Do you consider I have glandular ptosis? Pseudoptosis, grade I? Should I need a lift combined with breast augmentation? (Photo)

Question

Hello! I am a 35 yo woman considering a breast augmentation with low profile, still deciding between 275/315cc implants low profile. Ive seen 2 deferent doctors and one of them says 100% sure I need a lift, the other says I'll be fine with 250cc. I want something very natural. My back/shoulders are small, I usually use a xs size, my bra size is 34. I have been researching and do you think I would need a regular lift? an periareolar mastopexy? or just an implant 300cc?

Wayne I. Yamahata, MD · Answer

I can see why you might receive two different recommendations because your photos suggest you are a borderline candidate for a lift. Depending on your goals you would probably achieve a reasonable outcome with either option. To provide a more definitive recommendation would require a physical examination. At this point you may want to further discuss the anticipated outcomes with your two surgeons or possibly consider a third opinion.

Daniel Barrett, MD · Answer

Dear Carpediem77,
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

Carlos Marciales, MD · Answer

Hello, yes, you have pseudo breast ptosis, you need a secondary breast lift, and breast implants to improve the upper pole of the breast.

Brian K. Reedy, MD · Answer

Thanks for your question! I think a lot of this depends on what you are looking for as an end result. It would be helpful to see B&A photos that are "wish pics". I think you could get by with just an implant if you are okay with being bottom heavy. Maybe another opinion isn't a bad idea. Good luck!

Gary M. Horndeski, MD · Answer

Your breasts are too low on the chest wall and you have no upper pole volume. The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Karl William Schwarz, MD · Answer

In my opinion you would need a full lift and not a concentric lift. A full lift is also known as the 'inverted T' or an 'anchor pattern' with an incision that goes around the areola and down the center of the breast and underneath in the infra-mammary fold. I would suggest using a high profile implant but if you prefer a flatter, less projecting breast than I would stay with the low profile. As for size you have to keep in mind there has to be a fit between your breast and the implant and it looks as if your breast is fairly wide which would require a little bigger implant in order to fit your breast.

Connie Hiers, MD, FACS · Answer

You do have some ptosis and I would recommend a lift, probably a vertical lift.  Measurements are needed to see which lift should actually be done. If you just go with the augmentation, you will notice the sagging even more. I would also place the implants behind the muscle for better coverage, upper breast fullness, and support.

Camille Cash, MD · Answer

From the submitted photos it appears you will have the best result from a breast lift with augmentation.  The lower profile implants will not give you much projection nor fullness in the upper portion of the breasts.  You may want to consider a moderate or moderate plus as options.

Michael S. Kluska, DO · Answer

With 25 years of experience in the field of cosmetic breast surgery, I highly recommend that you undergo simultaneous breast augmentation with breast lift, placing the implant under the muscle. Long-term results in a patient like yourself with implant only will result in further ptosis + pseudo-ptosis. In your situation you have both.

Mats Hagstrom, MD (license on probation) · Answer

In your case, I think pseudoptosis is the primary diagnosis.
The indication for a breast lift is determined by the relationship of your nipple position to the infra mammary fold. If you put a chopstick or a pencil at the inframammary fold, then look in the mirror to see if your nipple is above or below the chopstick then you’ll know your nipple position in relationship to the fold. if the nipple is significantly below the fold, then a lift is typically indicated.
If your nipple is at or above the fold, then a lift may not be necessary.Low profile implants are a good option in my opinion.
I generally always recommend patients have multiple in person consultations before selecting a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients, who had similar body characteristics to your own.
An experience provider should have no difficulty showing you the before and after pictures of at least 50 previous patients.
 Being shown a handful of pre-selected images, representing only the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider, getting a good understanding of what your results will look like or knowing how many of these procedures the surgeon has actually done.
There are three variables that determine breast augmentation outcomes.
The first is the patient candidacy for the procedure. This includes variables, like nipple position, breast, divergence, and breast position and asymmetry on the chest wall.
The second variable is the choice of implants in regards to size shape, and type.
The third variable is the surgeon ability to place the implant in the correct anatomic location.
There isn’t much patience can do regarding their own candidacy, but understanding your candidacy for the procedure helps. Patient understand what type of results they are capable of, and can increase overall patient satisfaction.
The two valuables patients do have control over is implant selection in conjunction with your provider, and of course, provider selection.
 Ask each provider what their most common indication for revision surgery is, what their revision rate is, and what their revision policy is.
All plastic surgeons do revisions.
You want to avoid providers who tend to have implants that bottom out.
Surgeons who fail to properly position implants in the correct anatomic position, may end up doing more revision work for implants that bottom out.
This is a fairly unfortunate undesirable outcome that can be avoided by working with the right provider.
Choosing the correct provider can be challenging.
Look for providers who have obvious evidence of being highly experienced who come across as being patient advocates, honest and competent.
Look for providers who are transparent and appear to have what looks like an endless collection of before and after pictures.
My personal preference is generally sub, pectoral placement of implants.
Best,
Mats Hagstrom, MD

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