What are my options? Would implants be enough or is a lift absolutely needed? (Photos)

Question

I have some asymmetry I am trying to correct, but I have gotten several opinions from different surgeons. Left breast has more hang/sag to it, but nipple is in a relatively good place. Not facing downward. Most of my breast tissue is in the lower pole under the nipple though, so I have no upper pole and its deflated. Right side is just smaller and a little deflated. I would say left side is 34B and right side is 34A if that. I want to avoid lift scars, but I want nice results too. I like a natural sag. surgeon A- suggested full lift on both with implants (said its easier to get symmetry when you can adjust both breasts) surgeon B- suggested unilateral lift (anchor) with implants. said a full lift on both is absolutely unnecessary and overkill. surgeon C- first suggested full lift with implants (said the same- its easier to get symmetry when youre able to adjust both breasts-until I reconsulted with him, and I explained I wanted to avoid a lift because of the scars, so he changed the plan and said we can do implants under the muscle dual plane for a bit of a lift, without actually doing a lift, and if i decided later I wanted an actual lift, I could still do that, so i wouldnt be burning any bridges. Those were his words. surgeon D- suggested unilateral lift and implants Would implants alone be enough? What kind of lift do i really need to achieve my goals? First photos are mine, last few are my goals

Gerald Minniti, MD, FACS · Answer

First, if you have at least 1.5 cm of skin pinch width in the upper pole of your breasts, there is no reason not to do subfascial placement of your implants; it would better redistribute the soft tissue of your breasts than a subpectoral pocket. Also, there is no reason not to use Motiva Ergonomix implants; better look and feel, with less rippling and the lowest risk of capsular contracture of any implant. The main discrepancy between your breasts is more glandular ptosis on the one side, which is a function of more vertical skin excess. The simple recipe would be a slightly longer inframammary incision on the affected side, which would allow for removing inframammary skin to correct that vertical excess. There would be no vertical or periareolar scars.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Absolutely surgeon C's second explanation. In my experience, I have had 199 patients with similar breasts who I have performed surgeon C's approach and only 2 patients (1%) later requested a lift. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Donovan Rosas, MD · Answer

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.
With regards to your specific question, the more consults you obtain the more opinions you will obtain. For this reason, I suggest no more than 2-3. If the first 2 disagree, a tie breaker may help decision making. All are reasonable options. I would caution using a lift and augmentation interchangeably. They are different procedures that perform different tasks. 
Based upon your photos, nipple position is preserved. This may obviate the need for a lift.
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.

Gary M. Horndeski, MD · Answer

Your breasts have descended inferiorly and laterally and you have not breast tissue approaching the midline to give cleavage. The minimum you could get by with is a donut mastopexy, which will elevate the breasts slightly more higher and more medially. The other alternative is a lollipop lift, which usually does not produce much of a lift at all and has a vertical scar. Same can be said for the anchor lift but it has more scarring. The breast lift I recommend is the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Michele A. Shermak, MD · Answer

Hello - thank you for your question. I think if you choose a full implant I think you may get some great results without a lift. You do not burn any bridges and can get a lift later, but if that is a possibility I would recommend you undergo an augmentation under the muscle. Your nipple is at or above your crease under your breast so I'm not sure a lift is absolutely necessary.

Shlomo Widder, MD · Answer

Dear Kourtney,
   Thanks for posting your own pictures and your goal pictures. From observing your pictures you appear to be A cup size on the right side with level 1 ptosis  and small A cup size on the left side with level 0 ptosis. Your goal pictures reveal perky breasts and  full C or small D cup size. To achieve your goal, you will require 375 cc or 425 on the right side and 425cc or 475cc on the left side for full C cup size or small D cup size. In order to get the nice perky look as on your goal picture you will benefit from a mini lift (donut, purse string) which will raise your nipple areola complex without the vertical scar of lollipop lift or vertical and sub mammary scar of the full lift (key hole) . The donut scar will be at the natural transition line between the dark areola and light color skin.
    Always consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly check the before and after pictures in the photo gallery to make sure that they are numerous, consistent and attractive with nice cleavage, perky, nice mini lift scar, full upper pole and natural looking.
                Best of luck,
                                 Dr Widder
                       widderplasticsurgery.com

David Shokrian, MD · Answer

Hello, upon reviewing your photos and understanding your asthetic goals for your breasts I believe using motiva implants placed in the subfacial plane will achieve the look you’re hoping to achieve. I don’t think you need a lift on either side as your main issue is deflation of the breasts. I’ve done dozens of implants on similar patients with very positive outcomes. Hope that helps and good luck!

Sameer Karkhanis, MS, DNB · Answer

Hello. I would recommend a hybrid breast augmentation i.e. breast augmentation with implants and fat grafting for better cleavage and upper pole fullness. We routinely do these surgeries at our Centre for Cosmetic Surgery. For any further queries feel free to connect with us. 
Thank you.

Regards,
Dr. Sameer Karkhanis,
Centre for Cosmetic Surgery, Mumbai, India
+919833571333

What are my options? Would implants be enough or is a lift absolutely needed? (Photos)

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