This is a very common question for patients in your situation. While the implant will serve to fill some of the volume you have lost over time, it will not lift the breast or the nipple. You certainly have some degree of ptosis (droop) to the breast that could be helped with a lift (mastopexy). The answer to your question really comes in answer to your expectations.
Is your main concern to fill the volume lost in your breast so that you feel more full an natural in clothes? If so, then you may be well served with just an implant. But just know that an implant without a lift will not give you back the breasts you had in youth in that perfect position without bras or clothing. To get back to that point, you would need a lift in addition to the augmentation. This will require additional surgery and additional scars that you have to be willing to trade for the added benefit.
Also, keep in mind that if you just have the implants placed now and are unhappy with the results, then you can always have a lift procedure performed at a later time. These procedures are often done in two stages anyway by some surgeons as they feel it is safer. This will give you the chance to see if you are happy with your results from implants alone.
Discuss your concerns with your surgeon. It is only through a discussion with him or her about your expectations and goals that you can make the decision that is right for you.
Best of luck!
This is the most common question I get in my office and the answer is simple. It depends on you. I divide the patients into 3 categories.
1. Patient who only need implants. For these patients, the easiest way to determine what they want is based on a "wish pic." Try to find a picture of someone who has a similar body to you beforehand. Discussions about cup size or how natural or unnatural rarely help. I even had a patient tell me she wants completely natural breast in the C cup range just like Pamela Anderson.
2. Patients who can have a lift or just an implant. I have found 50% want the former and 50% want the latter. Their nipples may sit at or just above the inframammary fold. For the ones that want a lift, they usually specifically say they want their nipples to be higher and the whole breast to sit higher on their chests. For the one who only want an implant, they usually don't care about the nipple position and prefer to have large implants without the extra scars from a lift. These patients may be little saggy but their wish pictures are also someone who is a little saggy and they like the "natural" appearance of tear-dropped shaped breasts.
3. Patients who need a lift. Their nipples may be below the inframammary fold or pointing down. Usually these patients also need an implant.
Here Are My Concerns for the Future
present an excellent question. I agree with your surgeon that you are
borderline in terms of an absolute need for a breast lift, and there is some
degree of uncertainty based on the elasticity of your tissues. You will be
relatively large with the amount of breast tissue that you currently have and a
400 cc implant, and I would be concerned that even if you are happy now, that
in 10 years you may feel that your breasts make you look heavy. I would tend to
recommend a somewhat smaller implant with a breast lift. I would not be
concerned about a double bubble, but you will have a better shape with a breast
lift. Good luck with your decision!
Based on these photos alone, you do not need a lift. A properly planned and executed sub pectoral (sub muscular) breast augmentation should give you the ideal final beautiful result without the "dreaded double-bubble effect". At 3 to 6 months post op, a Benelli (circumareolar) mastopexy (lift) could be easily added if necessary. I seriously doubt it will be necessary.
The "need" for a lift is determined by where the nipple sits in relation to the inframammary crease behind it when you are upright with arms down. If it is more than 2 cm below the level of the crease behind it then it is not feasible or reasonable to get an implant alone to be properly positioned behind the nipple-areola/breast. 2 cm or less and an implant will give the illusion of a lift but does not actually raise the nipple position (or breast) up in relation to the chest wall behind it. Also, you might not need a lift now but your breast can continue to sag as time goes on. Some feel this is because of overly large and heavy implants (400 cc is considered borderline large) but in my experience breasts sag because they're going to sag, not from the implant (or bra).
Proper sizing of implants is not by cc's but by the width of the implant in relation to the width of the breast and a choice of forward profiles that correspond to roughly increasing the apparent breast size by 1-2 cup sizes. The number of cc's is looked up with the properly sized and chosen implant. As in dress or shoe sizes you don't choose a number and work backwards, you get measured and know what size will fit you (or what effect it will have in the case of an implant).
Lift or not? Am I making the right choice?
I give patients in my practice the option of a lift or an augmentation if they are in the borderline area. An augmentation will fill out the skin and add upper fullness. The lift will reshape the breast and raise the position of the nipple and reduce the diameter of the areola. This gives a more complete rejuvenation of the breast however it comes at a higher cost and also more scarring on the breast. Most breast lifts are performed using a lollipop type of procedure. Having said that, you haven't ruled out the possibility of a breastlift in the future if you are not happy with the results of the augmentation alone. There are quite a few plastic surgeons who do not perform a one stage augmentation/mastopexy.
Consult with your plastic surgeon again and tell him your concerns. One thing I would recommend against is to have larger implants than you want to "avoid" the lift.
Best of luck.
Lift or not? Am I making the right choice? (Photo)
Based only on the question and posted photos I believe you would be a good candidate for a 'composite augmentation' - implants + fat grafts to even out the volume and shape.
Based on your photos, you may be satisfied with an augmentation alone, but you will certainly look more youthful with a lift. You can always do only the augmentation first, and see if your happy with that shape and nipple position. Good luck with your procedure!
From your photos, you would probably benefit from some type of breast lift (donut, lollipop or anchor). Although, you don't have to have the lift, I believe you will be happier with the shape if you do have at least a donut type of lift. Check back with your surgeon. You could consider having the augmentation alone, and if not satisfied, a donut lift could be done as a secondary procedure, possibly under local anesthesia. Best wishes, Dr Lepore.
A breast lift would give a more youthful shape to the breast and address the excess skin you have. A breast augmentation alone would only address the volume loss. If you are happy with your current shape then you can do the augmentation alone. Please seek an in person consultation with a board certified in your area to come up with the best treatment plan. Good luck, Dean Vistnes.