Am I a good candidate for a breast lift w/auto-augmentation; breast lift with fat grafting, increase upper pole volume? (photos)

Based on your photos, I think you would achieve a more favorable result from a breast augmentation with a lift as you are beginning with a fair amount of sagging breast tissue. A breast lift will improve your breast shape and raise the nipples to create and overall perkier appearance while the implants give you the size increase you are looking for. Getting implants alone will create a situation where the breast tissue is falling off the implant causing a "Snoopy dog deformity" if placed behind the muscle.  If placed in front of the muscle, these large implants will weigh down the breast and cause a "rock in the sock" deformity. I recommend setting up a consultation with a board-certified plastic surgeon to devise a treatment plan. Best of luck!

Hi BD8404,

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

Thanks for your question. From your photos and desired results, it looks like you would be best served with a combination of breast lift with augmentation.  The parameters of both the breast lift and the position of the breast implants should be designed to keep the implants relatively low while lifting the breast tissue and nipple to sit directly over the implants.  Many techniques exist in breast surgery, and combined lifting with augmentation is especially tricky.  The key is working with an expert, board certified plastic surgeon.

I agree with you and I do not like vertical scars and would not recommend an anchor lift.  The technique I do 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 and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

I do not think autoaugmentation or fat grafting will give you the volume or fullness you want. I think you need a breast augmentation with implant and a breast lift. Good luck.

Measurements are needed to be certain, but you might do well with a vertical lift and avoid the underneath scar. Please visit with a plastic surgeon to discuss your options.

Restoring shape and volume is what breast enhancement procedures are all about.  When there is loose skin, this must be addressed.  There are many options available with different lift procedures and a multitude of breast implant options.  Here is a basic list of the four options available:
Breast lift alone (mastopexy)Breast lift combined with a small breast implant (below the muscle)Breast lift followed by a large breast implant (2 separate procedures)Breast implant alone (on top of the muscle, silicone)Every woman is built differently and every breast is different, even on the same person.  So, each procedure is customized for every individual.  The final decision on how to proceed can be made after a history and physical examination, detailed measurements, photographs, computer simulation, trying on sizers, reviewing before and after photographs of other women similar in shape and size and talking with your surgeon.  A surgical plan will be developed that depends on:
Patient desiresThe breast "footprint"The expertise of the surgeonCostDown timeScarsRisks and potential complicationsPlease consult with a Board Certified Plastic Surgeon who performs breast enhancement procedures frequently.  This is an outpatient procedure with a quick recovery and a very high patient satisfaction rating.  Based on the photographs submitted, a vertical (lollipop) breast lift would be the best option.
Good Luck!

The most reliable and long term results are from placing an implant to  produce upper pole fullness.  Fat grafting has unreliable long term results and often lead to disappointment when trying to create a noticeable difference.  If you are comfortable with an implant that will provide you with the best results.  If not then do not expect a significant level of improvement in the upper pole volume.  

It appears that you have a good amount of natural breast tissue.  You also have a grade 3 ptosis or sagging.  The pictures don't give me an idea of the upper poles or upper half of the breasts.  So, to give you the best aesthetic result you would need a breast augmentation and full (anchor) breast lift.  There are numerous problems with fat grafting.  First, fat is very fragile and if it doesn't get a good blood supply after being removed via liposuction it will die.  When fat dies it either just disappears or it can turn into fat necrosis.  Fat necrosis appears as round, very hard, calcified masses.  Because the fat can die most likely you will end up with two different sized breasts.  The fat grafting won't do anything for the breasts sagging.  Unfortunately, because the nipple areolar complexes need to be lifted a fair amount this necessitates the scar in the inframammary folds.  Finally, it's rare to have keloids in surgically created wounds.  It's more likely to have hypertrophic scars.  These are like keloids but not as bad.  I see my darker skinned patients often after surgery to watch for this.  If it starts to occur an injection of steroid can stop the process.

I think you would be disappointed with fat grafting as it will not give you enough volume.  I would recommend breast lift with implant augmentation.  Best wishes