I want to close my cleavage gap and have upper pole fullness. I had my lift, now what type of implant do I need? (Photos)

Question

I had a lift April 06,23. I as a deflated , saggy 36DDD-E. I still want large breasts. I have no upper pole due to nursing. I want to accomplish two things: close my clevage gap as much as I can, and get upper pole without having breasts that are too obnoxious. I want the fake look, but I want it done tastefully. I'd like to stay around a DDD post augmentation but really want that rounded upper pole with side boob. Is mesh a good option for me? Is High-profile best? Is this realistic?

Daniel Barrett, MD · Answer

Dear Original753484,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Finny George, MD · Answer

Hi, thank you for sharing your question. You are a good candidate for breast implants. The projection of the implants does not need to be high profile but the positioning is key.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. A high profile implant can help a bit with upper pole fullness. Eventually over time with gravity even a high profile implant may drop. Breasts will not stay up perky over time. Fat grafting can help fill the area to create a bit more cleavage. Speak to you plastic surgeon about this concern. See your options.

Ted Eisenberg, DO, FACOS, FAACS · Answer

I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Jeffrey Lisiecki, MD · Answer

Based on the goals you've described of adding more cleavage and rounded upper pole fullness while not increasing your volume too much (as you said you wanted to stay around a DDD), high profile implants would not be the best option.  High profile implants add a lot of projection, but they aren't as wide so they don't add as much upper pole fullness per volume as a lower profile implant like a moderate or low plus.  Measurements and sizing here would be important to find an implant that fits your breasts and to best understand how much bigger you would like to be!

Gianfranco Frojo, MD · Answer

I would recommend a revisionary breast surgery that would include placing an implant to provide upper pole height/fill (usually a low plus profile as these implants are taller for projection ratio) with an internal bra (Galaflex) for soft tissue support. We would also need to perform another breast lift to optimize the breast shape and nipple position. I would highly recommend finding a highly trained aesthetic plastic surgeon (preferably 6 years of dedicated plastic surgery residency and 1 year of aesthetic fellowship). Best of luck!

Gary M. Horndeski, MD · Answer

You need a repeat lift. The technique I 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 (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to revisionary breast surgery Over many years, I developed a technique called "Reductive Augmentation" which includes breast augmentation, mastopexy - lift, and removal of inferior pole breast tissue is performed. This procedure is particularly suitable for patients who would like a more round appearing breast and upper pole fullness. I have treated many patients with very similar breast issues as yours. I published this technique in the International Journal of Aesthetic Surgery in 2017. You should be able to have beautiful breasts and all of your goals accomplished. Best wishes to you.

Dallas Buchanan, MD · Answer

It sounds as though you were thrilled with your surgery and care with Dr. Fakhre. I would suggest you go back to him and discuss the best ways to achieve your desired results. No online forum where doctors you do not know commenting on photos is going to take the place of an in-person consultation with a board certified plastic surgeon. 
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Sean T. Lille, MD · Answer

Dear Original, 
I see women in my practice with this same canvas' asking for the same thing you are. You have a nice result, but it doesn't look like your surgeon was planning on you having an implant when this lift was performed. You still have a lot of breast tissue and skin sitting on your chest, and the distance from the nipple to the crease is very long. I think the breast envelope will need to be smaller so the breast will not hang off of the implant. In addition, you will need to choose a wide implant  (like Mentor's classic profile) to maximize your cleavage. 
Best wishes to you!

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