Should I consider a lift after downsizing 100cc's? (photos)

Dear faithgbd,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You have a waterfall deformity where the implants are high and the breast tissue is low. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Well, if you like that your breasts and nipples have a "natural" shape with some sagging, then you do not need to have a lift. Your breasts and nipples will sag a little more after you downsize, but it won't be too much change. The lift requires scars and if you don't want the scars, then don't do the lift. A circumareolar lift may have the effect of flattening the front of your breast, and so you should ask your surgeon about that before you agree to it. Bottom line is that I would not talk you into a lift if you are happy with your breast sagging now. Hope that helps.

Let's be clear. The first photo showing your entire torso from the lateral perspective reveals a nipple areolar complex that is below the horizontal meridian, and pointing down. For many women with breast implants, this is acceptable, and for those women I wholeheartedly agree that no surgery is necessary. However, some women want a nipple that sits at or slightly above the horizontal meridian, and pointing straight ahead or slightly up, similar to an objectively idealized breast shape. Your implant downsize will have a slightly negative impact on nipple position, but not as much as you would think. If you decide to also perform a lift, a circumareolar type would be wrong for you. Your nipple areolar complex objectively needs to travel a distance roughly equal to its diameter higher on the mound, something that could never be accomplished with that lift. Worse, by trying to 'push the lift to its limits', you will get all the usual problems associated with that lift: wide and irregularly shaped areola, pleating, thick scarring, flattening of the mound, and persistent breast sagging. To get a truly effective lift, you would need a full mastopexy with the associated vertical incision. I'm aware of your skin type, but done well, it would be virtually inconspicuous with proper execution and care after surgery.

I think a luft would be necessary if you downsize. However as far as implant size I would suggest around 250cc

Yes, you will not achieve a youthful shape without a lift. I don’t think a halo loft will be enough. However the scars are obviously a concern. You could downsize without a lift and see what the results are . Some patients will accept some sag to avoid scars.

Your implants are too large for your frame and tissue, and you will look better with smaller implants. You do have sagging now and this will be more noticeable with smaller implants. A vertical lift may be needed. Your surgeon can guide you to the best choice of lifts.

Dear faithgbd,
That's a bit of a limited photograph. However, going just on that and your description of things you will definitely need a breast lift. Regardless of the type of lift, your nipples will require a scar around the areolae. A donut mastopexy will not give you enough nipple elevation. A lollilop (circumvertical) lift would be a much better option. Good luck!