I'm looking for recommendations for the best breast outcome. What should I do? (photos)

It appears that you will benefit from a lift and augmentation. In your case I would use textured silicone breast implants placed under the muscle. Please know that implant placement is vital in long term esthetic results. Do not allow anyone to place implants over the muscle as there are no structures to impede implants from making their way down your chest. The result will be low lying implants that will eventually stretch things further and making correction more complicated. Placement of implants completely under the muscle will help keep the implant in place. I would also recommend you choose the smallest implant possible to reduce long term complications associated with implants (chronic pain, displacement, contracture, etc).Hope this helps,Gary Horndeski M.D.

Happy New Year. Thanks for your question.Based on your pictures, I think you would most likely benefit from silicone moderate profile implants placed under the pectoralis muscles, combined with a vertical breast lift. Under the muscle implants would show less rippling, as would silicone implants. This is important for you because you are thin and have hollowing of the upper pole of your breast. Under the muscle implants will also give you a higher, more perky result than over the muscle implants.Based on your pictures, I think you definitely need a lift. Without this the breasts would appear to hang off of the implants and your areolae would not be addressed. (You noted that you want them smaller.) The exact implant size and specific type of lift you would require would be determined based on a thorough consultation and exam, although we have a general idea from your pictures and could get very close to making the specific determinations with a virtual consult. Most likely an implant in the high 300 to low 400 cc size-range would be appropriate.Good luck. You appear to be excellent candidate for these procedures. 

You would do well with a vertical augmentation mastopexy (lollipop lift). In my opinion, you have enough ptosis to warrant a mastopexy done with the augmentation otherwise you will be back for a staged mastopexy (not that there is anything wrong with that if you are absolutely opposed to mastopexy scars). Thanks for sharing.

It isn't possible to give you the best advice without a complete exam. From your photographs, it certainly seems that you need a mastopexy to correct your nipple position. You also, of course, need an implant to achieve the volume you want. Because you have little breast tissue for coverage, you will probably want to consider a silicone implant. There are many decisions that have to be made between you and a board-certified plastic surgeon.

Thank you for your pictures. Your most solid recommendation should come from you directions to go examination. Based on your pictures you're going to need a breast lift and more than likely the implants need to be placed under the muscle.

Hi Finally Free,Happy Holidays!Here are a few thoughts for you and I hope they help.  Put an index card in your breast
fold. If your nipple is at the edge of the card or below, then you would
be a candidate for a lift, either a vertical or anchor or areolar. If
your nipple is above the edge, you could be a candidate for an internal lift called the dual plane.Regarding your size:  This is perhaps the hardest decision for a patient
to make, as well as the surgeon. Cup size estimates can be misleading, but I
generally advise patients that they will experience an increase of
approximately one cup size per 200 cc. You can try on implants in the office by
placing them into a special bra.  Approximately 50 cc (1-2 oz.) is added to the final volume to account
for flattening of the implant in the partial submuscular pocket. "I would recommend submuscular to avoid wrinkling, and mammograms are more accurate and the chance of a capsule is less."  Once you
decide on a size you like, then add on about 25-50 cc, because in real life the
implant will be flattened slightly by your tissues.Multiple measurements need to be taken to fit
an implant to your exact anatomy. Have your surgeon's office show you the
charts of the implant dimensions for the various profiles of silicone and
saline from the manufacturer. Then you and your surgeon can piece
together the puzzle by matching your measurements, with your wishes, versus
your tissue cover and the available implants to arrive at a surgical plan.Keep in mind larger implants tend to have
more problems over the years.Since
silicone implants wrinkle less than saline implants, they might be your best
bet.You can
also approximate this at home by measuring out an equivalent amount of rice
placed into a cutoff foot of old panty-hose, and put this in your bra.Wear this around the house for a while, and
see what you think.Implant size must
square with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements
of your chest wall are taken (seven in total). Implant size selection has been an issue of much discussion. Therefore, I use a wide variety of methods, but the implant size is
always established preoperatively.Also,
patients are advised to bring reference photos demonstrating their ideal size
and shape. A photo album of patient pictures is maintained to assist them.
These photos ultimately help in determining where the implants will be placed,
since they can be shifted inside (to provide more cleavage), to the outside, up
or superiorly, and down or inferiorly during surgery. In determining the final
size selection, I always place the highest priority on the preoperative
measurements and potential tissue cover. Then, the patient’s verbal requests
are factored into the analysis. Our
average size over the last 7,000 implants was 350. We use the quick recovery approach, so click on the
web reference link below to have this explained.Be sure to see only a board certified
plastic surgeon (by ABPS - The American Board of Plastic Surgery) who is a
member of ASAPS (The American Society for Aesthetic Plastic Surgery) and or a
member of ASPS (The American Society of Plastic Surgeons). Also, ask if they
have an established, high volume breast augmentation practice, performing several
hundred breast augmentations each year. Be sure the PS has been in practice for
a while, 20-years or more might be a good gauge.Does the PS offer all three incisions?Discuss the implant type (gel or saline),
shaped "gummy bear" or non-shaped, smooth or textured, implant pocket
(over or under the muscle) and the "quick recovery approach."Ask to see their before and after photos if
you didn’t see any on their website. If they are experienced, they should
have several 100 breast implant patients for you to view. I would also
recommend that your doctor offer you the chance to talk to past patients who
would be happy to discuss their experience with you. You need to feel
comfortable, so make sure the environment is safe as in an accredited surgery
center. Also, ask a prospective surgeon if he or she has ever published journal
articles in professional peer-reviewed journals, which they can provide
you.All
the best, “Dr. Joe”

After viewing your images I think you are a candidate for:-subfascial breast augmentation-anatomical macrotextured implants-Lejour's (or equivalent) mastopexy with vertical scar (lollypop)Submuscular or subfascial will produce the same result (if properly executed), however subfascial is a modern tredn allowing lesser pain, quicker recovery and lower rate of postoperative complications.Teardrop or anatomical implants are better filling the upper pole (google images for "anatomical versus round implants").

Thanks for your inquiry. If you are looking to have a fuller higher breast and smaller nipples than a lift combined with implants will meet your goals.  There are several different types of lifts that can be described in more detail by your PS.  I generally insert the implant under the muscle when doing augmentation + lift surgery so there is more coverage of the implant.

I would suggest both a lift and an augment. Implants under the muscle because you are so thin and a vertical lift (aka lollipop) to reduce your nipple size and bring it to a better position on your chest. I don't think a periareolar lift would get enough change in nipple position for you. Implant size would have to be determined during an in person consultation using sizers or a computer simulation. Best of luck!

A breast lift with submuscular implants is the procedure for you. You usually reduce the areola size when doing the lift. If you want nipples that are shorter then this is a extra procedure. It looks like a moderate plus about 350cc would be about right. Good Luck and please see a board certified plastic surgeon in your area for consultation. Good Luck!