32DD/34D bra, how would you treat pseudoptosis breasts? (Photos)

Question

I have pseudoptosis breast with significant sagging below my crease. I wear a 32DD or a 34D bra (Victoria’s Secret sizing). I would like natural shaped breasts with an implant for fullness. Would I have to get a lollipop incision in order to achieve this? Or could I just get a crescent wedge to decrease the sagging?

Steve Laverson, MD, FACS · Answer

Your glandular ptosis may be treated by a variety of approaches.  Your relative skin excess is distributed across the entire lower portion of the breasts, so skin removal and tightening in that area should be part of the plan.  Your nipple position may or may not need elevation depending on measurements, but it appears from your side profile view that the nipples are above your inframammary fold so not raising the nipples too much (if at all) is important.  Whether or not a vertical approach, a transverse crescent, or a combination of the two (Wise pattern) is preferred depends on your sentiments and your surgeon's flexibility.  My recommendation would be for a vertical breast lift  (probably without horizontal component to minimize scar) to manage flattening on the front of your breasts and to produce a rounded rather than a "pancake" breast with the most aesthetic shape and nipple projection.

J. Timothy Katzen, MD, FACS · Answer

Hi michele511,

I appreciate you reaching out with your question about treating pseudoptosis, especially given your current breast size of 32DD/34D. Your provided history and pictures are helpful in formulating a response.

An important consideration in your case is deciding the desired breast size post-surgery. If you're content with maintaining your current size, a breast lift would be an appropriate approach. However, if you're looking to increase your breast size or achieve more upper fullness, breast augmentation, possibly combined with the removal of some breast tissue at the bottom of your breasts, would be worth considering.

In terms of implants, for optimum results, I typically recommend smooth, high-profile, silicone implants. These tend to provide a more natural look and feel. Placement above the muscle is often ideal for maximizing upper pole fullness. The specific type of breast lift that will be most suitable for you, whether a lollipop or an anchor incision, will partly depend on the size of the implant you choose. It's important to note that more enduring results are typically achieved with lollipop, vertical, or anchor mastopexy compared to crescent or wedge mastopexy.

I hope this guidance has been helpful in addressing your concerns about pseudoptosis with 32DD/34D breasts. It's crucial to consult with an experienced, board-certified plastic surgeon who has a strong background in breast surgeries. They can provide personalized advice and ensure that the chosen procedures align well with your aesthetic goals.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Finny George, MD · Answer

Hi, thank you for sharing your question. I believe that the latter option you suggested would be sufficient to correct this problem. With the addition of implants, you will have a beautiful outcome.

Gerald Minniti, MD, FACS · Answer

It's simply a matter of skin excess, which exists in both the horizontal and vertical directions. Crescent lifts do virtually nothing except elongate and expand your areola. A lollypop pattern lift would work for some, but not you. You have too much vertical excess, which is most directly and best managed by an anchor scar lift. Please be careful, you'll find many doctors willing to give you what you want and it won't be a good outcome.

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them 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.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Miguel Mota, MD · Answer

Great question! Thank you for posting with these excellent photos. A crescent lift would only slightly improve your areola position and would do nothing to improve the sagging bellow your breast crease. Plus, your areola position isn’t that low, this is why you are correct in your diagnosis of  pseudoptosis.

Your main issue is the tissue bellow your breast fold and the only way to fix this is with a lollipop incision… or better yet a traditional anchor lift. If you want implants, a breast lift with implants can be done as well with either a lollipop or an anchor incision. I recommend taking out some tissue and replacing it the the implants. It is important to not make your breasts any bigger then they already are. Increased size and weight will actually make them sag sooner, so I would avoid going any bigger.

Best of luck,
Dr. Miguel Mota

Connie Hiers, MD, FACS · Answer

You have ptosis of your breasts and need at least the vertical lift to lift and reshape your breasts.  Small implants placed behind the muscle can help give more upper breast fullness.

Ralph M. Rosato, MD · Answer

The distance from you nipple to the crease of the breast is too long. This distance has to be shortened. A removal of skin at the breast crease will do that. I would recommende supporting the implant with either allograft or mesh.

Marcos Lopez, MD · Answer

Thanks for this question. Let me start by saying there is probably more than one way to achieve your goal. In my practice, I have found that a lollipop lift combined with an implant is the best way to achieve your goal. As you know, the pseudoptosis is caused by extra breast tissue at the bottom of your breast. The lollipop lift removes some of this extra tissue while also allowing for internal sutures that can help to add shape to the bottom of the breast. When combined with an implant for upper pole fullness, you end up with a much more balanced and lifted result.

Jared Blau, MD - Account Suspended · Answer

Thank you for sending in the images. A “lollipop” lift does a nice job of removing the lower redundant tissue and tightening the loose breast. If you see a surgeon with 3D imaging in his/her office, this effect can be demonstrated.

32DD/34D bra, how would you treat pseudoptosis breasts? (Photos)

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