Breast 4 kids and weight loss. Do I need a lift? (Photos)

Hi, Thank you for your inquiry! We here at Mays Plastic surgery would love to sit down for a consult to discuss your concerns. With breast laxity you have options. A breast lift, and adding volume, whether its fat transfer to your breasts or implants. Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

Dear Compassionate93747,

determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thanks for your question! I don't think you will need a lift depending on your goals. I would suggest an in-person consultation for a true evaluation. Good luck!

This is Dr Özge Ergün
Thank you for sharing your photos
You presents with an anatomically favorable post-gravid breast contour, specifically following four prior parturitions.
• Clinical Assessment: We observe minimal parenchymal ptosis and a favorable orientation of the Nipple-Areola Complex (NAC), which remains in a functionally and aesthetically acceptable anterior projection.
• Indication: The primary aesthetic deficit is volume depletion, which is secondary to glandular atrophy, and this can be effectively addressed with alloplastic augmentation (implants).
• Surgical Plan and Prognosis: These positive pre-operative findings are a strong indicator that a satisfactory aesthetic result can be achieved with isolated breast augmentation, precluding the necessity for a concurrent mastopexy (breast lift).
• Implant Pocket Recommendation: Placing the implant in the subfascial plane is recommended to optimize the overall contour, ensure adequate soft tissue coverage, and potentially mitigate the risk of post-operative animation deformity compared to alternative placements.
You are therefore considered an excellent candidate for a straightforward augmentation procedure with a high probability of achieving a successful, highly satisfying outcome.

Thank you so much for sharing your photos, that really helps in understanding your goals and current anatomy. From what you’ve described and shown, it looks like most of your volume loss is from the upper portion of the breast, with some skin laxity after weight loss and breastfeeding.
In many cases like yours, implants alone can restore beautiful fullness if the nipples are still positioned near or above the breast crease. However, if there’s moderate sagging or the nipples point downward, adding a breast lift (mastopexy) together with the implants usually provides the most natural, youthful contour, lifting the breast and restoring fullness at the same time.
The best option really depends on your skin elasticity, nipple position, and how much lift you’d like to see. A detailed in-person consultation allows us to take precise measurements and discuss how to achieve the most balanced, long-lasting result while keeping your goals and proportions in mind.
Warm regards,Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon

From your photographs, it seems you may not need a lift to get a nice result from breast augmentation. A lot of the decision depends on a good examination and understanding the patient expectations. You may consider a consultation with a board certified plastic surgeon who specializes in breast surgery to discuss your expectations and even start thinking about implant sizes.

Question:
Do I need a breast lift, or can I get by with implants only?
Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery – Frisco, TX:
Thanks for your question and for providing photos. Based on the visible moderate skin laxity and your current nipple position, it’s likely that a breast lift (mastopexy) will offer you the most natural, lifted, and youthful result, but let’s explore why.
⸻

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.
Based on your photos alone, it is difficult to offer any real advice regarding the need for a lift. Your degree of ptosis/sagging is not significant so you likely represent a borderline candidate. This decision is best reserved for an in-person consultation and exam.
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.

Do I need a breast lift? You might not need one. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Compasionate93747,
The best way to answer this question is to understand the difference between a lift and an augmentation. A breast lift, or mastopexy, will elevate the height of your nipple and tighten your skin envelope. A breast augmentation with an implant (or fat) will add volume to your breast. In some situations, an implant will add enough volume to fill in the lose skin and raise the nipple. In other situations, an implant will be combined with a breast lift for the desired result. Some patients want a breast lift alone because they want perkier breasts without any additional volume added. Best to have a consultation with a plastic surgeon to understand the results of these options and see what meets your goals the best!
Dr Stein