Thank you for asking about your mommy make-over.
- Thank you for explaining your anxiety.
- Even for someone your height, a 700 cc implant is a big, heavy implant and is likely to cause all the problems of large breasts - including sagging.
- Nor do I think it will look pretty -
- I suggest you have the lift and later or at the same time, a smaller implant.
- Your breasts look as though you need a lift and after major weight loss, a lift is almost always needed.
- If your surgeon won't do a lift and insists on 700 cc implants, get smart and get a second opinion before surgery.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS
I think this is a bad plan. You are going to accentuate what you don't like about your breasts. Lift after implant is just as risky as lift/implant together. You should be having a lift as the first procedure and then an implant later if you want one.A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.
The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.
Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.
Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.
See the below link on some suggestions on finding the most qualified Plastic Surgeon for a consult.
Thank you for sharing your photos and questions. Based only on your photos and no physical exam, I would recommend having a breast lift. 700 cc implants are very large, but that will not keep your breasts from falling off the implants, giving a Snoopy nose affect. This is because when implants are placed beneath the muscle, and your breast tissue is very lax, the implants sit higher than your breast tissue. Nipple placement should be even with the crease where the breast meets the chest wall from underneath the breast. It is hard to determine without a physical exam and the pictures are helpful, but the angles are a bit misleading.With that said, there is nothing wrong with doing the breast lift after you have healed from the augmentation. Six to twelve months after, your surgeon should be able to gauge the type of breast lift that can be done. But I expect you will need some type of lift.Good luck!
Anxiety prior to surgery is very normal; its complete elimination is usually not possible. Assuming you have chosen your plastic surgeon carefully, other important "variables" such as anesthesia provider and surgery facility will be selected based on everyone's first priority: safety. This careful selection should give you some peace of mind that you will be safe around the time of surgery.
Discuss your specific areas of concerns with your plastic surgeon who will be in the best position to help you calm your nerves.
I ask my patients to try to be as calm as possible prior to surgery; this “calmness" tends to translate to a smoother postoperative course. You may be able to alleviate some pre operative anxiety with music, exercise, meditation, a glass of wine (if ok with your surgeon), and positive/objective focus on the long term outcome/benefits etc. prior to your procedure.
I, like many other respondents here, would not proceed with the breast surgery as you have planned; the breast lifting procedure is the primary procedure that will help you achieve aesthetic outcome that you will be pleased with long-term. Be careful with your decision-making regarding the type of operation and size of breast implants utilized…
I hope this, and the attached link, helps.
In my opinion, the plan you have outlined - is a bad idea... You present with sagging breasts- the treatment of which is -- an anchor lift-- not a breast augmentation alone especially with such large implants as you have mentioned. I would never put implants alone in the case like this without a lift operation.
Some apprehension before major surgeries normal. Most patients can deal with it but if your symptoms seem extreme your surgeon may want to prescribe a mild sedative
Congrats on your upcoming MM. If you are satisfied having a larger droopy version of what you already have, proceed with the large implant. If you desire a rounder, higher breast mound, a lift and smaller implant would be preferable. The Lap band procedure accomplished rapid weight reduction, however the speed at which you lost weight has undoubtedly weakened the "carrying capacity" of your breast skin brassiere. Review some of the Realself galleries to identify examples of your desired outcomes and back track the details of the implants used.
Your instinct to be nervous about your current surgical plan is appropriate. I agree with the other surgeons on the forum- the plan for your breasts is not ideal. If your priority is to have nicely shaped, youthful breasts, the lift is the most important component of the surgery. You would need at least a vertical (lollipop scar) lift and possibly an anchor scar lift. As far as adding volume, I often would recommend upper breast fat grafting in weight loss patients to avoid excess implant weight and strain on the skin. Alternatively, a moderate sized implant (with possible internal reinforcement with a material like Strattice) could be used to enhance your upper pole fullness and shape without undue risk for early re-drooping. There shouldn't be an issue doing an augmentation mastopexy in one stage if it is performed by an experienced plastic surgeon. If you go with the current plan and add 700cc implants without a lift, you will have large, droopy and distorted breasts and will likely have a lot of additional stretch damage of the tissues from the implant weight. I would strongly suggest you get a second opinion before proceeding with surgery. Good luck!
I would for sure recommend that you get a breast lift added to your mommy makeover. If you don't, then the weight of the implant will make your breast even more saggy and heavy. I also agree that a 700cc implant is very large. Sometimes a large implant cannot be added at the same time as a lift due to the tightness and would need to be done as a second stage surgery surgery. I would make sure you are visiting a board certified plastic surgeon and possibly go for a second opinion.