Can I get my desired result without a lift?

Great questions! Either of your breasts could easily be augmented to get a great shape with an increase in volume. The caveat is that you would still be asymmetric with implants alone given the difference in the baseline nipple position. For maximum symmetry, a lift on the right would be necessary.

All breasts are different left to right before and after pregnancy, surgery, etc.

Your right breast would still be low (improve a tiny bit) with still more ptosis than left if only implants were used.

For best symmetry, a lift on the right with implants on both sides would be best.

An exam and consultation with a plastic surgeon is recommended to further discuss your options and expectations.

I recommend a circumareola lift with placement of implants. The circumareola lift on the lower breast will allow the nipple-areola complex to be elevated to match the other side. On the side that is higher, you may need to lower the inframammary fold slightly. The implants can be placed through the circumareola incision avoiding the vertical scars.

Best Wishes,

Gary Horndeski, M.D.

Dear jessden95, thanks for sharing your questions and concerns, after evaluating your case the position of your nipple under the inframamary fold and this little ptosis you mentioned you look like a great candidate for breast augmentation with implants without the lift, with this you can ensure long term results. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia

You are right that since both nipples are above the fold, you would not need a breast lift. The only reason to consider one is to provide better symmetry with respect to nipple position.

Hi and thank you for posting the question. These issues come up all of the time. Everyone has some asymmetry - for some it's mild, and for others it can be more substantial. In your case there is likely a difference in the breast volume from side to side. In many cases we can correct this by using two different implants. As you pointed out, you also have ptosis/pseudoptosis on your right side. That breast will most likely have a larger skin envelope. So if you put two closely sized implants in the right side will have a looser look and feel. The right nipple areola complex is also lower as you point out. This can be addressed to some degree by using two different versions of pocket creation - we would dissect the pocket a bit more on the right (we would call that a dual plane 2 or 3) to encourage the nipple to move upward a bit. If that gets you close you could stop there. Otherwise you would get the rest of your symmetry with a lift. We don't find many patients who are ideal candidates for it, but you could do a donut mastopexy where the scar only goes around the areola on the right. That would allow us to make a smaller areola to better match the left side while also lifting it to a higher position.

You can proceed with a breast augmentation without a lift based on your nipple position. Differently sized implants can be used to help improve the volume asymmetry. However it is important to note that you still may have some nipple asymmetry after surgery if it is not addressed. See a board certified plastic surgeon near you to learn more.

This response was dictated using Word recognition.
My apologies in advance for a grammatical errors.
Thank you for an excellent post. That was well thought out and includes the exact kind of pictures we need.
Other people posting should take note.
There are three variables that determine the outcome of the breast augmentation surgery.
The first patient candidacy, the second is implant selection under the third is the surgeons ability to put the implant and the correct anatomic location.
Variables affect, patient candidacy include breast position on the chest wall, breast, or nipple divergence, Breast droopiness and other variables.
In this sense, I think you are a good candidate.
Your breast both forward(No diversion) and appropriately positioned on your chest wall.
Most people have the left breast, sit slightly higher on the chest wall than the right side.
this seems to be true for you as well.
I think you Can easily avoid having a breast lift, but you will have slightly different looking breasts after augmentation because they look slightly different now.
Overall, the outcome should be a nice improvement and your breast should look better.
Implants selection is a very Importance variable.
Decisions need to be made in regards to what type of implant (saline or silicone), size and profile.
Generally speaking low profile implants look more like a pancake and high profile implants look more like a tennis ball.
These are obviously exaggerations, but I think you get the idea.
With the same high profile implant will have a smaller diameter and have more projection.
A low profile implant will have a wider diameter and be less thick.
plastic surgeon will have their way of guiding patients through the implant selection.
Some providers do this better than others.
Providers guide you through the implant selection process is really important and you should take notes about this during each consultation.
Some providers will ask patients to make the final decision regarding implant selection. Other providers will make the final decision based on input from the patient.
My personal preference is to first work with before and after pictures until I have a really good understanding of what the patient is trying to achieve.
once I have images of patients with ideal outcomes also had similar characteristics to start with. I bring those pictures with me to the operating room to use as guidance.
I use temporary sizers to determine what size and shape implants will give the outcome consistent with the pictures. The patients have showed me.
I typically have a selection of implants available during surgery.
I find this to be the most accurate way to get this variable done correctly.
It’s really important to spend enough time, listening and guiding patients through this process.
The third variable is basically doing the procedure well.
I think most top-notch plastic surgeons generally put the implants under the pectoralis muscle.
Putting the implant above the muscle is technically much easier But has certain disadvantages.
Regardless of the position of the implant, the doctor put the implant in the correct anatomic location, regardless of its relationship to the pectoralis muscle.
If the implant sits too high, then patient may need revision to lower the implant later.
If the implant is placed too low causing Implants to “bottom out” The patient has a difficult situation that requires complicated and complex revision surgery to correct.
You want to avoid plastic surgeons who have attendee of developing bottomed out implants.
Getting the implant in the correct anatomic location is much easier when working with implants that actually fit the natural diameter of the breast.
Working with excessively large implants will generally always increase undesirable side effects, increase complication rates, and increase the chance of needing revision surgery.
I suggest you print copies of your body pictures that you included in the post.
Bring those pictures with you to use as a reference during every consultation.
The surgeon is going to examine you and you’ll get a chance to see yourself in the mirror, but when you reviewing before, and after pictures, you need to have a reference to what you look like, and your pictures are going to do that well.
I suggest you start the process by making a list of plastic surgeons that seem to have extensive breast augmentation experience in your community.
Look for the plastic surgeons who do most of the breast cancer reconstruction in your area.
Surgeons who do a lot of breast reconstruction are usually really good at all aspects of breast surgery.
commit to having a certain number of consultations.
I think for most people having 3 to 5 consultations is appropriate for this type of surgery.
There is definitely a significant difference in skill and experience among different providers.
Picking the right plastic surgeon is in the end by far the most important variable and it is the variable patient should spend the most effort on.
except for implant selection is the variable you have the most control over.
Do not schedule surgery or pick a surgeon until you’ve completed all your consultations.
Most people do not have experience consulting with plastic surgeons.
Plastic surgeons on the other hand, have a given thousands of consultations.
Recognize that you are hiring somebody to perform a service for you.
It is your responsibility to vet the person that you are about to hire.
during each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures
Being shown a handful of pre-selected images representing only the best results of a provider career may be insufficient to get a clear understanding of what results look like in the hands of each provider.
You should also make sure the provider is showing you results of previous patients who had the same breast characteristics to your own.
I highly experienced plastic surgeon should have access to 100 or preferably thousands of before, and after pictures to choose from.
An experience provider should have no difficulty showing you the Before and after pictures of at least 50 previous patients.
Ask each provider what their most common reason is for doing revision surgery, what their revision rate is and what their revision policy is.
All plastic surgeons do revisions.
Breast augmentation revision rate may be around 10%.
Providers who claim to have very low revision rates are either not delivering the best possible outcome for their patients are not being honest. The one thing you want to be on the lookout for is plastic surgeons who end up having to correct implants that have “bottomed out”. As mentioned previously, this is often associated with augmenting excessively large breasts, which may require opening the IMF infra mammary fold.
This is an undesirable complication that is technically difficult to correct and is best avoided by carefully choosing providers who know what they’re doing.
The best plastic surgeons are detail, oriented, and tend to be meticulous.
This is usually true for all aspects of their work.
Somebody thorough in the operating room is likely to also be thorough during their consultations.
Someone rushes consultations is likely to also be rushing Surgery.
Be prepared to take notes during the consultation.
Take note of how long the consultation lasts or how many minutes the surgeon spent talking to you.
Make a list of things you think should be covered during the consultation and immediately afterwards check to see how much effort the surgeon spent talking about each of the variables.
Were they thorough in discussing risks and complications? Did they spend enough time talking about the difference between saline and silicon implants.
What was their method of helping you select the right implants and why?
Did they talk about revisions?How many before and after pictures did they show you? Did they show you pictures of previous patients who had similar body characteristics to your own? Did you leave feeling like the surgeon listen to you?
Patients become better at consulting with plastic surgeons by repeating the experience.
You may find the right provider during your first consult, but you’re much more likely to find a better provider if you continue having more consultations.
You’ll start having a better understanding of the complexity of the procedure and all the different variables involved.
At first, it may seem very overwhelming with a lot of Words, phrases, terminology, and concepts you are unfamiliar with.
You will with experience start understanding these more and more.
This is another advantage to having multiple consultations.
I think minimum patient should have at least three consultations but I think scheduling five or more would be in the patients advantage.
Even if surgeons charge for the consultation it is money well spent.
You’ll be reminded of the outcome every day for as long as you have the implants.
If it’s done correctly, you’ll be done and over with and can enjoy the change for decades to come.
If done incorrectly, you’ll be left in the frustration needing to have surgery after surgery.
The time to be critical of plastic surgeons is during the vetting process while you’re consulting with providers.
Never schedule surgery on the day of the consultation.
Always finish all scheduled consultations before selecting a provider.
If you find yourself, unsure or still have questions then have a follow up appointment before you have surgery.
There’s nothing wrong with having a second consultation with the same provider.
Remember that you’re paying for the service.
You’re hiring someone to do something for you and you should take ownership and responsibility for vetting the provider and finding out what is best for your needs.
Best of luck with your endeavor.
Mats Hagstrom MD