Can deflated breasts with pseudoptosis get good results with implants only and no lift?

Question

I am 35, I have breastfed 4 babies and recently lost weight, my breasts feel completely deflated there is no tissue in the upper pole and the lower pole is just skin. My areolas are above the inframammary crease and I would like to know if I can get a good result with just implants and no bl. I do worry about implants bottoming out though since that is the natural shape of my breasts.

Gary M. Horndeski, MD · Answer

Placing implants
would fill your breast envelope but will create large sagging breasts, which
will be unattractive and you will be dissatisfied.  Instead, I recommend The Bellesoma Method,
which will lift your breasts, reshape them creating upper pole fullness.  At the same time or later, fat can be
transferred to augment the volume of your breasts.  Best Wishes,Gary Horndeski, M.D.

Terrence Scamp, MBBS, FRACS · Answer

Hello there That's a really complicated question . I guess the short answer is ..."It depends"A lot of the decision-making process is made just by the appearance of the breasts . In some cases it is obvious on examination that a good result will require a lift . Conversely there are cases where it is mostly just deflation and an implant will do a great job .But there are many who fall in the grey zone , where a lift will make the breasts sit better and look more shapely , but the benefits have to be weighed up against the scarring . It may just come down to personal taste - whether or not you dislike sag more than scarring .If the lower part of your breast is very expanded then it is likely the implant will tend to sit there and the breast look bottomed out . A lift does more than just move the nipple ; it tightens the skin envelope and makes the breast tissue and the implant sit in a more favourable position .From your photos I think you are likely to get better breast shape with a lift . But that's just from a photo .So I suggest you have a consultation with an experienced breast surgeon - or more than one - and give it all some thought.CheersTS

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. You are a great candidate
for a breast augmentation without need for a formal lift.   The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.  This entire surgery
can be performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Daniel Barrett, MD · Answer

Hi cheetara_3018,
  
Determining whether you need simply a breast implant versus a breast lift or both 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 breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift. 
  
These two surgeries can be done at the same time and this may be optimal as the risks can be minimized.  
  
In addition, upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear fuller. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side.
  
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals. 
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery 
  
Member, Am. Society of Plastic Surgery

Robert D. Wilcox, MD · Answer

Dear Cheetara_3018,
  
Absolutely.  Since your nipples are above the inframammary fold, you do not need to have them moved up higher on your torso.  The problem you have is a mismatch between two little breast tissue and too much skin.  A medium to large implant will correct that imbalance and restore the shape that you desire.  I hope this has been helpful.  
Robert D. Wilcox, M.D.

Gregory J. Stagnone, MD (retired) · Answer

Based on the pictures, you look like a good candidate for breast augmentation without a lift. In fact it's uncanny how nearly identical you look to one of my photos posted here on RealSelf! Because of the deflation and lack of tissue I'd probably encourage you towards silicone gel implants since I think they'd provide a much better feel to your newly enhanced breasts. Once you choose your surgeon(s) for consultation, the measurements taken will confirm this and you can then try on appropriate sizers to get a preview of what you can expect. Bottoming out is a risk, so it may be wise to err slightly conservatively in your choice of implants. It's well recognized that larger (heavier) implants do take a greater toll on the tissues but there is truthfully no way to predict with certainty when it will or won't occur since everyone's tissues and capsule formation are unique.

Can deflated breasts with pseudoptosis get good results with implants only and no lift?

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