A lift with implants or only slightly larger, high profile implants to give appearance of a lift? (Photo)

Hi diamond93

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 type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

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

Based on your photos- in my opinion - you're NOT a candidate for breast implants -alone. I would seriously consider a standard breast lift/mastopexy. Whether or not you would benefit from implants as well- should best be discussed and evaluated during your in person evaluation/consultation with an experienced Board Certified PS

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. Your nipple sits below the
inframammary fold and without a lift in addition to the implant, this will not
have a natural shape.  A breast lift with an implant can result in a very
nice shape if good technique is used.  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.   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

This is a very good question, and based on your pictures, I suspect you would need both a breast lift and an implant.  Simply choosing a larger implant will not add much towards lifting your breast but actually could work against you by causing a sagging over time.  I certainly understand your wish to avoid extra scarring associated with a lift.  For this reason, you might consider having the implants placed first, allowing the tissues to settle, and then performing the lift secondarily.  This might allow a lift with a shorter scar, or you might be surprised and feel very happy with the implant alone.  Again, this is a great question and I always like to take the path that will not burn any bridges.

Hello, thanks for your question and provided information with pictures as well.. Implants with high profile will be better for you, they will give you projection and volume, implants doesn't lift the breasts, if you put them without a lift, your breasts will look the same, you need a lift with implants to get the look you're looking for. Good luck!

Thank you for the question and pictures.  
 I think that it is likely that you will benefit from breast lifting as well as breast augmentation surgery.  Based on your photographs, I would be concerned that you will not be pleased with the long-term outcome achieved with breast augmentation surgery only. 
 Generally, I do not suggest that you utilize larger breast implants (than you will feel comparable with physically or psychosocially) in the attempt to avoid the need for breast lifting.   
Of course, breast augmentation/lifting surgery is a more complicated procedure (and more complication prone);  careful selection of plastic surgeon and careful communication of goals will be key.  Furthermore, you will need to carefully consider the trade-offs (such as additional scarring) associated with breast lifting versus the upsides briefly discussed above.
 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals.  Best wishes. 

Based on your photos and extensive experience in these matters, I feel that you would do best with a breast lift and breast implant (a tissue reduction as well). An implant alone will result in larger breasts with a lot more fullness, especially up top but your breasts will sit at the bottom of the implant and won't look attractive when you are naked.

Just based on your photos, you do need a lift to raise your nipple higher. The high profile will not raise it enough. Implants make breasts fuller, but do not lift. If you are happy with the location of your nipples, then just have implants to make them fuller.

If you like the size of your breasts, but they sag - then get a lift!If you want your breast smaller and they sag - then get a breast reduction/lift!If you want bigger breasts and like the shape - then get a breast augmentation!If you want bigger breasts and them lifted - then get a breast lift with augmentation!However,Implants do not lift breasts - they only make them sag over time.Breast lifts don't enlarge breasts, but make them appear larger because the flat sagging breast volume is now shaped into a perky mound of tissue.Patients that get implants with the hope of a lift often end up unhappy and concerned that they are too big and still Saggy!In my practice, I perform many different types of breast reductions. I choose the technique based on the patients desires, anatomy and other issues including skin elasticity and any previous surgeries.

1.     For patients with a sternal notch to nipple distance of less than 25cm's, I will offer the Goes Technique (a circumareolar procedure that reduces and lifts the breasts with an internal brassiere) or the Lejour technique (a lollipop technique that gives the best shape). The Goes technique is durable but not as perky as the Lejour.

2.     For patients with a sternal notch to nipple distance of 25-35 cm's, I will offer one of two Lollipop scar techniques. The Lejour Technique (in my opinion) gives the best shape and durability of all techniques discussed. I can make a significant volume reduction and almost never need to add a transverse incision. The Hall-Findlay Technique is my second choice and I only use it for patients that have previous scars on the upper half of the breast. These scars can limit the blood supply for a Lejour technique, so I choose the Hall-Findlay for these patients. The problem with the Hall-Findlay is that the shape is not as nice or perky as the Lejour, and for the bigger/lower breasts, the scar must be changed to an anchor scar.

3.     For patients with a sternal notch to nipple distance of more than 35 cm's, the only technique I use is the Mckissock technique - an anchor scar technique. While this technique has been around for a long time, it has stood the test of time for the largest breasts. A common criticism of this technique is a boxy result and poor scarring of the transverse scar.

As for arguments from doctor to doctor, you need to compare the different techniques to understand what they are offering you. If they only perform the Hall-Findlay technique they may tell you that you need an anchor scar. While physicians trained and experienced with the Lejour technique will be comfortable offering you a lollipop incision. My advice is to check with the surgeons for the specific technique - not the specific incision. My best advice is to choose the experienced Lejour Surgeon.

If you would like more information, please read my book "Cosmetic Breast Surgery - A Complete Guide From A to Double D" or go to my website to see more on all the different techniques available.

You would get the best result with a full breast lift with breast augmentation. Putting in a large implant to fill things out would just leave you with a larger sagging breast.  Please seek an in person consultation with a board certified plastic surgeon in your area. Be sure to express your goals and expectations to your chosen surgeon. In my practice in the San Francisco Bay Area I have come to the conclusion that the happiest patients are those that have realistic expectation on what a procedure will and won’t do for them. Good luck!
Dean Vistnes, MD. 
Vistnes Plastic Surgery 
San Francisco Bay Area 
#realself #drdeanvistnes #breastlift #breastaugmentation