Deflated breast 10 year post pregnancy. Would a large implant reduce the need for a lift?

Question

I am 5’1 100 lbs with 32 D I had my last baby 10 years ago. My breast look somewhat deflated but not really sagging. Would going with a larger implant reduce the need to get a lift since I have more tissue? It would be over the muscle most likely. What size would you recommend?

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
An augmentation will not lift. A subglandular implant that is large enough may mask the need for a formal mastopexy but these cases are rare.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Daniel Barrett, MD · Answer

Dear Rational860281,
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

Luis A. Mejia, MD · Answer

Dear Rational860281, thank you for your question, before anything it would be good to see some pictures to evaluate your case. For this kind of questions it is necessary to see pictures or and in person consultation to provide at least an idea. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.

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

Leila Kasrai, MD, FRCSC · Answer

Without photos and your current measurements it would be difficult to give you advice. It is true that high profile implants can give you a bit of a lift, but if your nipples are at or below your breast fold then a lift would be recommended. In terms of size, your surgeon would be able to give you a range.

Gary M. Horndeski, MD · Answer

If you are worried about lifting your breasts then a large implant is the worst possible thing you could do. The larger the implant then the more it will weigh, the more it will stretch the breast and the lower the breast will become. Unfortunately, you have not provided photographs. However, you need a lift and 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. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

You did not supply photos of your breasts, something that is mandatory for questions like yours. However, your specific question of implant size or position or profile and reducing the need for a lift can be answered without photos. The answer is 'it depends'. It depends on the photo you would present to a prospective surgeon in consultation. If that photo shows a breast with nipples at or slightly above the horizontal meridian of the breast mound, the answer is you'll need a lift; size, position, or profile with not achieve that result, which requires the nipple to rotate into a higher position. Alternatively, if your goal photo shows a woman with low positioned nipples, then the answer is you won't need a lift.

Harry T. Haramis, MD, FACS · Answer

Without photos or exam, in my experience, breast changes after pregnancy can be restored with breast implants.

Many such patients can avoid a formal lift by placing the implant above the muscle as you ask or dual plane which is half under and half over muscle.

Yes, a larger implant would give more “lift,” size will depend on your measurements and anatomy, goals.

An exam and consultation with a plastic surgeon is recommended to best discuss your options and expectations.

Ram Kalus, MD, FACS · Answer

Thank you for your question. Without an examination in person or photos, it is not possible to provide you with any specific recommendations. A “larger” implant is rarely a good substitute for a breast lift (mastopexy). Instead, a larger heavier implant will usually provide a temporal solution that will ultimately result in a greater degree of stretching and thinning of the breast tissue and skin envelope. 
Please consult with an experienced board certified plastic surgeon whose aesthetics align with your own based on his or her Before and After gallery. Best of luck to you.

Camille Cash, MD · Answer

Photos or an in person evaluation is needed for the best recommendation.  Implants do provide upper pole fullness to the breasts but they don't really correct sagging or low nipple position.  I encourage you to meet with a board certified plastic surgeon near you to discuss your concerns and learn what is recommended based on your examination.

Deflated breast 10 year post pregnancy. Would a large implant reduce the need for a lift?

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