fullness.  This increases the complications and might be best considered after the lift has healed and at that point you can tell if you actully need an implant.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

You have enough of your own breast tissue that a breast lift with a reduction down to a C cup would be enough.

Thank you for your question and the photos.

You have enough of your own breast tissue that a breast lift with a reduction down to a C cup would be enough.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Best combo procedure for poor breast skin quality

Thank you for your question and the photos. From the picturs you provided it clearly shows that you have more skin than actual breast tissue. You want to go down to C cup. In this case breast lift( anchor) lift would achieve several objectives. It would remove the excess skin, reshape and reposition the areola and reduce the breast size. You will have, however, upper pole flattening. If you wan to improve the upper pole fullness you will need an implant. Implants under the muscle should not affect the pectoral strength or function.

what you need is a consultation with a board certified plastic surgeon. During the consultation your hopes and desires will be addressed. You need to see before and after photos and you and your surgeon can decide to the surgery in one or two stages. I wish you all the best.



Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Best for saggy breasts

You will need a reduction (which includes lifting the breasts) .  You will likely need a two stage approach to get the optimal result.  The second stage would be to place implants which will provide superior pole volume or upper breast fullness.  However, the implant will add volume and make you bigger.  Placing the implants under the muscle should not prevent you from exercising or weight lifting.  You should consult with a board certified plastic surgeon, or more, to discuss your concerns and the best options for you to achieve your goals.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Breast Augmentation With Poor Skin

From your pictures it appears that you would benefit from a Breast Lift using vertical techniques. If you are interested in a very high profile, you may also want to consider implants placed under the muscle. For a better idea you should schedule an exam with a board certified plastic surgeon. During the consultation the surgeon will be able to take measurements and lay out a precise treatment plan taking your wants and needs into consideration.

Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 75 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.