What's Best for Me - Augmentation (Overs or Unders) or Lift with Augmentation? (photo)

I have already seen about 4 surgeons and they gave me different answers, i am so confused now, i just want everything to go smooth and get long term results.Would love to get DD. I am 34 years old, had 2 pregnancies and my breasts went to F-G size with a first one. I measure 32B/C now but they are deflated and empty. My sternal notch to nipples is 23 and 24mm. Also i have a very thin skin, i get cuts and bruises easily. I wear 6-8 size tops. Please could you tell me what would be best for me!

Doctor Answers 8

Options for deflated breasts

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Using a larger implant could fill out the breast without the need for a lift, but your breasts may end up hanging a little lower. Generally the larger the implant, the faster your breast will sag.
It would be best to see a surgeon in person to discuss what size implants are best for your chest measurements and existing breast tissue/skin thickness. He or she could help you decide what size implant and if a lift would help you achieve your goals. Don't be afraid to get more than one opinion.

Jupiter Plastic Surgeon
4.9 out of 5 stars 41 reviews

Breast Augmentation and Lift Options

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You have gotten different answers because there are different approaches, and each approach has its own set of consequences.  The best way to get firm advice is by scheduling an in-office consultation.  Having said that, implants alone will give you all the fullness and shape that you want; however, your skin looks like it is prone to stretch. If you go to the DD range, you should expect more stretching over time. At some point, you may then want to consider a breast lift. Your other main alternative would be to go ahead with a smaller implant and perhaps a vertical breast lift. The negative aspect of this method is inevitable scarring, but the lift will help you raise the breast tissue a bit on your chest.  Good luck!

James N. Romanelli, MD, FACS
Long Island Plastic Surgeon
4.4 out of 5 stars 25 reviews

What's Best for Me - Augmentation (Overs or Unders) or Lift with Augmentation?

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Thanks for the questions and posted photos. But over the internet is NOT the correct forum to give specific treatment choices. Best to seek in person evaluations from boarded PSs in your city. Ask if the doc has the logo "the circle" of the ASPS! 


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There is no one answer to your question.  A lot depends on what type of look you are trying to acheive.  It appears you have a long thorax with low lying breasts.  If you want a more perky and higher positioned breast then a lift with implants is the right approach.  If you would be happy with larger, fuller lower positioned more hanging breasts then an augmentation alone would be appropriate.  You need to discuss your desires with your plastic surgeon.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Over/Under with or without lift

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Placing an implant on top of the muscle may accelerate breast sag and can even lead to a rock in a sock look. As your nipples look to be above the breast fold, your best bet would be to get an augmentation via an extended dual plane approach without a lift. Hope this helps! Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon

Lift or augmentation

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Hello. Judging by your pictures, your nipples are not below your inframammary fold meaning you do not need a lift. That being said you may still consider a mastopexy if you want youthful perky breasts. As far as long term results a mastopexy would most likely look better longer if you are ok with the scars.
Jaime Perez, MD
Breast Augmentation Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

BA+Lift vs Ba with anatomical shaped implants

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Thank you for your interesting question.

I think your breast cannot be improved "only" with a breast augmentation with round implants. Yo would have a better appearance if a mastopexy/breast lift would be associated. As you state in your question ("...I want a long term results...") the final result without a lift would be poor in 2-3 years time.

If you don't want to add mastopexy scars to your breast augmentation, the best and more suitable option is to perform a BA using ANATOMICAL SHAPED IMPLANTS (f.e. Style 410 -Natrelle, Allergan- or CPG -Mentor-). Another nice option are the STYLE 510 implants -Natrelle, Allergan-.

Anatomical implants have been approved by FDA recently. We use them in EU since 1999, and I think we obtain nice results in BA, speacilly in those were the nipple-areola complex is slighty 'dropped' but not definitely descended (near or below the IMF).

Enrique Etxeberria, MD
Spain Plastic Surgeon

What's Best for Me?

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Most surgeons in the US prefer subpectoral placement of implants for most patients. That is particularly true for patients either starting out on the small size, and for those getting enlargements of over a cup size.l

As to the lift,  a useful recommendation depends a lot on your goals. Although the nipple/areolar position looks ok on the photos when evaluated in terms of the  relationship to the breast fold, the whole breast looks a bit low on your chest. This may appear more noticeable with a larger breast. (When you were pregnant and a size F-G did the nipples appear too low?)

Based upon the low set breasts, a lift might be useful. But all depends upon your goal. The tradeoff is more scar,and more chance of needing a touch up procedure. 

Thanks for your question. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.