Do large implants still look natural? Do I need a lift? Which lift? If I go submuscular does it matter silicone or saline? (phot

I am 29, 5'4 145lbs. I loved my breast from 18-22, not anymore. I feel my breast are sagging now and I wish to fix my inverted nipples. My chest looks great only when I am in a push up bra. I want to achieve a more appealing look without the bra. I think I only want submuscular position because I have not yet had children. I am in school pursuing a career in law and I don't want to look like a "bimbo" for lack of a better word. I want a round and full look. I'd like a DD if it would fit my body.

Doctor Answers 7

Do large implants still look natural? Do I need a lift? Which lift?

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Thank you for the question and pictures. Yes, based on your photographs and description, I think you will benefit from breast lifting; a vertical or "anchor" breast lift will likely be necessary.  In my practice, I would likely recommend the use of silicone gel breast implants placed in the sub muscular (dual plane) position.


 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.

Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with will a significantly higher risk of complications and need for additional surgery.  Again, it will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery.

 Remember, that during breast lifting surgery, some skin is removed, thereby limiting the "space" available for breast implants. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “round and full look” or "DD cup" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Breast augmentation and lift candidate, some advices:

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Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 350ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 367 reviews


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If you would like a DD cup size, then you do not need a lift.  However, a more conservative breast size with a lift is a better option for you.  

Breast lift with implant

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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 wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size 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.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 173 reviews

Do large implants still look natural? Do I need a lift? Which lift? If I go submuscular does it matter silicone or saline?

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Thank you for your question.  Based on your photo a combination breast lift with a vertical component and implants may well be her best option.  Her most important decision is the choice of an excellent experienced board certified plastic surgeon.

Implant size is based on a measurement of the base width of your breast..  You can try the Rice test in the privacy of your own home which is described in the link below:

Your plastic surgeon should offer you sizing during which various sized implants are placed into a non-padded bra.  This will allow you to get a better understanding of what a too large implant would look like.

Looks like

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you will need a lift and an implant to achieve your desired goals. The size and "look" is ultimately chosen by you and your surgeon, you can have a tasteful DD IF that will fit your body type and look "natural" for you. Size and shape depends on goals and your chest dimensions. Without an in person physical exam it is impossible to tell what type of lift you will need, likely a lollipop will get the job done, BUT if your nipples are still in a reasonable position you MAY be able to get away with augmentation alone, appears from pictures you will need the lift, but only a in person physical exam will be able to answer this question. You should see 2-3 surgeons qualified and capable of performing your surgery prior to signing up with anyone for surgery. 

Breast lift / aug.

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by looking at your story and photos, I can tell you that you would look great with a breast lift and augmentation. The only breast lift that will give you the look you want is a vertical or lollipop incision breast lift. It can be done with a sub muscular augmentation. To acquire a D or DD, you will need volume and projection. A mentor gel ultra high implant will give you what you are looking for but proper measurements must be done first to determine which size. A proper consultation is needed. Thank you. 

Luis A. Vinas, MD
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 30 reviews

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.