Do I need a breast lift as opposed to just getting implants and what kind of implants?

Question

I've had 3 consultations: 1 said I needed implants only, the other 2 said I'd get better results with a lift and implants. I have never had children. Age (49) and weight(5'9" 130 lbs now). My current breast size is 32DD so I'm considering 400cc saline implants. With a lift, is that a safe size and what kind of implants: i don't understand high profile, mentor, etc. I want to look the same but perky and more youthful. Thank you for any and all advice!

Brian C. Reuben, MD · Answer

Thank you for your question and photos.  You do have some excess breast tissue falling below the bottom crease of the breast.  The lowest part of the implant is at that bottom crease.  The implant sits behind the breast and not in the breast.  Therefore if you have breast tissue falling below the bottom crease, it will fall over the top of the implant and give a less than desirable shape.

Jed H. Horowitz, MD, FACS · Answer

Implants with no lift is usually a mistake. Most breasts will look larger and more droopy. They will sag more and sooner because of the excess weight. The shape will usually not be satisfactory. There will sometimes be a “Snoopy” breast or double bubble. If the nipples is in a fairly high position on the breast or “glandular” ptosis or drooping, an implant may be useful.A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is used for #breasts which sag or droop (ptosis). Sagging of the breasts may occur with normal development for some women, or as part of the aging process. Pregnancy, breast-feeding and weight loss are other conditions which increase breast ptosis. Some patients will have a better shape to their breast such as increased superior fullness if an #implant is used at the time of mastopexy. This is called an #Augmentation/Mastopexy. The procedure can also be combined with a minor breast reduction to reduce the breast width if desired. The surgery will create an elevated, more youthful breast contour. Also, the procedure will create nipple and areolae of the desired size and at the correct height.

#FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast. A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.

I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

#FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast. A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.

I prefer to  use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

Gerald Minniti, MD, FACS · Answer

Hello, I think it's safe to say no on-line consultant can determine where your inframammary fold lies, so determining the need for a lift is more conjecture. However, my best guess is that it is at least at the level of your nipples, and with that much tissue hanging, you'd do better with a lift. Implant size is determined by analyzing your tissue capacity as well as determining aesthetic goals using sizers. 400 cc implants would be relatively large if combined with your current breast size. Both round and shaped implants are available, the difference being not in the result produced, but the longevity of the result being greater in the shaped implants due to their form stability.  More than 90% of plastic surgeons in the US have never used shaped devices, fearful that they might rotate. However, FDA date show that they have the lowest overall complication profile. Go visit a few ABPS certified/ASAPS member surgeons that specialize in all forms of cosmetic breast surgery, not just implants. Best of luck!

Amy T. Bandy, DO, FACS · Answer

From your photos, I agree that you could get good results with implants alone, however the final determination would be if you would be happy with the location of your nipple areola and the breast mound location on your chest wall would not change.  A lift will simply elevate the location of your nipple areola which I don't think is necessary if you would be happy, as you say, with having the same look that you do now but just more youthful & perky.  An in office exam and evaluation would be helpful and to go over photos of other people similar to you so you could see some before & after photos to see likely results. As far as the implants are concerned, I typically choose which implant is going to be best for your body according to your breast width measurements and the volume that you want, so it is not an easy straightforward "high profile" or "moderate profile".  Good luck!

Farbod Esmailian, MD · Answer

Although a proper exam is needed with measurements, judging by your photos I would vote for you needing a lift to get the best result.  In addition if you wanted additional volume then an implant can be added to the surgery.  So patients are happy with the volume they have and simply desire to have more upper pole fullness.  In those cases a small breast reduction can be performed and a smaller implant can be placed to help with the upper pole fullness in addition to the lift.I would recommend that you visit with another 1-2 board certified plastic surgeons who perform a tremendous amount of breast augmentation with mastopexy together.  The two procedures can be done together safely and effectively to get you the result you desire.Hope that helps.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).

Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.

These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess if you need a lift and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.  Yes, I think that you will benefit from breast lifting as well as breast augmentation surgery.

Of course, breast augmentation/lifting surgery is a more complicated procedure (and more complication prone);  careful selection of plastic surgeon and careful communication of goals will be key.  Furthermore, you will need to carefully consider the trade-offs (such as additional scarring) associated with breast lifting versus the upsides briefly discussed above.

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 will a significantly higher risk of complications and need for additional surgery.  Again, it will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting 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 "DD cup" or "perky" 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, helps. Best wishes.

Curtis Wong, MD · Answer

as yours are (long distance between the clavicle and your nipple), its best to have a lift or you will have an unusual look with large, low positioned breasts.  And if you want to really have a face upper pole, I would recommend you consider a reduction with augmentation and use of your own tissue to help reinforce the bottom of your breast.  But if you ever have to get rid of the implants for any reason, you will be considerably smaller in size.  But this approach gives you the most durable results for preserving the results over time.

Thomas Hubbard, MD, FACS · Answer

It is clear why plastic surgeons have given you different opinions whether you need a lift or not, that's because a considerable amount of women would be pleased with implants alone. Giving fill to the hollow above balancing out some of the sag below.  It's also clear that 400 cc implants would be a safe size.  I don't think the type of profile is a difficult decision either since your surgeon will decide based on breast width.  The profile is usually determined by the choice of an implant that is more narrow than your breast.  You wouldn't want it to be wider than your breast.  Yes, it's possible you would be disappointed with implants alone either because you might feel your nipples are a little low, especially on the left.  Or you find you wish you just had less breast tissue hanging below your natural fold since that doesn't change much with breast implants.  In other words, breast implants don't lift the hanging breast tissue much at all.  A full lift is an easy decision if you are willing to pay the price for the scars around the areola and vertical scar from there down.  This will put your nipples in a much more ideal location.  And if the vertical technique is used there will be much less, if any at all, breast tissue hanging below the fold.  Pseudoptosis would be taken care of.  Remember when choosing your type of lift what you want to accomplish.  There is a Benelli lift that limits the scar to around the areola, but all it does is reduce the size of the areola when large and move the nipple up.  It will leave the same amount of breast tissue hanging below the natural fold.  In other words the Pseudoptosis is not helped by the Benelli lift.  In my opinion, for the most exciting and youthful shape, a vertical lift is necessary and the scars would be well worth the trade off.  I hope you find this information helpful.

Zachary Farris, MD, FACS · Answer

Based on your photos, you have a good deal of pseudoptosis and your breasts are positioned pretty low on your chest.  To achieve perky breasts, you would need a lift in addition to implants.  Breast implant selection is an important process and requires good communication between you and your surgeon. Typically, breast measurements are initially obtained to provide an initial guide to implants appropriate for your chest. It's then advised that you try different sizers in a normal bra with a tight t-shirt to get an idea of what your breasts would look like. It's important to focus on the look that you want and not overly focus on a specific cup size or implant size. Be sure to consult with an experienced board certified plastic surgeon. Good luck!

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