Would I require smaller or larger implants along with a full lift? (photos)

My areolas have stretched from a previous donut mastopexy. I have sagging due to having slight tuberous breast before benelli lift, then breastfeeding two children. I am so unhappy with how my breasts look. I would like more fullness and a much smaller Areola. What is needed to achieve this? Can I reduce my Areola enough without causing necrosis? I feel like I have a lot of skin to remove. I also have implants that I believe are around 300cc. To me it looks like I don't even have implants in there at all!

Doctor Answers 19

Larger or Smaller Implants With a Lift?

Unfortunately for you, this the typical sort of unsatisfactory result that occurs with an inappropriately used Donut mastopexy with an implant. Your areolar size can be reduced, but you will need at least a vertical if not a full anchor type lift. I am not sure what you mean by more fullness but am guessing that you would like to more fullness primarily in the upper part of your breast. This could be achieved by modifying the implant pocket so that your implant sits higher on your chest wall. It would be difficult to move to a larger implant size while at the same time doing a significant breast lift because the two procedures would tend to work against one another. Staying with a similar sized implant and moving it upwards along with a full lift would give you a result with more upper fullness and better breast shape even if your breast overall is slightly smaller. 

Larger or Smaller Implants With a Lift?

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Unfortunately for you, this the typical sort of unsatisfactory result that occurs with an inappropriately used Donut mastopexy with an implant. Your areolar size can be reduced, but you will need at least a vertical if not a full anchor type lift. I am not sure what you mean by more fullness but am guessing that you would like to more fullness primarily in the upper part of your breast. This could be achieved by modifying the implant pocket so that your implant sits higher on your chest wall. It would be difficult to move to a larger implant size while at the same time doing a significant breast lift because the two procedures would tend to work against one another. Staying with a similar sized implant and moving it upwards along with a full lift would give you a result with more upper fullness and better breast shape even if your breast overall is slightly smaller. 

Would I require smaller or larger implants along with a full lift?

I am sorry that you are in this difficult situation. Areolar enlargement is a fairly common outcome of the Benelli Lift, despite multiple procedural modifications designed to minimize this problem. You do now have a "Snoopy Breast deformity". What that means is that your native breast tissue has drooped off of the underlying breast implant, resulting in a double breast appearance. Correction of these problems will mandate a keyhole pattern type of mastopexy in order to achieve the best breast shape and appearance. Good luck!

Steven M. Gitt, MD, FACS (in memoriam)
Phoenix Plastic Surgeon
4.8 out of 5 stars 36 reviews

Would I require smaller or larger implants along with a full lift?

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I am sorry that you are in this difficult situation. Areolar enlargement is a fairly common outcome of the Benelli Lift, despite multiple procedural modifications designed to minimize this problem. You do now have a "Snoopy Breast deformity". What that means is that your native breast tissue has drooped off of the underlying breast implant, resulting in a double breast appearance. Correction of these problems will mandate a keyhole pattern type of mastopexy in order to achieve the best breast shape and appearance. Good luck!

Breast Augmentation and Mastopexy (lift): Information

Dear Ms. Shaki8752,

Thank you for your, photos, story and questions.

Nothing substitutes for a personal evaluation and a face to face discussion of your options.

Unfortunately without a examination I can advise you in general terms, however I hope you will find them helpful.

My responses are the following:
I. SIZE: 
1)size of breasts is a personal choice.
2)using the formula 1oz. = 30cc ....take 8 and 1/3 oz of rice = 250 cc or
10 oz. = 300 cc and place in a nylon stocking to create your own "sizers". Then place in a full bodied non padded bra and try on some form fitting clothes.
Caveat: The bigger you go the faster you will potentially again sag.

II. SHAPE
1)the reason your breast hang/sag is that your current "skin bra"
is larger than your breast tissue.
2)there are three main types of breast lifting procedures which will reduce your nipple areolar complex into proportion with your breasts:
a) periareolar (doughnut scar)
b)vertical (lollipop scar) a combination of both a & b
c)inverted t (anchor scar) a combination of a,b & c
Based on the limited photos of you most likely will need option 2-c (the anchor scar mastopexy) to achieve the upper pole fullness you desire.
3)implant selection/profile of implant:
a)for the same volume the higher the profile the narrower the base width.
and thus the rounder the implant with the higher projection.
b)there are slight difference in projection between a moderate to high profile implant. However the ultra high profile breast implant is definitely the "roundest"
implant available.
c)ideally the base width of the breast should equal the base width of the implant. Would need your breast width measurements to pick the best implant, thus I personally chose the profile based on the patients chest measurements (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outer chest/arm area)
d) on occasion to achieve the "round look" I will select a normal saline filled breast implant and overfill to achieve a more rounder appearance. However, the breasts may feel more firm.

III. CLEAVAGE
Is mostly determined by your anatomy.
It can be improved by:
1) with accurate placement of the implants, if aggressive surgery to increase cleavage a condition called Synmastia could occur (uni breast or breast loaf deformity)
2) post operative massage.

MODEL PHOTOS
Select several nude photos of your ideal breasts and bring with you to your appointments.
I advise you make several consultative appointments with several experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally member s of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes and success,


R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Breast Augmentation and Mastopexy (lift): Information

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dear Ms. Shaki8752,

Thank you for your, photos, story and questions.

Nothing substitutes for a personal evaluation and a face to face discussion of your options.

Unfortunately without a examination I can advise you in general terms, however I hope you will find them helpful.

My responses are the following:
I. SIZE: 
1)size of breasts is a personal choice.
2)using the formula 1oz. = 30cc ....take 8 and 1/3 oz of rice = 250 cc or
10 oz. = 300 cc and place in a nylon stocking to create your own "sizers". Then place in a full bodied non padded bra and try on some form fitting clothes.
Caveat: The bigger you go the faster you will potentially again sag.

II. SHAPE
1)the reason your breast hang/sag is that your current "skin bra"
is larger than your breast tissue.
2)there are three main types of breast lifting procedures which will reduce your nipple areolar complex into proportion with your breasts:
a) periareolar (doughnut scar)
b)vertical (lollipop scar) a combination of both a & b
c)inverted t (anchor scar) a combination of a,b & c
Based on the limited photos of you most likely will need option 2-c (the anchor scar mastopexy) to achieve the upper pole fullness you desire.
3)implant selection/profile of implant:
a)for the same volume the higher the profile the narrower the base width.
and thus the rounder the implant with the higher projection.
b)there are slight difference in projection between a moderate to high profile implant. However the ultra high profile breast implant is definitely the "roundest"
implant available.
c)ideally the base width of the breast should equal the base width of the implant. Would need your breast width measurements to pick the best implant, thus I personally chose the profile based on the patients chest measurements (a high profile on a wide chest may not result in the cleavage desired and conversely a low profile on a narrow chest may result in implant in the outer chest/arm area)
d) on occasion to achieve the "round look" I will select a normal saline filled breast implant and overfill to achieve a more rounder appearance. However, the breasts may feel more firm.

III. CLEAVAGE
Is mostly determined by your anatomy.
It can be improved by:
1) with accurate placement of the implants, if aggressive surgery to increase cleavage a condition called Synmastia could occur (uni breast or breast loaf deformity)
2) post operative massage.

MODEL PHOTOS
Select several nude photos of your ideal breasts and bring with you to your appointments.
I advise you make several consultative appointments with several experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally member s of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

My best wishes and success,


R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Unsatisfactory breast lift/augmentation

The mastopexy procedure performed depends on the patient's goals, tolerance for incision, skin quality, and desired size. If the reason for your previous mastopexy is to avoid the vertical and horizontal scar, then the Benelli was likely chosen with the understanding that there would be some compromise of shape and results. If the only complaint now is the wide areola, then the areola can be reduced reliably by using a permanent gortex suture as a pursestring. It will reduce the areola and  cause some mild flattening, but will not cause incresed upper pole fullness. 

Unsatisfactory breast lift/augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The mastopexy procedure performed depends on the patient's goals, tolerance for incision, skin quality, and desired size. If the reason for your previous mastopexy is to avoid the vertical and horizontal scar, then the Benelli was likely chosen with the understanding that there would be some compromise of shape and results. If the only complaint now is the wide areola, then the areola can be reduced reliably by using a permanent gortex suture as a pursestring. It will reduce the areola and  cause some mild flattening, but will not cause incresed upper pole fullness. 

Would I require smaller or larger implants along with a full lift?

Thank you for the question and photos.  Yes, I think you can benefit from revision breast surgery and areola reduction.
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation revision 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.
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 know words such as “natural” or "D 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 revision surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Would I require smaller or larger implants along with a full lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for the question and photos.  Yes, I think you can benefit from revision breast surgery and areola reduction.
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation revision 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.
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 know words such as “natural” or "D 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 revision surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Would I require smaller or larger implants along with a full lift?

Based on your photos I would recommend a breast lift with or without an implant to add volume. You will require a vertical breast lift for optimal outcome. Consult with a board ceritfied plastic surgeon. 

Regards, 

Would I require smaller or larger implants along with a full lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Based on your photos I would recommend a breast lift with or without an implant to add volume. You will require a vertical breast lift for optimal outcome. Consult with a board ceritfied plastic surgeon. 

Regards, 

Would I require smaller or larger implants along with a full lift?

To be able to answer completely I would need to see you for breast measurements and assessment of tissue quality. You can have your areola pigment reduced with no problem at all. If you are looking for breasts that sit higher you certainly may need a full lift but from your pictures it appears that the nipple is in a good enough position to not have a lift. It really just depends on what is found on exam and from listening to you to see what your goals are an if they are achievable or not. 

Would I require smaller or larger implants along with a full lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
To be able to answer completely I would need to see you for breast measurements and assessment of tissue quality. You can have your areola pigment reduced with no problem at all. If you are looking for breasts that sit higher you certainly may need a full lift but from your pictures it appears that the nipple is in a good enough position to not have a lift. It really just depends on what is found on exam and from listening to you to see what your goals are an if they are achievable or not. 

Breast Augmentation - Revision Mastopexy

Thank you for your question.  I'm sorry you are unhappy with your breasts. Your desired result of more fullness and a smaller areola can be achieved with a circumvertical mastopexy and exchange to a larger implant. Please discuss your concerns with a board certified plastic surgeon who specializes in cosmetic breast procedures. Hope this helps and good luck with your surgery

Breast Augmentation - Revision Mastopexy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question.  I'm sorry you are unhappy with your breasts. Your desired result of more fullness and a smaller areola can be achieved with a circumvertical mastopexy and exchange to a larger implant. Please discuss your concerns with a board certified plastic surgeon who specializes in cosmetic breast procedures. Hope this helps and good luck with your surgery

Breast augmentation - revision, but what?

Thank you for asking about your breast lift and augmentation.

  • A vertical mastopexy will give you a lift and a better shape while reducing your areolae.
  • With a better shape, the implant size may not need to be changed.
  • An exam is needed - and discussion of the look you want.
  • Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Breast augmentation - revision, but what?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for asking about your breast lift and augmentation.

  • A vertical mastopexy will give you a lift and a better shape while reducing your areolae.
  • With a better shape, the implant size may not need to be changed.
  • An exam is needed - and discussion of the look you want.
  • Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Example of the often times disappointed patient having had a donut mastopexy.

The areola is large and flat which is predictable with this type of mastopexy. Conversion to a more customary mastopexy will allow for better shape to the breast and a more normal diameter to the areola.

Example of the often times disappointed patient having had a donut mastopexy.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The areola is large and flat which is predictable with this type of mastopexy. Conversion to a more customary mastopexy will allow for better shape to the breast and a more normal diameter to the areola.

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.