What kind of breast lift? Will I get a good result without implants? (Photo)

I understand it can be confusing to see multiple consults and get different opinions. Based on the photo, a donut lift would provide a wholly inadequate lift. The benefit of the technique is less scars, but the problem with this technique is less lift, and more flattening of the breast if you try to get more out of it than it can offer. This technique is limited in the amount of lift it can offer, and at most it would raise your nipple position 2 cm higher than it currently is, which is not much, and not enough to reshape your breasts and provide an adequate lift. A full anchor scar would be needed for a full lift, and would not only raise the nipple, but would also reshape the breast to a perkier shape. Even if no breast tissue is removed, you will feel the breasts are smaller, since a large amount of skin has been reduced, and the breasts now sit in a compact shape. The skin takes up a lot of room in a bra, so your cup size may go down. This is all fine and good, as long as you are aware and not looking to maintain the same amount of volume in a bra, or increase the volume. I have included patients who had a lift with and without implants on my website, and there are photos of donut lift alone, as well as anchor scar alone, and this may help you get a sense of who is a good candidate for each type. I agree you could get a decent shape and size without implants, but the "perfect size" is very subjective, so without talking to you further it is unclear if the result would meet your expectations in terms of final volume, regardless of which surgeon you chose. Please make sure you choose a board certified plastic surgeon with experience doing both types of breast lifts, and with before and after results you like. Patients who have lost a lot of weight also can have different elasticity to the skin, which has to be taken into account when planning a lift as well.

I recommend a lift and breast implants. The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Absolutely forget the donut lift you need a full anchor.  Truly hard to conceive a donut lift doing anything at all.

Based on your picture it looks like you are a good candidate  for a full breast lift and no implant, I believe you can get a great result,consult with a board certified PS.

Based on the photos, it looks like you would benefit from a full lift (anchor scar).  The lift will raise the position of the nipples so both are aligned and pointing straight ahead, not downwards.  However, if you you're looking for some upper pole fullness, an implant will help you get a fuller look.  

Thank you for the question!
It is always difficult to balance the extent of surgery versus the desired results.  As surgeons and patients we are generally best off with "as much as necessary and as little as possible."
You have two main decisions:
1. Implant versus non-implant:  Since you have enough natural volume for a B cup, there is no real benefit to an implant and staying with just a breast lift simplifies the surgery, lowers the cost as well as the risks and avoids issues related to implants.  Here simpler is better.
2. Extent of scar with a lift:  In this case I agree with the majority opinion of the surgeons you saw.  An anchor scar would be my strong recommendation and I think any approach with less scar will have significant compromises in terms of shape and areolar stretch.  The donut approach works for very minimal lifts but can lead to flattening of breast projection and long term stretching of the areolar diameter in more extensive cases (which is the category you are in).  Here more extensive is better in your situation.
Patients understandably worry about the extent of the scar with breast lifts and good surgeons are always trying to minimize scar length and appearance.  At the end of the day, I find that patients really want the best shape and projection for their lifted breasts and also that their worries related to the extent of scars fade into the background.  The most visible scar is the one around the areola in any case and almost all breast lift designs incorporate this.  Some patients are prone to hypertrophic or keloid scars and it is a longer discussion as to the trade offs in their case.
I tried a lot of donut mastopexies when they were popularized 20-25 years ago and the results in patients with grade 2-4 ptosis were never as good as a lollipop or anchor scar (in my hands).  I think I have revised most if not all of those surgeries over time and I am pretty sure I am not alone in this.
Recent emergence of "auto-augmentation" (moving some of the droopy breast tissue as far up vertically as it will reach) has improved the ability of conventional lifts to fill in the upper pole of the breast and create a look that can rival an implant in some patients.
I would trust the two surgeons who suggested the anchor procedure in your case (60 lb weight loss and grade 3/4 ptosis) and pick the one you had the best feeling about.

Hello,You can discount the donut lift doctor. You are clearly only a candidate for a true breast lift given your asymmetry and skin excess in both the vertical and horizontal vectors. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Best of luck!

Thank you for you question and photo,               The Bellesoma Method is a current technique to lift and/or reduce breasts without using implants or the ugly vertical scars.  The incisions are hidden around the areola and in the inframammary crease. The vertical incision has been completely eliminated. The areola incision heals almost invisibly due to the fact that there is hardly any tension on the closure. With this particular technique, ducts are preserved along with nerve supply maintaining nipple sensation and the ability to breast feed. Because the breast is reshaped internally and is secured to your chest muscles, upper pole fullness is possible.  You would need to wait at least 6 months before undergoing another breast surgery.  Attached is a patient who underwent The Bellesoma Method. Please note that her tissue was used to create upper pole fullness and cleavage without any foreign materials (mesh, implants, etc).  It is a proprietary technique that only surgeons that have been trained by me can perform. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

If you only want to be a B cup, I would agree that an implant is not necessary.  You do however have a lot of excess skin and I would definitely recommend an anchor breast lift in order to give you the best result.  Best of luck.  

If you don't want implants and you're content with a B cup, definitely no implants.  Implants are for one purpose only: volume.  You don't need added volume.  You want breasts repositioned higher on your chest, and a more youthful shape.  A well performed mastopexy (breast lift) alone will accomplish these goals.  Your breasts are asymmetric, so the lift should be performed to improve symmetry.  You already did the hard part (weight loss).  No "anchor" scar (Wise pattern) necessary, a lollipop type scar should be sufficient.  Many breast lift results with and without implants shown in our gallery, but the link here shows lift alone after REMOVAL of implants.  A quick look at the "before" photo shows why you don't want implants if the associated volume addition is not important for you.