40, 2 children - I want to increase upper pole fullness. Advice on implants and lift recommendations? (Photos)

Hi, Thank you for your inquiry! We here at Mays Plastic surgery would love to sit down for a consult to discuss your concerns. With breast laxity you have options. A breast lift, and adding volume, whether its fat transfer to your breasts or implants. Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

Dear lauraheaver87,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

After pregnancies and weight changes, the loss of upper pole fullness is often combined with skin laxity. In this situation implants alone cannot fully correct the shape. They restore volume but also add weight, which can make the breast sag more over time.
That is why a lift is usually required to reshape the breast and support the implant if you also want lasting improvement in contour. The type of lift depends on how much sagging there is, but even a conservative lift can make a big difference in creating a natural look while keeping the implant in the right position.
A lift combined with implants is the most reliable way to achieve the balanced and youthful result you are describing
— Güray Yesiladali, MD

At 40, after two little ones and the natural ups and downs of weight changes, it’s so normal to feel like your breasts have lost some of that youthful shape and fullness. You’re not alone in wanting to restore the gentle roundness at the top without going “too big” or looking unnatural.
A small implant can softly bring back that upper curve you miss, while a lift ensures the breast stays perky and doesn’t sag further. Together, they often create the most flattering balance, restoring fullness while keeping everything lifted, feminine, and natural-looking. Many women find that a modest implant with a vertical, or “lollipop,” lift is the perfect sweet spot, giving just enough fullness while beautifully reshaping the breast.
The goal isn’t to change who you are, but to give you back the confidence and silhouette that makes you feel like yourself again, refreshed, elegant, and naturally you.

Thank you for your photos. You appeared to have a grade 2 ptosis (breast hang) In order to give you a youthful breast shape and contour you would need to have a breast lift to position your nipple and areola to the correct level. A breast augmentation would give you some additional volume and some upper pole fullness. How high your upper pole fullness goes, would depend upon the width of the implant that you chose. Your implant choice should be guided by the dimensional measurements of your breast, which your plastic surgeon would perform during your consultation. These dimensional measurements would also help determine which type of breast lift pattern would be most beneficial for you. Adding a breast implant, without a breast lift would increase the amount of ptosis that you have and be counterproductive. Best wishes.

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos, you would likely benefit from a lift in conjunction with an augmentation.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

A full breast lift would most likely be sufficient in reshaping your breasts to make them perkier. Implants wouldn’t be necessary unless you want to have larger breasts or significant roundness.

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After 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

"Given the minimal deformation and ptosis in the breast, which is a common outcome of childbirth, gravitational effects, and the aging process, your optimal solution would involve either an implant-assisted 'lolipop' (vertical scar) mastopexy. Considering the patient's broad breast base, I would recommend a moderate-profile, wide-base round implant, typically in the 250-350cc range, to achieve the desired aesthetic outcome."

Thanks for your question! You are a great candidate for a vertical mastopexy and implant of a moderate size. I would also suggest a moderate or low plus profile to get upper pole fullness but also not too much size. Find a qualified breast surgeon in your area. Good luck!