Which Kind of Breast Lift and Implant Size is Right for Me?

I'm 5'9", 135 lbs and have had (and breastfed) 3 children. I would love to have a breast lift and augmentation without the vertical scarring but am not sure if this is right for me. Do I need a full mastopexy with an anchor incision or can I get away with a Benelli lift with an implant and achieve a great result. I am planning to get a 492cc saline implant with moderate profile. I am also wondering whether that size implant would look good on me w/o being too big that it makes me look heavy.

Doctor Answers 25

Breast Augmentation with Lift

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From your pictures, you would be a great candidate for an augmentation mastopexy. I always tell my patients that a circumareolar lift will provide a modest lift in the breast with a good aesthetic outcome. A true mastopexy with a vertical scar will always provide a better and longer lasting result, of course with the disadvantage of the added scars. I recommend a full examination by a plastic surgeon to determine your best options.

"Getting by " doesn't lead to "great results" in augmentation mastopexy

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Compromises don't lead to great results in any cosmetic surgery procedures.  You don't have an easy starting point and need a wide implant to fill in the gap you have in the middle.  The breasts also need a lift.  You can try a periareolar lift and see if you are happy .  You won't get a great shape from it though but there will be less scars.

You can always convert to a full lift later from the periareolar.

Lift and Implant Selection

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 It is very difficult to determine the best lift technique and  exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below.

Breast Surgery

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Unfortunately without high quality photos and a through in person physical exam along with a long discussion about your desires it is hard to give great information on the internet and you should see an in person exam with a board certified surgeon

May be able to avoid a breast lift if desired

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If you select the right implant with enough volume and projection you should be able to get the uplift without a breast lift.  You always run the risk of  needing a lift in the future if the shape does not turn out the way you expected.   If your nipple pointed down then a lift would definitely be needed.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast augmentation/lifting

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Based on your pictures I think you will achieve the most  predictable results with a vertical mastopexy. You do not need a full mastopexy and a  “doughnut mastopexy” may not achieve your goals and has  predictable downsides.

 The more breast surgery I do the more I realize that there is no correlation between the size of implant and resulting cup size.  This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saiine/silicone  and low/moderate/high profile), bra  manufacturer variance  in cup sizes, the  degree  of filling of the cup  with breast tissue,  and the subjective differences in patients perceptions of cup size. 

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  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 “C cup” or "fake looking" or "top heavy" 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.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

I question whether you need any lift procedure at all.

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You certainly do not need a full mastopexy with a resultant anchor scar pattern. I even question weather you need any mastopexy at all. I say this because it appears that your nipple is on line with the impression the bottom of your Bra strap has made on your chest. This impression is just barely visible in the photo. But if this is so it would indicate that the nipple is at least on line with if not ever so slightly above the fold beneath the breast{the inframammary fold}. When the nipple is in this relationship to the fold it is possible to achieve a subtle lift with an implant alone avoiding the need for the additional scarring inherent in any type of Mastopexy or breast lift. I would recommend you undergo only a breast augmentation with the implant placed above the muscle since in this location the implant will impart maximal lift to your breast.Note that your implant can be placed above the muscle because you seem to have enough of your own breast tissue to adequately camouflage the implant and avoid visible surface wrinkling. I would also advise that you scale down your implant size aspirations to around 350cc -400cc to avoid an unnatural result. Worst case with this scenario is that you would have to come back at later date to perform the lift if you were unhappy with the effect of the implant alone. But I think risking a second operation is worth the opportunity to first see the improvement provided by implants alone.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Augmentation-mastopexy needs to be tailored to each individual

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From the look of your breasts in the photos, and the size of implant that you have chosen,I believe that you have one of two choices. The first would be an augmentation with a circumareolar lift. This will give you a good result most likely, and avoids an incision on the front of the breast. However, the circumareolar lift is limited and cannot correct major breast skin laxity in the horizontal plane. In order to do so, you may require having a vertical lift in combination with your augrmentation. This would certainly give your breasts a perkier look. Should you have any questions, feel free to email me directly at kb@drkevinbrenner.com

Best of luck,

Kevin Brenner, MD, FACS

Kevin Brenner, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 23 reviews

Breast implants and breast lift, mastopexy

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A breast uplift just on top of the areola is what I combine my breast enlargement procedures with in someone who has had children like you have. I also notice that one breast is lower than the other. I would take more skin off that side to equalize the position of the nipples. This type of uplift will not reshape your breasts but it will also not give you the longer and sometimes bad scars. You should still maintain sensation. I then place the implant through this cut. I recommend silicone implants and on top of the muscle in your case. I individualize for all my patients and try and give them what they want. You may want to check out my unbeatable all-inclusive breasst enlargement special. Watch my videos.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Implants with or with a lift.

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Women often ask whether a lift is necessary if they are having implants placed. In many cases the decision is obvious. In your case, it is difficult to tell without measurements, however some inferences may be made from your photos. You have mild ptosis of the nipples in comparison to the breast fold. Your breasts are fairly far apart on your chest wall. With a 492cc implant it is very unlikely that you would need a vertical scar type mastopexy.

As for implant choice, I would recommend a high profile implant. These implants have a narrower base and more projection. Because you have some deflation to your breasts, the more projecting implant will help to "fill out" this skin envelope and may completely obviate the need for a lift. Moderate profile implants of that volume (492cc) are quite wide and you may feel like they are "under your arm." As far as size, that really depends upon your breast measurements and your overall goals.

The mastopexy portion of the procedure could be done at the same time or staged to allow the breasts to recover from the augmentation. I recommend staging in your case because you may be very happy simply with a large implant augmentation.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.