Grade 1 ptosis Breast augmentation w/no lift?

Question

Grade 1 ptosis Breast augmentation with no desire for a lift. I like my areolas , which are large btw. I do not mind the mild sagging I just want upper pole fullness and mine is quite flat. I’m considering 450cc or 500cc high profile under the muscle. My surgeon suggested i do it without a lift and if i need to lift it i can do it later on. I am interested in knowing what is best for me and what paitents successfully did something similar with good results

Ted Eisenberg, DO, FACOS, FAACS · Answer

Hard to tell for sure from the pictures posted, but if the nipple is below the fold under the breast when looking straight on with arms at your side then a lift is necessary. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

You are a very poor candidate for breast augmentation because your breasts are low and lateral on the chest wall. I recommend a breast lift using 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. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

Your breasts will not look natural or attractive after breast augmentation without a lift; they will look abnormal. Your goals are not just larger breasts; they are also to have attractive breasts. A breast lift, with its attendant scars, will achieve that goal because the shape will be pretty and the scars will be minor or even imperceptible. Implants without a lift and scars will not.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and seen just about everything.  A large portion of my practice is dedicated to revisionary breast surgery.  In your case, you have grade 2 ptosis for sure.  If you place an implant you will definitely have a waterfall deformity and an unattractive breast.  No one comes to me wanting breast lift scars.  It is a fact that you have a certain anatomy, and your best result will require a lift.  You should be able to have a beautiful results with a lift.  The incisions look their worst at 2 to 4 months, but they do heal very well and by year are barely noticeable.  I would reconsider your position regarding having a lift.  Best wishes to you.

Jacob Carlson, MD · Answer

Your surgeon's recommendation for performing an augmentation first certainly isn't wrong. With the high profile implants of that size in the dual plane position, you're going to get some mild elevation of the areolas. It won't be the same as a lift, but it change the amount and the position of the most projected portion of the breast. With the natural position and amount of breast tissue you have, you are at a high risk of developing a waterfall deformity in the future. That could be addressed with a lift in the future.
In short, I think you would benefit from a lift, but whether that happens with your augmentation or at a later stage is matter of your mentality. I would recommend considering your ability and means for one surgery vs. two. In addition to that, implants are not lifelong devices, so you will have to have another surgery in the future for your implants (i.e. to replace or to remove them), so you could also defer a lift to that time.

Donovan Rosas, MD · Answer

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision. 
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.   
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure.  Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.
Based on your photos, you would likely benefit from a lift. However, you always have the option of staging the procedures and allow yourself to decide whether a lift is something you desire.
There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon Patient should discuss their concerns with their physicians in order to make an educated decision.

Darryl J. Blinski, MD · Answer

Based on your Nazi posted photos, you were not a grade 1 breast ptosis. You are a grade 4.. Your nipple complex is hang below your infinite crease just by that alone gives you a grade 4 ptosis. therefore, if placing a larger implant under your muscle to get a pole fullness, it would exaggerate the ptosis of your breast. In my opinion. Best of virtual consult with to discuss in better detail. Please understand you most likely need a full breast lift with breast implant, but again best of virtual concert with good luck.

Grade 1 ptosis Breast augmentation w/no lift?

Answers (7)

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