Plastic surgeon says I don't need a lift... but I'm not sure. (photos)

Hello,Thank you for your question and for posting a photo. One rule of thumb when determining which plastic surgeon will perform you procedure is to make sure all your questions are answered. If you are unsure, I would recommend asking the plastic surgeon with whom you initially consulted. Secondly, I encourage patients to narrow their potential list down to 2 or 3. Lastly, I would schedule consultations and choose a board certified plastic surgeon that is aligned with your desired outcome.When making the decision to have breast surgery, understanding the difference between a Breast Lift (Mastopexy) and Breast Augmentation is paramount. A Breast Lift can improve the elasticity of your skin and for many women improves the upper portion of their breasts while not addressing the overall size and fullness. A Breast Lift with Implants is essentially 2 procedures in one. First it lifts the breasts back to their original position addressing droopiness and elasticity. The breast implants work to achieve a perkier, fuller, more voluminous breast size by one or more sizes. A Breast Augmentation can aid in increasing the size and volume of your breasts. This surgery does not address issues related to sagging or loose skin that is common in women who have lost a lot of weight, had children, breast fed or simply a matter of getting older and gravity starting to kick in.The best thing you can do is to examine your plastic surgeon's before and after photos with a critical eye. I encourage patients to bring in photos of the results they desire. You need to know where you are at to know where you are going. I wish you the best on your journey and hope you find answers on this big step in self-improvement.Sincerely, Jeffrey Sweat, M.D.Board Certified Plastic Surgeon in Sacramento, California

Determining whether a lift is necessary is an important part of the examination. There are several factors that determine whether a breast lift is needed, breast skin elasticity, breast deflation, breast measurements such as the nipple to fold distance as well as the nipple position. Without knowing your specific measurements its not reasonable to say definitively. With patients who have good nipple position the decision as to whether a lift is needed can also depend on the size and shape of the implant chosen. The most reliable opinion you will receive is from an in person examination. I would recommend a second opinion if you have doubts. 

Best wishes,
Dr. Jan

Thank you for your question and photos.  An in person consultation with a board certified plastic surgeon is necessary to fully examine your breasts, discuss your aesthetic goals, and explore all surgical options. That being said, based on just the photos submitted, you appear to have volume loss and some degree of skin laxity therefore an implant alone may not give you the desired result. If your skin is lax there is only so much an implant can do in which case a mastopexy will be required. You can always opt to have the augmentation done first and stage the mastopexy at a later time; although the downside would be two surgeries and thus two recovery periods. Hope this helps!

Thank you for your question and photo.  A lift does a couple of things:  it lifts the nipple up if it's too low, but it also tightens the skin envelope around the implant and the breast if it is too loose.  In your case, depending on the implant size you choose, a lift may be necessary to tighten the skin to give the breast a nice shape.  

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a breast lift.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thanks for your question and for sharing your photos. Given the position of your breast I think you would benefit from a lift in addition to implant even though your nipple position is good. It depends on the look you are hoping to achieve, however. The problem with placing an implant alone is that the surgeon may be inclined to choose a larger implant to fill the loose skin and this may not be your best choice in the long run. A more moderate implant above the muscle could work but you will not get any degree of upper pole fullness with this approach and the breast may end up sagging even more over time due to lack of skin elasticity. 

If you are unsure about the advice you have received, it may be helpful to seek a second consultation or second opinion to clarify what you are looking for and what your options are. Best of luck!

I would agree with Dr. Squires in that you can probably get by with just an implant but the results may look like you just "got by".  From the picture you provided, you appear to have very loose skin to your breasts and so a lift may be necessary to tighten this skin.  Given how loose your skin appears to be, I would also not use a large implant because this will simply accelerate the stretching of your skin and decrease your overall result. I hope that helps and wish you the very best.  My suggestion would be to get a few consults from Board Certified Plastic Surgeons who specialize in breast enhancement surgery and go from there.I included a link to my page on breast lifts to give you even more information to help you decide.  

Thank you for your question and photos. It looks like a lift will be required in addition to placement of breast implants. I do not think you will achieve a satisfactory result with either augmentation or a lift alone. It is best to have an in-person consultation with a board certified plastic surgeon who specializes in cosmetic breast surgery. Ask to see a lot of before and after photos of their work. Hope this helps and good luck!

HI Mindy,I think that you will need some procedure to tighten up the loose skin beneath the nipple -areola complex unless you want to be a very large size. Your nipples maybe the correct position, but your skin  is not. If you want VERY large breasts, the implants will tighten everything. If not, the skin will be loose.Also, you may look tight in the first few months without a lift, but later, the loose skin that you have will start to descend. I think that you will need some sort of tightening of the skin, and perhaps you should discuss this further with your PS.Best,Dr. Christine Rodgers

Hi MindyB,

Determining whether you need simply a breast implant versus a breast lift or both 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 breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

Also, breast implant selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery