Are my 32DD breasts too saggy and do they require immediate attention? (Photo)

Hello and thanks for your questions and photos.  After reviewing your description, photos and desired result, it seems that you would be a fantastic candidate to have a breast lift using the Bellesoma technique. You appear to have between a Grade 2 and 3 degree of ptosis.  You've provided great information - the only thing that would be more helpful in order to give you the best advice about your options would be an in-person exam.
Bellesoma is a new breast lift technique that seems like it would be a great fit for you, and would improve the appearance of your stretch marks.  This procedure utilizes 3-D volumetric scanning and a multi-point measuring system to design a customized, precise surgical blueprint exactly tailored to your body and the lifted, perky breasts that you desire. The Bellesoma procedure reduces the sagging of your breast, lifts your breast and reduces areola diameter, preserves the nipple sensation and ability to breast feed, and looks as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is no vertical incision traveling down the front of your breasts.  If you would like to add more fullness and volume, a natural fat transfer using your own tissue can be performed after your lift to give you the look you're wanting.
Some of the differences between Bellesoma and the traditional breast reduction/lift techniques:
-Bellesoma creates upper pole fullness and projection that traditionally needed an implant to achieve.
-There is NO vertical scar, only well-hidden scars in the fold under the breast, and around the areola.
-The breast is dynamically supported by attaching it to the muscle, so there is no recurrence of sagging which are expected with traditional lifts or reductions.
-The entire central portion of the breast is undisturbed, so nipple sensation remains intact and is very unlikely to be compromised giving the best possible chance for future breast feeding.
-For absolute best results, patients should have a stable weight and have a BMI under 30.
The procedure is accomplished by using the skin of the lower pole of the breast (the part below the nipple that sits in the bra cup) to shape the whole breast into a perky dome, then straps are made of the extra skin, anchoring it to the underlying chest muscle so that there is virtually no chance of repeat sagging.  The skin that above your nipple and below your collar bone is utilized to cover the perky, lifted dome that has been created and then a new (usually smaller) circular opening for the areola is placed at the high point of the cone, creating your new lifted, full and shapely breast.
From your description and photo, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast lift and possible results.  
Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500

Hi meena2929,

Determining whether you need simply a breast implant versus a breast lift or both 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 breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. 

My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift).

Most importantly, it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, it is actually breast tissue that is being brought together to support the breast and hence improves longevity.

In addition, upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear fuller. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Based on your pictures you seem to be a good candidate for a breast lift, an in-person consultation would be best for a detailed exam and evaluation.Always see a board certified PS.