Implants Without a Lift? My Weight Has Fluctuated. (photo)

I'm a 33 year old woman who has sagging breast due to weight loss and gain repeatedly, and I'm wondering if it is possible for me to do a breast augmentation whit out a life. I am thinking 400 - 450cc gels depending on how much needed to fill the lose skin. I am also wondering if i should go over or under the muscle. Since I'm worried about DB going under and that going over would just make them sagg even more.

Doctor Answers 14

Breast implant sizing is important

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You appear to be a great candidate for a breast augmentation. I am a fan of smaller implants, and thusly would base implant selectin on the dimensions of your breasts. I prefer the dual-plane position for smooth silicone implants. I generally use a infra-mammary incision. If you want to avoid the 'double bubble' appearance, I would suggest choosing an implant with diameter that is smaller than the base width of your breast.

Breast Lifting Necessary?

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Thank you for the question and pictures.

Based on your pictures I think you are an excellent candidate for breast augmentation without the need for breast lifting.  Generally, I suggest some muscular augmentation (dual plane)  for the best results and avoidance of complications.  I also think the size range you have mentioned may be spot on.

Some thoughts  regarding the procedure may be helpful...

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  in my practice I find the use of goal pictures to be very helpful.  in your case you could use your own before breast-feeding pictures as the goal. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

Implants without lift

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You may not need a breast lift, however to determine this you would need a consultation with a surgeon who has experience with performing breast augmentation on breasts affected by mild to moderate sagging. You can consider Allergan Inspira Truform 2 implants with a narrower base width for more projection.

Please see an experienced board certified plastic surgeon to find out whether you are a suitable candidate. Best of luck.

Breast augmentation without a lift

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Great question, Maribelle!  Lots of women are in your situation and ask the same question in my office every day.  Based on your photos, I think a breast augmentation alone with submuscular placement of the implants will give you a great, natural result.  Of course, you should be examined by a board certified plastic surgeon who will take multiple measurements of your breasts and discuss your situation with you in more detail. Then, you and your surgeon can make a plan that best fits your goals and desires. I hope that helps and wish you all the best!

Breast implants and lifts

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The consensus of opinions here is correct that you do not need a lift because your nipple-areola position is at or above the inframammary crease level but I can't see how anyone can choose a volume without knowing the width of the breast and the profile choice of the patient. I also don't think that a properly fit implant will do anything to the skin. It may look less loose but its actually feel and quality will not be changed. Today it is clear that for a number of reasons implants should be behind the pectoralis muscle for the upper half of the breast but not the lower half. A dual-plane release of the pectoralis muscle and control of the inframammary crease level (which will have to be lowered slightly) should avoid a double-bubble. I also don't think putting implants above or below the pectoralis muscle has anything to do with future sagging. Properly positioned breast implants are just a pillow and don't make breasts sag nor does putting the implant below the pectoralis muscle prevent sagging. 



Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast Augmentation - Implants Without a Lift? My Weight Has Fluctuated. (photo)

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Not necessary to get a good result, but might be necessary to get the result you're hoping for.

The photos suggest that you would do well with implants alone (I would recommend smooth, round, submuscular and not overly large).  But, in all fairness, it looks like you're holding your shoulders back, so you may have slightly more sagging than it would appear.  And the next factor - the amount of elasticity in your skin, which may be stretched out from weight gain and loss - cannot be addressed via a photo.  The lower and looser your skin is, the more you might "need" a lift in order to place and keep the implants at a height you might want.

However, I think that a good argument can be made for undergoing just a breast enlargement (ie, implants alone) and accepting the result you'll get, in exchange for having undergone a much simpler procedure (than if you add a lift), along with attendant scarring and risks.

I'd recommend that you just have implants; I think you'll be happy with the result.

I hope that this helps, and good luck,

Dr. E

Breast augmentation without lift

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Thank you for your question. Based on the photographs you sent, it appears that you can undergo breast implant placement without a lift.

You have some asymmetry which will be more apparent after the operation. If you want this corrected, a nipple adjustment may be necessary on the left because that nipple is lower than the right.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Breast augmentation

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Thank you for your questions. Based on the information yuo provided and the photo, I think you are a good candidate for breast augmentation. I agree with the size and type of implant you mentioned, however, an accurate examination is esential to address this particular part of the procedure. I prefer under the muscle placement for several reasons.; the risk of rippling and capsular contracture are lower when the implants are placed under the muscle.

Here are some helpful tips for your procedure:

Here are some guidelines that help selecting the breast implant size. Patient must consider several factors when deciding which size implant to choose. Dr. Jaibaji, during the consultation, will assist you in making that decision.

The implant size depends on what the patient desire and what the breast can accommodate. In general, the larger the implant, the less natural the look.

The shape of the breast is a combination of implant size and bra type. Tell Dr. Jaibaji what cup size you desire, it would be very helpful if you can bring pictures of models. Also bring pictures of breast shapes that you do not like. The use of rice bags, different size breast implants during the consultation may help but is by no means accurate. During the consultation Dr. Jaibaji will show you before and after pictures that would help you make a decision.

In different women the breast shape will look different even if the same size implant was used. There are certain things to consider that will determine the final shape; these are: original breast volume, breast base diameter, shape of the chest wall, tissue stretch, history of pregnancy, height of the patient.
Each cup is about 150 cc. in other words, if a patient had A cup and wants to be full C, 400- 500 cc implant is required. That does not mean the breast can accommodate that size implant. Dr. Jaibaji will be able to decide that during the consultation. Projection is another thing patients need to consider. The more projection is desired a high profile implant is chosen.

Overfilling the implant; in many occasions the plastic surgeon overfills the implant up to manufactures recommendation. The aim is not only to make the implant firmer, but more importantly, to avoid wrinkling of the implant, also known as rippling. The rippling can be visible and seen in the upper and lateral part of the breast.

Cleavage is the medial distance between the breasts. The cleavage improves after augmentation. However, if the distance between the breasts remains wide, then the bra can adjust the cleavage and improves the shape.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

Implants without a lift.

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I think that a sub-muscular dual plane approach is a wise one without a breast lift. I cannot comment on what size would be appropriate without seeing some measurements of your breasts and you also have to understand that the breast would remain where it is on your ribcage, the lifting of the nipple and areola will be more of an optical illusion as the upper pole is filled up, but the location of your breast tissue and areola will not change.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Implants without a lift

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With weight loss, the skin quality usually weakens.  An implant may cause them to sag bit more.  Sometimes a circumareola lift is all that you might need.  An exam is key.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.