I would like more fullness and projection. I'm concerned about scarring, will I need a lift as well? (Photos)

Question

41F I am not entirely unhappy with what I have naturally, but I would like a little more fullness. My natural breasts are wider across my chest and don't project out as far as I would like. Is that possible without completely messing up what I have? Would a lift be recommended as well? I do have concerns about significant scarring.

Moises Salama, MD · Answer

Thanks for your question. From your pictures, it seems like you may be a good candidate for a breast augmentation. I recommend scheduling a consult for a proper evaluation. Please always consult with a board certified plastic surgeon. Take care, Dr. Moises Salama, board certified plastic surgeon

Daniel Barrett, MD · Answer

Dear Philosophical690953,

determining whether you need simply a breast augmentation versus a breast lift 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 a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based upon your photos, it appears that a lift will not be needed. Nipple position appears preserved.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Dino Mendez, MD · Answer

You can have a really nice improvement in your fullness and shape with breast augmentation alone. Your breast position is sitting a little lower because of your breast size, if you're okay with this, then I dont think a lift is needed. Just make sure you are wearing bra support consistently post op.

Sean Hill, MD · Answer

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery in Frisco, TX:
Thank you for your question and for sharing your photos &mdash; they offer valuable insight into your anatomy and goals.
Based on what you’ve shared, you have mild ptosis (sagging), which is very common &mdash; especially after weight changes, pregnancy, or with age. The good news is that you have a couple of solid options to achieve the fuller, more lifted look you’re going for: 1. Breast augmentation alone using a larger implant can sometimes fill out the existing skin envelope and restore upper pole fullness. This is a good option if you want to avoid additional scars and your nipple position is close enough to ideal. 2. For more precise shaping, especially if your nipple sits below the fold or if there’s extra looseness, a breast lift with implant (augmentation-mastopexy) may be a better option. This allows us to both enhance volume and elevate the breast tissue and nipple, giving you a more youthful and perky result.
The right approach depends on your aesthetic goals, tolerance for scars, and natural anatomy. At Lone Star Plastic Surgery, I take a tailored approach to every breast procedure &mdash; balancing volume, shape, and skin quality to create natural-looking, long-lasting results.
And always make sure your surgeon is board-certified and experienced in breast surgery, so you get results that are not only beautiful, but also safe and stable over time.
Warmly,Dr. Sean HillBoard-Certified Plastic SurgeonLone Star Plastic Surgery – Frisco, TX

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. You definitely would need implants AND a lift to get an attractive result. Often times, I will perform a technique I developed called Reductive Augmentation which also involves removal of extra beast tissue so I can use the implant to shape the breast. You should be able to achieve a beautiful result. Best wishes to you.

Gary M. Horndeski, MD · Answer

Your breasts are low and lateral on the chest wall. You would benefit from a breast lift and I recommend 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 (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

It is very likely that placement of implants would create desired look; scars are minimal and well hidden. Good luck.

Michelle Zweifler, MD · Answer

There are options for enhancing breast volume and projection.  Fat grafting to the breast is performed with liposuction from often the abdomen and adding to the breast in the desired locations; it may benefit from a second stage.  Small breast implants can enhance projection and fullness; but there are some risks.

Harry T. Haramis, MD, FACS · Answer

Breast implants will give more upper fullness and projection. Dual plane - half under muscle- or sometimes fully over muscle usually gives great results without a lift in similar patients.

Size and further details would be determined during consultation with a plastic surgeon.

I would like more fullness and projection. I'm concerned about scarring, will I need a lift as well? (Photos)

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