What type of breast lift?
You look like a great candidate for a vertical breast lift which should leave you with a nice shape and some upper pole fullness. NO breast tissue is removed so you size will be the same as it is now. If you have the diameter of your areolas reduced a little, it will give the illusion slightly larger breasts.
If you were my patient, I would not recommend an implant. You are already busty and don't "need" implants. Just a little improvement in the upper pole, in my opinion, is not worth the risk and long term upkeep of an implant. Implants are for flat patients, not for well-endowed ladies like you.
A few words of caution: don't sacrifice shape in order to avoid scars. It is almost always a mistake. If you are advised to have an implant and a periareolar lift (Benelli), I would be very, very cautious. Doing this procedure to avoid a scar (which is rarely a big issue long term) is not wise. Believe me, I have learned the hard way!
As far as longevity, most breast lifts last a good 10 - 15 years unless you have a baby or a big change in your weight or you burn your bra (not advised!). The breast lift will turn the clock back, but won't stop it from ticking. An implant may "stay put" over the long run, but your breast tissue will still go south over time resulting in a "double bubble". Yet another reason to shy away from an implant.
Lisa Lynn Sowder, M.D.
Vertical breast lift for long term fullness
You are lucky in that you appear to have excellent skin quality and need about a lift of only a few centimeters. In my opinion there are two options for you depending on whether you want to maintain the same breast volume size or not. If you wish to remain the same size, the best procedure for you is a vertical lift with a unique modification called the 'pectoralis sling.' It is a technique developed by the internationally reknowned plastic surgeon Dr. Ruth Graf. Using this technique I am able to create true superior pole fullness beyond what can be achieved with an implant and there are no late implant complications to worry about since there is no implant. An important key to this type of vertical lift is that instead of throwing away the tissue of the inferior pole of the breast (as is necessary with a conventional vertical lift) this tissue is preserved and mobilized to the superior portion of the breast where it is held securely by a sling designed from the superficial part of the pectoralis muscle. In this manner a beautiful natural appearing breast with superior fullness is created. As far as scars, the procedure would leave you with a lollipop scar around the areola and straight down.
Your second option would be to add a 270-330 cc implant which would add volume and reduce your need for a lift, allowing the scar to be placed around the areolar or even completely hidden with a unique technique that I perform called circum-nipple lifting. I would not recommend a submuscalar placement as this will cause distortion of the breast with arm movements which can be embarrassing and causes muscular forces to stretch and age the lift quickly. Subfascial placement preferably with a technique called 'cold-subfascial augmentation' produces a much more natural appearing breast, enhances the fullness and slope of the superior pole and protects the implant from accelerated aging due to its 'bra inside the breast' effect.
I hope this helps!
All the best,
Rian A. Maercks M.D.
Breast Augmentation and lifting?
Thank you for the question and pictures.
You should be commended on your way of thinking: you will be happier with your breasts if you achieve the “end shape and fullness factor" with the scarring an important ( but secondary) concern. I also think that you would benefit from the use of breast implants; otherwise you will likely be disappointed from the “fullness factor” standpoint.
I think the type of mastopexy you would benefit from is a vertical mastopexy with an incision around the areola and vertically. Exactly the procedure that is performed depends on your goals in regards to size, shape, superior pole volume etc. There is no good way to do this with “little or no scarring”. Based on experience, I would suggest that your 1st concern should be obtaining the best results possible (scarring concerns should be secondary). Most patients undergoing this procedure will accept scarring as long as their overall goals in regards to size, shape, contour and symmetry are met.
It will be very important to communicate your overall goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
If you decide to use implants ( for example to achieve more superior breast pole volume)
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible .
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
Breast Lift and Augmentation
Your question was well-presented and your goals are very clear. Based on your photographs I believe that you are an excellent candidate for the Vertical Lift (Lollipop Lift) that appears to be represented in the pre and post-op picture that you have included. A breast implant would definitely enhance your result by providing you with fullness in the upper aspect of your breast. The implant size is easily determined based on your breast measurements, skin quality, initial breast volume and desired look (how full you want to be). If you think that you may be happy with your breasts more 'perky' but not necessarily fuller, a lift alone is also a good option as the implants can add weight to your breasts and lead to sagging more quickly than a lift alone. Best Wishes!!!!
Do not need implants with Ultimate Breast Lift technique
The Ultimate Breast Lift technique gives patients of all skin types and breast types the upper pole fullness, lift and firmness they desire. The newly shaped mound is permanently attached to your chest with permanent sutures to minimize downward descent. An added benefit to this procedure is that there is NO VERTICAL SCAR. The results are natural and longer lasting than conventional methods. It's worth looking into. Best wishes, Dr. H
If you like the way you look in a bra, you probably only need a lift. The degree of sagging you have suggests that a vertical scar technique would be appropriate. I doubt if you would need an anchor or inverted T type lift. I often use tape to mimic the effects of a lift to see if a patient accepts the proposed end result. It seems as if you have adequate breast tissue to forego an implant. While an implant can add fullness and longevity to shape, there is a whole host of side effects and risks factors that you will need to accept. A careful consultation with a plastic surgeon might give you an indication whether that added risk would be worth the benefit.
Robin T.W. Yuan, M.D.
Breast lifting is a very artistic sculpting of the breast and some surgeons are better at it than others. It isn't so much the scar length or the name of the technique but the quality of the shape and the lasting nature of the result than counts. So, I'd recommend checking many surgeons photos and deciding whose results look best to you. The implant can add some upper pole fullness but doesn't make the result last longer. If anything it might hurt the longevity of the result especially if the implant is too large. About 20% of my lift patients go without implants.
You added photos of a patient before and after surgery. It is my impression that she does NOT have implants.
Which Style of Breast Lift Would Be Most Appropriate for Me?
In my opinion you should do extremely well with a short Scar breast Lift (Hall-Findlay Technique). The technique uses a lollipop scar though which the sagging lower portion of the breast is lifted and placed under the breast as an auto-implant. This results in long lasting perky breast lifts. In my opinion a breast implant would not help in the long run and would add more weight and sagging to already large breasts.
Peter A Aldea, MD
Breast lift: most appropriate for shape and size
You would do will with a lollipop lift and small implant or fat for shaping.
Lollipop lift (vertical lift), donut (periareola) lift, Benelli
lift, crescent lift, anchor lift (inverted T ). Most commonly, we prefer the
lollipop or donut lift because of the shape, small scars and easier healing.
Although the “anchor-shape” or inverted “T” incision is still more popular in
the United States, it represents an older technique with extensive scarring and
a less optimal result in many cases. These newer techniques are utilized in the
vast majority of cases, the rare exception being extremely large breasts. The
nipple-areola complex is repositioned higher, the excess skin is removed, and
the breast is reshaped in a pleasing contour and in a more normal position.
The crescent lift removes a small amount of skin at the top of
the areola. We find that there is very little
lift and the areola becomes oval in shape and distorted with this
The Benelli lift as performed by most surgeons is just the donut
lift, removing a donut shaped piece of areola and skin then using a
#Pursestring or double purse-string suture to tighten the skin. A true Benelli actually will expose much of
the breast through this incision and then the breast itself is shaped and
lifted with sutures. This is a more
complex procedure and is often not done as describe by Dr. Benellil.
The insertion of an
implant as well, may be advisable to restore superior fullness, which is lost
with aging and after pregnancy despite the rest of the breast being overly
large. Fat grafting can be used instead
of implants to improve the contours of the breast.
Options for improving breast shape and volume
You would be a good candidate for a vertical mastopexy with a breast implant for volume. There are several different types of breast lifts including a peri-areolar crescent lift, a doughnut or Benelli lift, a Vertical Mastopexy and a Key hole or anchor type mastopexy. All have specific parameters. Based on your appearance and the degree of breast tissue below the inframammary crease you would get the best result with a vertical mastopexy with a breast augmentation.