Can I get the smallest implants available to achieve perkiness without going up in size so I can keep my B? (photo)

I am 38 (no kids) but age and weight loss (approx 30lb) have left my perky C's saggy B's. I want to either get a lift or implants (or both if needed) but I like my size now because I am sporty so I am leaning towards just a lift. The scarring bothers me so I am wondering is it possible for me to get the smallest implant available in order to maintain my B cup? I don't mind going slightly larger to get the perkiness, but I don't really want to be a C.

Doctor Answers 14

How big should breast implants be?

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the below link.

Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Can I get the smallest implants available to achieve perkiness without going up in size so I can keep my B?

The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue for the first 3 to 4 months! 

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 417 reviews

Dr. Felipe Amaya recommendation

I was looking at your pictures and I agree that you do not need increase the size, but definitely need a lift with small implants must not change in size. This procedure requires scars (in inverted "T"), but eventually become very evident

Felipe Amaya, MD
Colombia Plastic Surgeon
4.6 out of 5 stars 40 reviews

Breast Lift with Implants

Although there is some limitation with photos alone, I would say that you would benefit from breast lift. Adding implants alone (especially smaller ones) will probably not give you the result you're looking for. It's possible you'll get some upper breast fullness and it may appear that the breasts are hanging off the front of the implants.

The two procedures are largely different in their purpose. Implants will increase the breast volume but won't really change the fundamental shape/characteristics of the breasts. A lift, in contrast, does not change the volume but does change the shape. Often a combination of procedures is needed to achieve the desired results.

The best thing you can do is seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon
4.5 out of 5 stars 29 reviews

A breast lift may be beneficial

Thank you for your question!

First, I would like to let you know that if you are planning to have children soon, then a breast lift or breast augmentation may not be recommended as both may interfere with breast-feeding and you may need a touch up after you're finished having children. You might want to wait until after pregnancy until you decide what you want to do with your breasts.

If you are not planning on having children, then I would definitely recommend a breast lift (mastopexy). Based on your photo, you seem to have grade 1-2 ptosis (sagging) and this means that your nipple is near the fold under your breasts (inframammary fold), and your breast tissue is hanging mildly below the breast fold.

An implant-based breast augmentation alone will not be effective. In fact, you will not only have to go with a larger than usual implant, but it will also appear too low on your chest (bottoming out). The weight of the implant will worsen the amount of sagging. You may also have a double bubble deformity where the breast tissue overlying the implant droops below in front of the implant. It may also cause a snoopy deformity (named after the cartoon character snoopy) that happens when the implant is held sitting in a high position by tight pectoral muscles, while the natural breast tissue falls off the implant and hangs below at the bottom curvature of your breast.

You might think that a smaller implant will fix the problem, but it will rather give a “Rock in a sock” appearance due to a near empty upper pole of the breast. This is because of the great amount of skin stretching, excess skin, and breast wasting that exists in sagging breasts.

As such, a breast lift will give you best aesthetic results. If you are already happy with you breast size, then you can just opt for a breast lift.

If, after the breast lift, it turns out that you desire a little bit of increase in breast size (i.e., 1/2-1 cup size) and you would like to make your breasts perkier, then having your breast filled with fat is a viable alternative or you can just get smaller implants. Fat transfer to the breast involves carefully harvesting your own fat using liposuction from areas in which you have excess, unwanted, and stubborn fat deposits such as the outer thighs and abdomen, and injecting it safely back into the breasts which may be lacking in aesthetics or volume. Compared to implants, and other methods, fat transfer is a very safe, long-lasting, and a well-tolerated procedure that produces natural-looking results with low amount of complications. (as long as you're happy with minimal volume increase)  This is because fat is the nature’s choice of filler for your body – a padding. Of course, you did mention you lost weight, so if you don’t have adequate fat stores or if you plan to further lose weight, then going with smaller breast implants may be a better option.
I urge you to have an in-person consultation with a board-certified plastic surgeon to assess your options and risks to make an informed choice.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Breast lift

A breast lift would give a more youthful shape to the breast and address the excess skin you have. A breast augmentation alone would only address the volume loss. You would get a good result with a breast lift alone and can always go back later if you want ever decide to increase breast volume. Please seek an in person consultation with a board certified plastic surgeon in your area. Good luck.

Dean Vistnes.
Vistnes Plastic Surgery
San Francisco Bay Area

#breastaugmentation #breastlift #drdeanvistnes #realself

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 48 reviews

Dr Kayser

Thank you for your question. The two procedures are completely separate and achieve completely different results. Although surgeons often combine the two, it is important to understand that they are different. A breast lift is simply the repositioning of your breasts to a more youthful position. Although some skin is removed, the breast volume itself is unchanged. This is no different then placing your breasts in a bra whereby the cup size remains the same even though the breast is lifted up. This is analogous to simply removing the wrapping paper from a present. The size of the box will stay the same even though the shape may change.An implant does only one thing and that is to add volume. It does not raise the breast, and indeed, in a patient who has drooping, the additional weight and stretch can actually make the breast hang lower. Although an implant may give a slight lift affect to the nipple with regard to pushing the nipple forward, called the swing effect, the overall breast position is unchanged.Your desire for breast lift is a good choice even though it will necessarily place a scar on your breast but adding an implant will necessarily increase your cup size. A final option would be to perform a lift with fat transfer. Fat is the ability of taking millions of small seeds or parcels from one part of the body and filling up areas of the breast which would possibly remain hollow or deficient with a breast lift. Although you are still adding volume, this would be more of a contouring procedure rather than a volume fill type of approach. Unlike an implant, which requires a specific pocket, fat can be placed throughout the muscle and breast tissue to fill areas that an implant would otherwise not be able to reach.In any case, I would recommend a consultation with a board certified plastic surgeon who is experienced with all these types of procedures. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 38 reviews

Lift without implants

Based on these photographs you appear to be an excellent candidate for a breast lift. I would suggest that you will not get the position shape and symmetry that you would like with an implant

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

Breast lift or breast lift with implants both good options depending on your wishes

Hello and thank you for your question.  A breast lift if definitely needed to improve the shape and perkiness of your breasts -- your nipple-areola complex will be placed more in the middle of your breast and have the whole breast moved off your abdomen onto your chest where it looks more attractive.  With respect to an implant, if you desire a "rounder" look but want to be overall the same size, you could ask for a small implant. Otherwise, you could get a lift without implants if you are ok with less upper pole fullness.  You could also get a lift and if you are not happy, have implants placed at a later stage.  I think you will do well no matter which route you choose as long as you go to a board certified plastic surgeon with expertise in aesthetic breast surgery. I hope this helps!


Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
4.8 out of 5 stars 27 reviews

Small Implants vs. a Mastopexy vs. a Mastopexy with an Implant

Hello, and thanks for the question and the photos. Though an in-person exam is always the best, from your pictures I would say that you need a lift whether you use an implant with it or not. The drooping, or "ptosis", you have is not severe, but an implant alone (even if it were larger) would just fill out the upper part of the breast, while the nipple/areola and lower breast tissue would still droop off of the implant to some degree. 
The best option would be a "vertical" lift with a "lollipop" incision that would go around the areola and down the center of the lower 1/2 of the breast. Scar quality can never be guaranteed, but you would not need the longer, "inverted T" type of scar which also exists in the fold underneath the breast. These lifts can be done in such a way that breast tissue is repositioned up higher on the chest wall, giving a fuller, perkier look to the breast. From the looks of the pictures, you have enough natural breast tissue to achieve a nice shape and fullness. Cup size is hard to estimate from pictures, but I would guess that you would be a small to medium B cup.
A small implant is also an option, but would best be done with the same type of lift (the implant would be placed through the lift incision). This would give you a fuller, slightly rounder look. The breasts would obviously be larger than with a lift alone, but it is likely, using a smaller implant, that you could stay in the large B to small C range and not impede workouts and sports.
Hope this helps!

Gregory A. Wiener, MD, FACS
Chicago Plastic Surgeon
4.7 out of 5 stars 78 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.