With all due respect, your goals are perfectly reasonable, but there are some trade-offs (pros AND cons) to each of these options, as well as one you haven't included in your list, that with more information may induce you to reconsider.Thanks for including photos--though not ideal views, they provide some information useful in answering. A physical examination by one or more ABPS-certified plastic surgeons would be better, and should be considered soon, as you seem to be asking questions based on your own research trying to replace what 7 years of post-MD surgical and plastic surgical training, plus 27 years of experience in breast surgery (in my personal case) should be providing. So here are my observations.Your breasts are pretty, though they do have a natural teardrop shape that you have indicated you would like lifted and fuller. But your nipples do face forward, and appear to be well above the position of your inframammary creases. A lift is not required to give you a very natural and beautiful result with implants alone. And breast augmentation with implants will require only a 3.7cm incision and a nearly invisible scar in most cases--I would recommend an infra-mammary (crease) incision for best visualization of the tissue planes, most precise and careful pocket creation in the submuscular plane, least likelihood of damaging the sensory nerve to your nipples, and the lowest likelihood for developing capsular contracture. Other incisions are possible but with additional trade-offs. Every surgeon has their own preferences based on training, experience, or habit.Silicone gel implants (the latest generation of cohesive implants by all 3 USA implant manufacturers) do NOT require periodic MRIs to look for leak (they are solid and cohesive and CANNOT leak), are softest and most homogeneous with your own breast tissue, have been exhaustively studied and do NOT cause breast cancer or autoimmune illness of ANY kind, and will likely last longer than you will (though implants are man-made and we're not supposed to say that. I happen to think that you will likely require or request revisionary surgery more likely for ANY other reason (size change, position change, or to deal with other rare occurrences such as capsular contracture, symmastia, or ptosis after breast-feeding) rather than for leak, rupture, or manufacturer defect!SInce the above list of rare things is relatively long, the key here is not saline vs silicone (though I do feel silicone are much better, especially in a young woman who will have them for a lifetime--salines show ripples, leak, and feel less natural), but rather WHO puts them in, where (below muscle for reasons discussed above and others) and how skillfully the surgery is performed.Implants alone will give you the increased fullness that you desire, and will better "fill" your slightly-moderately "loose" skin brassiere for which you apparently feel you want a lift. Implants do NOT lift breasts. However, increasing the volume of your breasts will give the appearance of more mass below the nipple line, which is why some patients (and surgeons) will say implants can provide a "lift." Not really, but if the breasts look better, more full, and similar-to-lifted "look" with implants, why not avoid the additional scars (visible nude) and cost (probably on the order of an additional $3000-5500)? Scars and dollars--there are a couple of major CONS.So why ask for a lift if you don't need one? I hope you aren't thinking you like the "Baywatch coconut" high round sharply circular look on top. Because if you do, that's fine, but that "look" is commonly associated with implants above the muscle and capsular contracture. You may like the look, but you would HATE how hard and tight they feel. Patients feel so self-conscious they won't even hug someone with those croquet balls in their chest. So, I would suggest submuscular silicone gel implants for the soft natural look and the least chance of capsular contracture, and a nice push-up bra or swim top when you want that look. But with soft, pretty breasts when nude, hugging, or being intimate. Sure, you know friends with saline that feel and look great, but the odds are more favorable with silicone, below the muscle, especially for the long term.As for fat grafting, this is neither "natural" nor recommended, especially in a young woman who wants to breast feed some day, and will presumably want to be able to have good breast exams without hard nodules of dead fat, scar tissue, and irregularities, and mammograms that don't have the microcalcifications that are caused when fat grafts die (50% of fat grafts survive in good surgeons' hands, but that means 50% die!) Surgeons who tell you that 100% of their grafts survive are lying. That's a bold but quite true statement. Don't take my word for it--look it up. Remember, even with a negative maternal family history for breast cancer, you have a 1 in 8 or 9 chance of developing breast cancer in your lifetime. So, if you're my wife or my daughter, no fat grafts in your breasts! The same advice I give to my patients.I've just given you lots to think about, Please click on the web reference link below for more information and carefully consider that you may actually be asking for the wrong things. Best wishes! Dr. Tholen
