Is a Lift Really Needed or is It Accomplishable with an Under Muscle Implant? (photo)

I've had about a 30lb weight loss and now my main goal for seeking surgery is to regain volume. The last surgeon I consulted recommendend an implant above the muscle and lift (leaving a vertical scar). I want to avoid the vertical scar and the need for a possble lift later due to the implant being over the muscle. My left nipple is 7.5 cm from the fold and the right is about 8cm. From the sternal notch to the nipples it about 22-23. I'm currently a B cup down from a full C to D.

Doctor Answers 17

An implant won't always accomplish what a breast lift can...

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Generally patients that have lost a significant amount of weight experience at least a mid-to-moderate ptosis (sagging). In order to get the best result from a breast augmentation it is essential to ensure that the breast gland is centered over the implant. Although many physicians have attempted to avoid the lift by using a larger implant, this has rarely resulted in a desirable final result.  One way to cheat the lift is to place the implant on top of the muscle as it allows the implant to settle lower in the breast. For someone on the borderline this could be an option.  Generally I prefer to place the implant below the muscle and perform a breast list because this has the longest lasting result.  And the scars typically heal well.


No need for a breast implant when utilizing the Ultimate Breast Lift technique

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Hi Gigi,

Congratulations on your weight loss!

Sounds like you've been doing your homework, good for you! There is a new procedure called the Ultimate Breast Lift that builds an internal cone from your own tissue and suspends it permanently to your chest wall, thus minimizing downward migration of the breast mound. This technique provides upper pole fullness without the need of an implant and completely eliminates the vertical scar. It essentially provides women with an internal push up bra. This is not a cookie cutter procedure like the others. Women come in all shapes and sizes and require individualized paramaters to design their ideal breast.

Best regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Do You Need a Breast Lift

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From your photos it is fairly clear from your frontal photos that you already have too much skin and a excess droop to your breasts - this is very common after weight loss. An augmentation alone will just leave you with larger, droopy breasts. This will progress with time and from the weight of the implant. No patient ever wants more scar, but neither do they want an inferior result. Patients quiet routinely accept the scar without an issue, however, if they are unhappy with the appearance they definitely will come back for a secondary procedure. 

You should see a board certified plastic surgeon in your area to get a formal opinion through and in-person consultation.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

Breast Lift with Breast Implants after Weight Loss

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Most people that have successfully lost a large amount of weight  are left with stretched skin that does not bounce back completely.  Skin removal with a lift is needed to give the best appearance.  Your photos show that your nipple and areola are well below the fold at the base of your breast.  You will definitely need a lift if you choose to have implants.  Without that, your nipple position will not be at the fullest part of the implant and will look unnatural.  That downward positioning of the nipple is sometimes referred to as a "Snoopy" breast, named after the long faced dog from the Peanuts comic strip.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Breast lift for an under the muscle implant

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Facts are an under the gland implant after weight loss more often allows you to forgo a lift because of the better marriage between the implant and the breast, hand in glove so to speak. Measurements are nice, but don't forget the pencil test, as the point of the lift is to keep the nipple up front and center over the implant. It is a myth that the submuscular approach will hold up the implant and reduce breast droop. Even under the muscle the lax breast will droop over the surface of the muscle and implant in time with a possible lift in your future.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast augment/lift

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Thanks for posting the measurements. I know that you'd like to avoid the scarring and you may not want to hear this but: the vertical breast lift with augment is the appropriate procedure. I do not think that undergoing an augment first will produce a satisfactory result and believe that the results will be dissatisfying in your case. A periareolar mastopexy is suitable for some patients but, judging from the photos, I do not think it is the procedure of choice for you.

Breast Lift Benefits

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Congratulations on the weight loss. Based on your description and photos, you will most likely benefit from a breast lift to accompany a submuscular breast augmentation. To verify, you will need an in person consultation and exam with an experienced and expert board certified plastic surgeon. Ideally, consult in person with 3 - 4 board certified plastic surgeons to explore your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews


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It is very difficult to give you a adequate recommendation without an exam, however  after looking at your pictures you most likely will need a lift ( with a vertical and probably a horizontal component), when performed together these surgeries are  sometimes difficult  to obtain a predictable result, hence why this combination of procedures is the most common combination involved in malpractice. If you are willing to have a low nipple areola complex and you do not mind to have these procedures perform in stages, then you can try a dual plane augmentation, you have a small chance of being happy with that , if you are not happy then you can have the lift as a second surgery, this will be the safer ombinstion, however most of my patients will go with the two procedures performed together.

the best reassurance to get a good result is to choose a good board certified plastic surgeon whom understand your goals,

good luck

Victor M. Perez, MD, FACS
Kansas City Plastic Surgeon
5.0 out of 5 stars 30 reviews

Breast lift

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I definitely agree with your plastic surgeon.  You need a lift with a small to moderate size implant and this is best done with a vertical lift.  An impant alone will never look right.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Breast lift

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Remember, breast implants make breasts fuller they do not lift them. From your photos, it looks like you need a lift.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.