Depends on your goals
If you want large breasts with some sagging, then an implant will be enough.The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.
Breast Lift and Implants
Thank you for your question and photos. You may want to consider a mastopexy and breast implants. Depending on how large you would like to be, Implants can be placed at the same time as a lift or as a secondary procedure once you have healed from the first one. I recommend that you book a consultation with a board certified Plastic Surgeon to discuss your aesthetic goals. They will measure you and talk about planning that suits your needs.
All the best
Breast Lift with Implants
Candidates for Breast Lift with implants (#Mastopexy) surgery are women who have #saggingbreasts due to past pregnancies, genetics, or aging. Often times the sagging is too great to be treated by implants alone. In addition, adding an implant gives both volume and shape to the newly lifted breast.
Women with asymmetric or enlarged nipples or areolae (pigmented areas around nipples) also may be candidates for a breast lift or a modification of a lift. #Asymmetric breast can be adjusted by adding or removing volume. One side can be tightened more or less than another.
Different size implants may be used for the two breasts. Different profiles of implants can be used depending upon the shape of the breasts, the type of lift and what the women wants to achieve.
The women that are candidates for #breastlift– include: A woman who’s had a pregnancy; her breasts have either just deflated, or the skin has been stretched from pregnancy, and or breastfeeding. They may be in a lower position than she would like. By doing the breast lift, we can tighten the breast, tighten the breast skin, and put it into a more youthful position.
The other category include patients who have had weight loss through either diet or surgical procedure. Many women will have breast deflation with #weightloss leading to #drooping or #ptosis.A #mastopexy or breast lift operation is designed to improve the shape and position of the breast swithout reducing their size. It is used for #breasts which sag or droop (ptosis). Sagging of the breasts may occur with normal development for some women, or as part of the aging process. Pregnancy, breast-feeding and weight loss are other conditions which increase breast ptosis. Some patients will have a better shape to their breast such as increased superior fullness if an #implant is used at the time of mastopexy. This is called an #Augmentation/Mastopexy. The procedure can also be combined with a minor breast reduction to reduce the breast width if desired. The surgery will create an elevated, more youthful breast contour. Also, the procedure will create nipple and areolae of the desired size and at the correct height.
#FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast. A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.
Breast Lift or Implants or Both
There are different techniques that can be employed to improve upon the shape and appearance of the breasts. These may include tightening of the skin and repositioning of the breast tissue, insertion of breast implants, or a combination of both techniques. In terms of breast implants, there are a variety of augmentation techniques that I can use and I am familiar with the use of both saline and silicone implants. The procedure is usually done as an outpatient procedure to help augment a woman's breasts or replace volume that has been lost after childbirth, breast feeding, through normal aging or weight loss. This may sometimes require more than one operation if both a lift and implants are needed. Which technique is used is based mostly on the individual patient. In general, if the nipple "hangs" more than an inch below the breast fold, some type of lift will be needed. From your pictures, I think you would be better served by both a lift and implants, but you should start with a consultation with a board certified plastic surgeon.
Breast lift with implant
Hello and thank you for your question. You are a great candidate for a breast
lift with an implant. The size 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. 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.
Harvard-trained plastic surgeon
Breast Augmentation and Lift
Thank you for your question.
It appears as though you do have some post-pregnancy sagging to the breasts, so a lift would be helpful. Since you want larger breasts also, an implant would also be of benefit. With the newer shaped implants, some patients can have breast augmentation alone and not need a lift, but you typically need a larger implant to get this effect. Best if you have a consultation with a plastic surgeon who will discuss your options with you.
Dr. Dan Krochmal
MAE Plastic Surgery
Thank you for your question and photographs. I would recommend that you schedule a consultation with a board certified plastic surgeon to have an examination of your breasts done. At that point, the surgeon can recommend whether you need a breast lift, breast augmentation or both. From the photos you have posted, it looks as though you would need a breast lift as well as a breast augmentation to correct the sagging and add projection and volume. At my office, we use Crisalix which is a virtual reality device that will allow you to view what your breasts would look like after a lift, or view different sizes of implants and pick which best suits your desires. As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate. Crisalix is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants. Thus, our patients leave the consultation feeling confident with the size of the implant they chose.
Best of luck in your endeavors!
James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science
Breast lift necessary?
Thank you for the question and pictures.
Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone.
You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.
Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.
Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.
To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.
The attached link may also be helpful. Best wishes.
Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision
I appreciate your question.
From your photos, you appear to be and excellent candidate for Breast Lift with Augmentation. A breast lift will reposition your nipples and reshape your breasts, giving them a more youthful appearance. Implants will enhance volume.The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.
Best of luck!
Board Certified Plastic Surgeon
Thank you for your question. Based on your submitted photos you appear to be an excellent candidate for a breast lift with augmentation to produce beautiful overall results. Schedule a consultation with a board certified plastic surgeon to be further evaluated. From there you can discuss surgical options, address your goals and work together to create the surgical plan that best helps you achieve the look you desire.
With kind regards,
Lane F. Smith, M.D., F.A.A.C.S., F.A.O.H.N.S., F.A.B.F.P.R.S.
Las Vegas Plastic Surgeon