Cresent Lift and 410/445cc Cohesive Gel Teardrops, over Muscle. Opinions? Comments? (photo)

5"4, 140lbs. I am 39 yrs, and I wear a 38b. I have droopy, deflated breasts due to breast feeding.

Doctor Answers 11

Lift and augmentation for these breasts?

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How big do you want your breasts to be?  From your photos it seams as though your skin envelopes are normal but you lack enough volume to fill them.  I would recommend augmentation alone to start with and then, in 6-12 months, if you feel that your are not perky enough (I bet you are!), you can always opt for mastopexy.

Goals and expectations

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I would really emphasize a full vertical lift and I would do it because it would allow me to shape your breasts which  I think is the most important part of your surgical plan

Subglandular Placement versus Submuscular Placement and Lift

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    Subglandular placement is argued by some to give more lift to the breast than submuscular placement.  Crescent lift is appropriate for very few patients, and most plastic surgeons prefer a circumareolar lift in most situations.  Some plastic surgeons may argue that if you need a crescent lift, you do not need a lift at all.

You need more than just a crescent lift

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Crescent lifts offer very little in terms of actually lifting the nipple position. You will likely need a peri-areolar lift, or possible even a vertical lift, depending on what size implant you eventually choose. My preference for implant placement is either sub-muscular or dual plane. These procedures can be done during the same do not need to stage them.

Cresent Lift and 410/445cc Cohesive Gel Teardrops, over Muscle. Opinions? Comments?

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Based upon the posted photos I would recommend a l-shaped lift first than as a second operation implants of UHP. 

Crescent Lift with Subglandular Cohesive Gel Implants...Interesting!

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Thank you very much for sharing your photo and question.  This seems like a really interesting combinations of solutions to your anatomical findings.  While there are some minor asymmetries and findings shown in your photos, you are not very far off from normal.  Your photos show only minimal breat ptosis and are unlikely to benefit significantly from a crescent lift.  You will get alteration of the areolar shape, little change in nipple position and poor quality scarring...not a good trade off.  Submuscular implants tend to do better long term in patients with little breast tissue in that the rate of capsular contracture, wrinkling and palpability are all lower...that's why it's the most popular technique.  Textured, shaped cohesive gel implants have not been shown to have a dramatically better outcome to justify their cost.  This is a personal choice here.  You would probably do well with smooth, silicone implants under the muscle and save some money.  Your result will be natural in appearance as long as your implants are not too large.  I would recommend having another discussion with your surgeon regarding all the pros and cons of the choices that you are making so that you have a full understanding.  Best of luck!

Crescent Lift with Cohesive Gel Implants?

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That is an interesting experiment, but I don't think I would try it. 

For starters, I believe the so-called crescent lift is worthless. It achieves very little in terms of changing the position of the nipple, it does nothing to reposition your breast tissue, and it only tends to elongate your areola while producing irregular, unnatural scarring. So I would avoid it. 

The question then is what about that subglandular (over muscle), shaped cohesive gel implant. As a general rule, I am much more in favor of submuscular (actually biplanar) implants. There is a lower risk of capsular contracture, lower risk of visible rippling, and they tend to hold up better over time. Also, the teardrop or shaped implants must be textured, so that the teardrop stays appropriately oriented, although they are definitely know to rotate sometimes. But texturizing an implant means the shell must be thicker to allow for the texturing and this makes the implant much more firm, thus negating the primary benefit of the gel implant. My experience with that type of implant has been limited to removing them from patients who don't like them. 


Impalnt and lift for you

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I amnot a big fan of textured impalnts, tearfrop, and I do not think that cohesive gels offer any significant advantage.  A submuscular implant with perhaps an areola lift may be reasonable and an exam is essential.

Purse string lift or circumvertical lift

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Thank you for the question and the photos.  The best result will be provided by the combination of an implant and a lift.  The implant type will not be as important of a decision as the lift type.  I have never really liked the crescent lift.  A breast either needs a purse-string lift to move and reshape the areola or a circumvertical lift to shape and lift the breast.  A crescent lift does not do either except just shifts the upper border of the areola which never really looks that good in my humble opinion.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Implant type and crescent lift.

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I prefer the implants under the muscle for the same reasons Dr. Pousti has so nicely documented.

Tear drop implants have been know to shift or rotate even years after placement. A round implant "behaves" more like a natural breast in that it is round when you are lying flat and takes a natural tear drop shape when you are upright. A "tear drop" implant is always shaped like a tear drop in any position.

I also agree that a crescent lift does little to lift the breast tissue and causes irregularities of the areola. Doing a biplanar technique (placing the implant under the muscle, but separating the breast tissue off the top surface of the muscle inferiorly for a short distance can help with small amounts of breast ptosis or droopiness. If you do require a lift, this can be performed in a second stage very easily and you may be able to get by without the additional scars.

Have open discussions with your plastic surgeon so you both are on the same page. Good luck. 

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.