Should I get breast surgery? Are my breasts abnormal/overly old and matronly for a 26 year old?

I feel like my breasts are less petite and pert. My areolae seem to have doubled in size since my second pregnancy, and are beginning to point down. Is this normal? Is it bad enough to warrant correcting? They're absolutely riddled with stretchmarks and I was wondering if anything could be done about this aswell? I spend my time between UK and USA. I would appreciate being told if there is anything medically/aesthetically wrong with my breasts, especially given my age, and what my options are...

Doctor Answers 24

Should I get breast surgery? Are my breasts abnormal/overly old and matronly for a 26 year old?

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Thank you for the question and pictures. Your pictures clearly demonstrate significant  breast ptosis.  You will benefit from breast lifting plus/minus augmentation surgery.
You will do best by seeking consultation with well experienced board certified plastic surgeons. Ask to see lots of examples of their work and communicate your goals clearly.

Some general thoughts may be helpful to you as you learn more:
Patients who are considering breast augmentation/lifting surgery should understand that this combination surgery is significantly more complex than either one of the procedures done separately. In other words, the combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately.
Furthermore, the potential need for revisionary surgery is increased with breast augmentation / mastopexy surgery done at the same time. This revisionary rate may be as high (or higher) than 20%. Patients should be aware of this higher revisionary rate; obviously, the need for additional surgery, time off work/life considerations, and additional expenses our “factors” that should be considered before undergoing the initial operation.

Personally, I find that the breast augmentation/lifting procedure to be one of the most challenging of the breast operations I perform, even compared to somewhat complex revisionary breast surgery. On the one hand, when performing breast augmentation/lifting surgery we are increasing the breast size with breast implants; on the other hand, we are reducing the breast “envelope” in order to achieve the breast lift. These two “forces” must be balanced as perfectly as possible in order to achieve the desired results. Removing too much skin/ breast tissue is problematic; removing too little breast skin/tissue can also be problematic. Remember also that patients presenting for breast lifting surgery and general have lost some skin elasticity/thickness making potential incision line healing problems and/or recurrent drooping/sagging important concerns to communicate.
The analogy I use in my practice is that of a thinned out balloon, being expanded with additional air, while at the same time removing some of the balloons rubber surface. I hope that this analogy helps patients understand some of the issues at hand when performing the combination breast augmentation/lifing operation.

To achieve a surgical result where the breast implant and breast tissue “come together” and behave like a single breast is one of my goals but can be difficult to achieve. Essentially, we are trying to create a breast implant/breast tissue interface that feels and behaves as naturally ( as a single unit) as possible. Generally speaking, making sure that the breast implant has some sub muscular and some sub glandular component ( dual plane) and tailoring the overlying skin/subcutaneous tissue/breast tissue as precisely as possible over the underlying breast implant is key.
Despite these efforts, breast implants are after all a foreign body that don't necessarily stay where we wish they would; therefore, breast implant related problems such as positioning ( too high, too low, lateral displacement etc.) can occur and may be a reason for returning to the operating room for revisionary breast surgery.I use a “tailor tacking” technique that allows a determination of what breast implant should be used to SAFELY produce the results the patient is looking for. This technique involves use of a temporary sizer and temporary “closure” of the overlying breast skin over the sizer. The use of the tailor tacking technique is very helpful. Breast lifting involves removal of skin ( and tightening of the breast skin envelope) while breast augmentation involves expansion of the breast skin envelope. These 2 forces are counteracting each other. Again, despite these efforts, breast implant and/or tissue/skin complications may arise causing minor or significant complications.

Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).

Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately. For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.

I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future.

Breast lift/Implants

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Thank you for your question and photos. It is quite common to experience sagging after childbirth. If you are happy with the volume of your breasts when wearing a non-padded bra, then a breast lift procedure alone may be enough to provided you with the lifted, perkier breasts you desire as well as providing the option of reducing areola circumference at the same time. If you also wish to add volume/upper pole fullness then inserting breast implants will be a good option and this decision can be made at a later date after recovering from your lift.

I recommend that you meet with a board certified Plastic Surgeon for an in-person consultation so that they can assess and measure you then provide you with surgical options. I recommend trying on breast implant sizers in office as well to get a feel for what the additional volume would look like.

All the best!

Changes to body after having children

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The appearance to your breasts and abdomen is very typical for a woman who have had children and nursed.  The longer you nurse the larger your breasts will become.  The enlargement of the milk glands will compress and shrink your normal breast tissue.  When you stop nursing the milk glands will shrink and now you are left with a lot more skin and less tissue so its normal to look saggy after nursing.  The same occurs with the abdomen.  The skin stretches and the abdominal muscle also stretches and often tear in the middle causing a condition known as diastasis.  Placing implants will restore the volume that you need but will not give you the small areolas you had prior to surgery.  A breast lift can accomplish that but with scars that you did not have prior to having children.  So you have to either accept a larger areola or scars if you wish to have smaller areolas. 

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 106 reviews

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Breast options

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Thank you for your question and for sharing your photos.  Your photos and description is representative of what can happen during the post-pregnancy period and is perfectly normal.  If this is something that concerns you, then surgery is a great option.  A breast lift will help make your breasts more perky.  A breast augmentation will add more volume to the breasts.  The combination would do both.  If this is something you are considering, then I would consult with a board certified plastic surgeon to discuss your options in more detail.

26 yo

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You have had more change in your breast contour than most after your pregnancy, but considerable improvement can be expected by doing a breast lift, which would remove some excess breast skin, reposition the nipples and areolas, and reduce the areolar size. 

A visit to a plastic surgeon will help sort out the possibilities for you ..All the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast surgery after pregnancy

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Pregnancy and breast feeding can destroy the beautiful appearance of a young perky breast. Although this is a normal and common occurrence it is most often not a desired one. This can be improved with breast surgery. If your breasts are a good size for you in a bra without padding then a breast lift may be the right operation for you. If you desire a larger breast then a breast implant (breast augmentation) may be the right thing for you. There are many other nuances of choosing. If you can tolerate being a bit larger then you may be able to get away without as much scar on the breast because the implant may take up the space of extra skin without needing to cut the skin out. If there are many stretch marks present then you will probably need a breast lift since the skin will just stretch more after placement of an implant. A consultation with an experienced plastic surgeon will be help you decide what is best for you.

Sagging Breasts after pregnancy

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Thank you for the question and photos.  It is without a doubt that women's breasts change after pregnancy.  It seems that your breasts have sagged a lot (ptosis) since your pre-pregnancy days.  Breast augmentation could benefit you by reducing the sag on your breasts (breast lift) and put in some implants if you want to increase your breast volume; depending on what you'd like your end result to be.  Visit your local board-certified plastic surgeon and ask for his or her advice on the matter.  Best of luck. Dr. Michael Omidi

An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and provide true medical advice.

Michael M. Omidi, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 122 reviews

Should I get breast surgery? Are my breasts abnormal/overly old and matronly for a 26 year old?

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Your breasts are not abnormal.  Their shape and size is entirely normal.

The question is only whether you are happy with how they look and feel. I presume that if you are writing this you have been thinking about it.

So try to think exactly what it is that are your issues.  Size? Shape? Feel?  Droopiness? Skin texture? 

If you want to be larger you would need an implant.  If you just want to be perkier you would need a lift.  If you wanted to be larger and perkier you would need an implant and a lift. 

Make a list and see a plastic surgeon.  There are great surgeons in both US and UK, though we all prefer you to come to the left side of the pond.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 reviews

Should I Get Breast Surgery. Breasts Are Matronly After Two Children

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It's not fair is it. You have become matronly because you are a matron, a mother. The breasts change, normal changes from pregnancy and lactation. The abdomen stretches and then there is loose skin and a stretched abdominal wall. There is obviously nothing medically wrong at all. This is an aesthetic problem and that is what all the plastic surgeons contributing on Real Self are here to help with, with empathy and respect. If you should choose to have surgery to improve the aesthetics of your breast, you would need to have a breast lift, and if you should choose to have the abdomen restored, you would have a tummy tuck. You can explore these procedures and options by doing further research on Real Self, at, the Aesthetic Society, and with a personal consultation with a board-certified plastic surgeon.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Pregnancies are not kind to female bodies

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 and what you have are the normal sequelae of having children... they give you something you never forget.  So you are natural and can be rejuvenated when you are ready for this.  If you plan more children, you should wait until you are done before you have 'mommy makeover' procedures.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 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.