Lift? Implants? Both? (Photo)

I've never had good skin elasticity. I have PCOS & by age 11, I was 5'4" with dd's. ive yo-yo'd between DD and B over the past 15 years. now, they still fit into a D cup bra, but the skin folds over. I'm 26 and I have never had perky, youthful breasts. so many of the lift before and after pictures I've seen barely show much of a lift. I want mine up and I'd love to not feel underboob on top of my ribcage anymore. but if I could get a pretty look with just an implant that'd be good

Doctor Answers 16

Breast lift with augmentation

Thank you for your question. Looking at your case you would be best served with a combination of breast lift with augmentation.  The parameters of both the breast lift and the position of the breast implants should be designed to keep the implants relatively low while lifting the breast tissue and nipple to sit directly over the implants. For the breast lift I would recommend a periareolar (donut) technique which can elevate and improve the position of the nipples, reshape breast volume, and improve symmetry.  Adding breast implants behind the lift will give you increased fullness and a much nicer shape, and is a great decision in this case. Many techniques exist in breast surgery, and combined lifting with augmentation is especially tricky.  The key is working with an expert, board certified plastic surgeon to get the best plan for you.

Lift? Implants? Both?

Thank you for the question and pictures.   Based on your photographs, it is most likely that you will benefit from breast lifting plus/minus breast augmentation surgery. In my opinion, you will not do well with breast augmentation surgery alone. You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.  Generally speaking, patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%.  Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.  To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key. Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery. I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.  Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only. For example, some patients who wish to maintain long-term superior pole volume/"roundness" or "implanted look" may find that this result is not achieved after the initial breast augmentation/lifting operation.  An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).  Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.   Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.  The attached link may also be helpful. Best wishes.

Implants with Breast Lift?

Thanks for your question, one that is commonly asked.  You definitely should consider an uplift combined with implants.  One option would be to use moderate sized implants combined with a Benelli lift leaving only an incision around your areolae.  If you wish a more conservative augmentation then more skin needs to be removed with a full mastopexy.  Watch the video link above for additional information and review the photos in my gallery.  They should both be helpful to you in making your decisions.Meet with an ABPS Bd Certified plastic surgeon in your area to see examples of other patients and to be certain that you are confident in both your surgeon and your choice of procedure and implants.  Best wishes, Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

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Breas

Thank you very much for enquire.
After having analyzed all the information and photos provided to us, I realize that you have very sagging and small breasts. In this regard, you need volume (implants) and projection (the lift): Breast Augmentation w/Breast Lift.
I recommend you to use microtexturized highly cohesive silicon implant ("gummy bear" implants), with high projection, and 450ml will be excelent on you, to fill the breasts properly.
Finally, to perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Respectfully,
Dr. Emmanuel Mallol Cotes.-

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 178 reviews

Lift with implants gives best contours

Hi,I have attached a link that might be helpful...

Hi Icbennett.  Thank you for sharing your photos.  You would do best with a lift and implants to restore the position & size of the nipples, and make the breast volumes more even.  You appear to have less stretch on the right breast and it will likely appear tighter/higher after surgery.  Since you have significant fluctuations in your native breast tissue volumes, this will likely continue after surgery so know that your cup size may change.  Be sure to consult an ABPS certified plastic surgeon who can help you choose the right implant and type of lift based upon your in person examination.  Good luck!

You definitely need a lift

To get the result that you're looking for, you will definitely need a lift. The next question is how large do you want to be? If you want to have more volume than a large implant will fill out some of the skin brassiere requiring less of a lift and consequently, less incisions. If you want to be only a little larger or the same size that you will need a lift requiring incisions around the areola as well as vertically. Obviously it's a trade-off so this is something you will have to discuss with your plastic surgeon. You need to feel comfortable with the surgical plan and whether it will accomplish what you are trying to do

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.4 out of 5 stars 16 reviews

Full breast lift with augmentation

You would most likely get the best result with a full breast lift with breast augmentation. 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
Vistnes Plastic Surgery
San Francisco Bay Area
#realself #drdeanvistnes #breastlift #breastaugmentation

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 42 reviews

Implant with lift

Thanks for your question and photo.Based on your limited view of chest, you would need breast lift to have perkier, more youthful-looking breasts.  Implants will give your fuller, larger breasts; however, it will not give you a better shape.Please visit a board-certified plastic surgeon to be evaluated in-person and to share your desired goal.Best wishes.

Lift? Implants?.....Both!

Dear Icbennet,  In my opinion, you would not do well with an implant alone. Doing a lift without an implant will improve shape and position, but will lack in overall fullness that most young women want with their breasts. I think a breast lift with a modest implant would be the best aesthetic result. Discuss all the options with your plastic surgeon. Good luck. Dr. Gervais.

Douglas L. Gervais, MD
Minneapolis Plastic Surgeon
4.8 out of 5 stars 168 reviews

Both

Dear Icbennett,
You definitely need a breast lift.  I would also recommend breast implants to give you more upper breast pole fullness and volume that has been lost.  Good luck!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.