Thank you for your question.You are a good candidate for a Breast Lift (Mastopexy) with or without Implant. This should give you your desired results. I usually provide some sizers to patients looking for Breast Implant. Please find a Board Certified Plastic Surgeon in your area who can evaluate you and discuss treatment options.
All The Best !
How do I select a size; breast augmentation/lifting surgery?
Thank you for the question and pictures. Based on your photographs, you should have a very nice outcome 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.
Ultimately, you will do well select your plastic surgeon carefully and communicating your goals, questions, and concerns. In other words, careful measurements, dimensional planning, and careful communication will be key.
Also, 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. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or 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. I have found that the use of words such as “natural” or "firm C cup" etc 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. The use of computer imaging may be very helpful during this communication phase.
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. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
I hope this, and the attached link, helps. Best wishes.
Breast Lift with Implants or Implants Alone
One of the more common scenarios that we as aesthetic plastic surgeons deal with in cosmetic breast surgery is the patient from either weight loss, or post pregnancy has a little bit of drop of the breast off of the chest wall that we call ptosis. The question then becomes in the patient's mind, can we just fill the space with an implant and create a youthful looking breast. It all depends on what the patient's perception of youthful is. My patients, more than likely, would like to have upper pole fullness of the breast without the necessity for wearing a push-up bra. In these situations, a breast lift plus an implant both centers the nipple and areola complex on the breast while replacing the lost volume with an implant. Most patients’ hesitation in doing the breast lift as well as implants, are the potential for bad scars. In my experience, we talk a lot about the scars of a breast lift preoperatively, but hardly ever in the postoperative phase. It seems to me, that when the breast is up high on the chest wall, youthful and perky, that one does not even see the scars. Most of the time, these incision lines heal uneventfully anyway. In the small chance that the scars are more red or thicker than one would like, we have many options in lasers, light sources, and laser assisted drug delivery techniques to mitigate against unsightly scars. Sometimes, patients who I've seen have seen other physicians who have recommended simply placing a large implant to "fill the space". This seems to be a very temporary fix for the situation in that the stretched out soft tissue that the implant is placed into, usually will allow very rapid descent of the breast, such that in just a few months, it looks like a bigger version of the breast that they first started with. They will then sometimes have a secondary mastopexy, and at that time, I would often recommend that they replace the very large implant with a smaller one. In my opinion, a large lift, meaning taking out as much of the stretched out skin as possible, and placing a more modest size implant will make a breast that will remain perky and up on the chest wall for a long period of time. In my opinion, perky breasts, not necessarily large breasts, look youthful. Patients will then ask, "why then does Dr. so-and-so tell me that I can just have implants?" My answer to this is very simple. It is far easier in most plastic surgeons’ skill sets to place a large implant then do a breast lift with an implant. The simultaneous lift and implant procedure is a little more challenging in that you're trying to do opposite things at the same time. One, you're trying to make the skin envelopes smaller and at the same time make the breast larger. One easy way to decide whether a lift is good for you, is to see your image in 3-D on a Vectra camera system. In our office, we can then compare two images: one with mastopexy with implants and the other with implants alone. In that way, both the patient and plastic surgeon can see what the difference in the look of both procedures are. Usually when implant is placed only, and a breast lift was really needed, what the patient will see is a breast that is falling off of a properly placed mound that's higher in the chest wall than the breast is. The breast seems to be falling off the implant. They will commonly squeeze the end part of their breast and ask, “why hasn't the implant filled this space out?” For me, the in between operation is to use a tall shaped implant. These anatomically shaped implants can create the illusion, that although the nipple has not really been raised, that the nipple is now more centered on the breast. While these implants do cost more than round implants, it still less expensive than adding a breast lift. All things considered, it's best to consult with a few talented and busy cosmetic breast surgeons to get different opinions. Good luck with your decision.
Selecting a goal for Breast Augmentation
One simple method for determining the size you wish to obtain with breast augmentation would be to select a formed cup bra that represents the size you are looking for and let your surgeon use sizer implants (while you are wearing the bra) to determine what volume implant would achieve your goal. Putting a T shirt on over the bra with the sizer implant in place will give you further feedback about your choice. Your surgeon would then be able to tell you if your breast has the capacity to accept this implant size. If not, the discussion would continue using smaller bras and sizer implants.
Breast Augmentation - Size Selection
Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.
Thank you for your question and photographs.I would recommend that you schedule a consultation with a board certified plastic surgeon to have an examination of your breasts done. At that point, the surgeon can recommend whether you need a breast lift, breast augmentation or both. From the photos you have posted, it looks as though you would need a breast lift as well as a breast augmentation to correct the sagging and add projection and volume. At my office, we use Crisalix which is a virtual reality device that will allow you to view what your breasts would look like after a lift, or view different sizes of implants and pick which best suits your desires. As the only board certified plastic surgeon in Pittsburgh offering this virtual reality imaging system, we have a 100% satisfaction rate. Crisalix is truly a unique experience for our patients as they can view themselves using virtual reality goggles and can instantly visualize their own breasts changing in size and shape with all of the various brands, sizes and shapes of breast implants. Thus, our patients leave the consultation feeling confident with the size of the implant they chose. Best of luck in your endeavors!
James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgery
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS, International Federation for Adipose Therapeutics & Science
How do I select a breast implant size?
Thank you for your question. You will need an examination by a board certified plastic surgeon who will take measurements of the base width of your breast. That measurement will determine the breast implant base with size that best fits your breast. The other issue is that based on the position of your nipple you may need a breast lift in addition to breast implants. If your nipple is below the fold under your breast then a breast lift is needed to avoid a "snoopy deformity".You can also do a Rice test in the privacy of your home to see how different sized implants will look in a bra. To learn more about sizing and how to do the Rice test please read the link below:
Breast lift and breast implants combined
The photos you have submitted reveal that the position of your nipples are on the low side. Thus, you would benefit from a breast lift (mastopexy) in addition to a silicone breast augmentation. You should convey your size preference to your plastic surgeon and they will be able to help accomodate you. You should achieve a very nice result.
Choosing the best Implant and Procedure
Breast implant surgery is accomplished by surgically inserting either a saline or silicione implant (prostheses) behind each breast. The saline implants (silastic bags filled with physiologic salt water) are placed either in front or behind the pectoralis major muscle and breast tissue. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift should have the implant placed above the muscle. Those patients with minimal breast tissue should usually have the implant placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you. When you come in for a consultation, the different options will be explained in further detail.
Breast Augmentation/Breast Implants/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision
I appreciate your question.
From your photos, it appears that you would benefit from a breast lift with augmentation. I breast lift would reposition your nipples and reshape your breasts, giving them a more youthful appearance. A breast augmentation would enhance volume.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.
Best of luck!
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute