Thoughts on needing a lift in addition to implants? (Photo)

Question

Looking for some opinions on if a lift is needed. I am confused due to my nipple positioning seeming to be in a better spot than what i see with a lot of the grades of ptosis. I am about a deflated c/d due to 60lb weight loss. My goal is to go as big and voluminous as my BWD will allow me to. Stats: 5’1 103lbs BWD 13

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on the photos alone, you may achieve a better result with a lift + implants rather than an augmentation alone.

Chet Mays, MD · Answer

Thank you for your inquiry and congratulations on your weight loss! Based on your photos, you would be a great candidate for a Mastopexy (breast lift) then you can try on various sizes of implants and decide what size best fits your goals. We would love to help you reach those goals. Schedule a consultation with a Board-Certified Plastic Surgeon so we can create a surgical plan for you!

Sacha Obaid, MD · Answer

Hello!  Based on your photos and previous history of weight loss, you appear to be a great candidate for a breast augmentation with mastopexy.  I would advise scheduling a consultation with a board certified plastic surgeon for a full assessment and to discuss your options.  Good luck!

Daniel Barrett, MD · Answer

Dear Resourceful911362,
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

Irena Karanetz, MD · Answer

Hello,
 
Thank you for the question.
 
Based on your photos, you appear to be a good candidate for a full mastopexy (breast lift) which will put your nipples into the correct position, decrease the size of nipple/areola and allow excess skin to be taken away, giving you a more youthful looking breast. Some people are a little apprehensive to the full breast lift due to the scars, but typically they do very well.
 
Donut breast lift can help decrease the size of the areola and elevate the nipples, but it will not change the overall shape of the breasts. 
 
Breast implants can also be added in order to increase upper pole breast volume.
 
I would encourage you to seek a consultation with a Board-Certified Plastic Surgeon to further discuss your options, specific techniques, concerns and expectations.
 
I hope this helps.
Best regards, Dr. Karanetz
 
Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon
Evolve Plastic Surgery
Queens, New York

Brian K. Reedy, MD · Answer

Thanks for your question! Your one breast is substantially droopier than the other. If they both looked like the perkier breast, I would say no to a lifit since you want a very large implant. In fact, a lift might be impossible with a large implant so you may have to take a wait and see approach. I would suggest an in person consultation. Good luck!

Gianfranco Frojo, MD · Answer

Yes, you would benefit from a lift to address the long nipple to fold distance. The nipple position relative to the fold is a very INexact, UNreliable way to determine if anyone needs a lift or not. This is a rather antiquated (Regnault classification) system.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Jonathan Heistein, MD · Answer

You can certainly have the augmentation without the lift, especially if you are going choose a very full size.  If you do that, then the advantage will be that you can avoid a lot of scars, but you will still have some sagging.  If you do the lift with the augmentation, then you will have more scars but the result will be tight without sagging.  Talk to your PS about both options so you can pick the one that you feel will be best for you.

Gerald Minniti, MD, FACS · Answer

Although your nipple position is favorable on your native breast, you have substantial ptosis and the nipple would be low relative to a properly positioned implant, creating a much less pleasing appearance. In addition, you have asymmetry to your breast's shape and size. What you should not do, either alone or in combination: place implant over the muscle, place an implant that is very large or of very high profile, or get a periareolar lift.

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