Hoping to achieve a natural look with minimal scarring - would a lift be necessary in my case? (photo)

Hello Lilithlvne, this is a good question, and one of the most common questions we see routinely in cosmetic breast surgery. Really, augmentation mammaplasty and mastopexy are two separate procedures. They are very commonly done together as a combination procedure with good results (combination approach is generally accepted to have a slightly higher revision rate), although there are surgeons out there that prefer to do them staged. Based on your pictures, it appears that you have grade I breast ptosis, which means your nipple position is approximately at the level of the lower breast crease. Not infrequently, in borderline cases such as yours, I will discuss with patients the option placing the implants only and only do a lift (typically at 6 months post-op) if needed. There is a reasonable chance you will need a lift in addition to implant (if I had to guess a very rough number, maybe 40-60%), but I am often surprised by how often a patient does not end up needing a lift. Alternatively, if patients prefer only one surgical procedure, they can opt to go ahead with augmentation and lift, however I am careful to counsel them that there is a slightly higher revision rate with a combination procedure, so there is a chance they would have two surgeries anyway. For whatever their worth, two additional points I would make: 1) I am always surprised by how little patients are bothered by the extra scars for a breast lift, and 2) I would not recommend picking an implant volume based on trying to fill out the breast envelope, but rather pick a size that achieves your volume goals. Hope this helps. Thanks, Brian

Please go see Dr Louis Strock in Fort Worth and let him know that Dr. Gianfranco Frojo recommended you. I trained under him. He is one of the best surgeons for this type of surgery in the world. Alternatively, you can also go see Dr. William Adams Jr in Dallas, Texas. These guys are world authorities in this topic.

Hello thank your question. I would suggest bringing in your wish pics. Talk to your plastic surgeon about your options given your desired goals. Also consider the future of how much further the breast tissue and implant will fall.

Dear Lilithlvne,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

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., USA

The submitted photo is not enough to make a definite recommendation. Typically if the nipple is at or below the level of the breast fold a lift is recommended. It is understandable to not wish to have unnecessary scars, but nor do you want to undergo a procedure and be unhappy with the result. Be sure the consultations you have are with experienced board certified plastic surgeons.

Better evaluation would include side breast photos along with the one you submitted. Based solely on your one photo, it appears that you would be better served with a submuscular silicone implant and at least a periareolar (around the nipple ) mastopexy (breast lift).
Best wishes,
Dr. Taranow

Just based on your one photo with arms elevated, you probably need a lift. During your consultation, you will be measured and examined, and all options will be discussed. If you wish a better Real Self consult, ask someone to take your photos with your arms down and a side profile as well.