Do I need a breast lift along with implants? (Photos)

I am going to have a full TT & breast augmentation. I am 36 years old. 5'8 140lbs. The doctor suggested a mini lift (periareolar) and 685ml subfacia anatomical "gummy bear" implants. Before breastfeeding 2 kids, I was a 36C. Now I am a large 36B. I'm concerned about the risks of periareolar lift as I am happy with the size/shape of my nipples. Do I need a lift or will implants alone be enough? The doctor said he didn't feel any diastasis & I likely wouldn't need muscle replair during my TT.

Doctor Answers 11

Breast lift with an implant

From your pictures you would benefit from a breast lift. Which type of lift would best depends on your exam. A peri-areolar lift does have the risk of stretching the areolar diameter or size. I would discuss this in detail with your surgeon to have a realistic understanding of the postop results.

Implants and lift candidate, some advices:

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 400-500ml 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

Breast lift plus implants, or teardrop implants alone?

Hello, without a proper exam it is not possible to make specific recommendations, but based on the photos it looks like you have moderate breast sagging (stage II ptosis).  Some of my patients with this degree of sagging will be satisfied with the result of implants alone, but others will want even more perkiness of the nipple.  If you are unsure, the lift can always be done at a second stage.  I would suggest discussing any concerns with you surgeon.

Do I need a breast lift.

It is very hard to tell from a photo alone if breast lift is needed unless you fail the pencil test, with the nipple below the breast fold. There are red flags in your question, such as subglandular augmentation with a quite large highly cohesive implant, an unusual selection, and no diastasis after two pregnancies. Ask questions carefully during your consultation, and let proper board certification guide you.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 40 reviews

Breast lift with implants

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  With that being said, based on your photographs, the best shape and contour could be achieved with an implant and a wise pattern breast lift. Your nipple sits below the inframammary fold and without a lift in addition to the implant, this will not have a natural shape.  A wise pattern lift with an implant can result in a very nice shape if good technique is used.  The size of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Do I need a breast lift along with implants?

Based on the pictures, the implants seem very large for your body. You may be better of with a lift but that can be done later if needed. Periareolar lifts give very little "lift" when patients have loose skin and small areolas.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 65 reviews

Do I need a breast lift along with implants?

I would recommend breast lift to change the shape for a pleasing cosmetic result with your new implants.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 reviews

Do I need a breast lift along with implants?

This is what I would tell you if you were my patient: If you are truly interested in implants near 700cc's you would likely benefit from a crescent lift and implant.  Be well aware of the fact that some patients require a more aggressive lift later to get the best result.  Also, I would inform my patients that the larger the implant, the faster they will likely sag.  If you are interested in an implant closer to 400cc's then I would suggest a vertical lift and implant placement.  Although you will have a scar down the central breast, you will likely have perkier breasts and less of a chance of sag over time.  I hope this helps. 

Do I need a breast lift along with implants? Yes...

Thank you for the question and pictures. Keep in mind, that you will be able to find a plastic surgeon who will recommend augmentation only, without breast lifting. In other words, there are very few "absolutes".


 Having said that, in my practice, I would not offer you breast augmentation surgery only; in my opinion, a breast lift is indicated as well.


Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with will a significantly higher risk of complications and need for additional surgery.  Again, it will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery.


 Remember, that during breast lifting surgery, some skin is removed, thereby limiting the "space" available for breast implants. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 


Generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:


1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.


2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.


3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.


 

 Generally speaking, the vast majority of patients who present for tummy tuck surgery benefit from muscle plication; as you know, this part of the tummy tuck procedure serves to re-approximate the muscles that have spread during pregnancy or weight gain/loss. Omitting this part of the procedure will potentially leave patients with continued abdominal wall laxity and, in my opinion, a less than optimal result.  Be careful with your decision-making…


I hope this (and the attached link, dedicated to breast augmentation/lifting surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Is a Breast Lift Needed Along with Implants

A #mastopexy or breast lift operation is designed to improve the shape and position of the breast swithout reducing their size. It is used for #breasts which sag or droop (ptosis). Sagging of the breasts may occur with normal development for some women, or as part of the aging process. Pregnancy, breast-feeding and weight loss are other conditions which increase breast ptosis. Some patients will have a better shape to their breast such as increased superior fullness if an #implant is used at the time of mastopexy. This is called an #Augmentation/Mastopexy.  The procedure can also be combined with a minor breast reduction to reduce the breast width if desired. The surgery will create an elevated, more youthful breast contour. Also, the procedure will create nipple and areolae of the desired size and at the correct height. 

#FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast. 

A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.

I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

Implants with no lift is usually a mistake. Most breasts will look larger and droopier.  They will sag more and sooner because of the excess weight.  The shape will usually not be satisfactory. There will sometimes be a “Snoopy” breast or double bubble.

If the nipples are in a fairly high position on the breast or “glandular” ptosis or drooping, an implant may be useful.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

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.