Getting 800cc silicone under the muscle, do I need a lift too? (Photo)

Personal physical examination is always going to trump even the best and most reasoned online answer from someone who has not examined you, so I will concentrate on a few basic facts that you can consider.800cc (cohesive silicone gel) implants are the largest implants presently available in the USA, though saline implants can be filled to even larger amounts for the appropriate patient whose anatomy allows. With implants of this size, your surgeon should also make your implant pockets somewhat higher than the final desired position (and the incisions should reflect this as well and NOT be in your present creases, but slightly lower, where the NEW crease positions will be when gravity does its inevitable thing and your implants drop.)There is no brassiere in existence that can prevent gravity from working, and implants will ALWAYS drop, with two exceptions--textured implants that adhere properly, and capsular contracture (CC), which yields the hard, Baywatch coconuts that cannot move, even with gravity!So let's assume your surgeon uses precise technique, meticulous hemostasis, and perhaps the Keller Funnel and Betadine or Adams formula irrigation, all designed to minimize the risk of CC, and your anatomy has the capacity for 800cc implants. It looks as if it does, but there is the need for a personal examination again!Since your surgeon has reduced the CC risk as much as possible, and assuming you have chosen smooth implants because they move more naturally than adherent textured implants, you can pretty much be assured that those 800cc implants will drop over the 6-12 months your breasts are healing (again, regardless of bra use). That means you will develop new lower creases on each side, a longer crease to areola distance, more fullness in the lower pole of still plenty-full breasts, and therefore may well NOT "need" a lift.This also presumes that you are not seeking the high, round, artificial Baywatch coconut look (which is the province of a good push-up bra, or if you develop high, hard, Baywatch coconuts from CC)!Others have addressed another issue as well, but let me be more blunt, and hopefully, clear! Breast lift flaps--particularly in the presence of such large implants-- may have compromised circulation leading to catastrophic skin loss, exposure of implants, and loss of any cosmetic result. The way some surgeons may choose to avoid these terrible concerns--associated with "full" breast lifts or (Wise) anchor pattern breast lifts--would be to recommend a modified lift like a vertical or periareolar lift. The former will have excessive tension just underneath the areolas, and has a tremendous wound breakdown possibility, and a periareolar "lift" does not lift much at all, sometimes leaves scalloped or "pleated" scars, and flattens the breasts. So I would suggest "waiting" on the lift for now, In fact, STRONGLY suggest!Remember, a lift can always be added in a (much) safer later operation if needed or desired, and avoids the healing issues, while allowing you to see how the less-costly and safe(r) breast augmentation-only operation does on its own. Just know that you will start out looking unsatisfactorily "snoopy dog" in appearance, and will need be patient with gravity. It (gravity) ignores no one! Best wishes! Dr. Tholen

Hello,'Filling up' the breast tissue envelope will never rectify the nipple/breast tissue position on the resulting mound. Is this why you are choosing such a large implant? Even if you choose a lift, the expansion of your skin envelope may preclude the doctor from performing a lift at the same time. Keep in mind that extra large implants have a much higher risk of complications and re-operations, and their long term effects on your body tissues are not always reversible. Please reconsider!Best of luck!

Thank you for the question and picture.  It is difficult to give you good advice based on the single photograph; you will be best off asking this question of your plastic surgeon who has had the advantage of examining you carefully.  Generally speaking, patients undergoing this combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery.
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
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 "D or E cup" etc 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. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
I hope this, and the attached link (dedicated to "larger" breast augmentation surgery concerns), helps.  Best wishes.