Lift or no lift with breast aug? (Photo)

Hi, thanks for your question. Your photos depict my typical patient whose had kids. Since I don't know your history I can't say for sure. IMHO you do not need a breast lift but could really benefit from a breast augmentation mammaplasty (BAM). The approach can be either through the infra-mammary fold or through the areola. I like a partial sub-muscular placement to achieve a natural result. My preference are silicone gel implants particularly when the patient has deficient soft tissue coverage. When looking at photos of a post-op augmentation it can be difficult to distinguish between a saline or silicone gel implant. However, in cases like yours the silicone gel will feel much better. Good luck, Dr. PG

It's understandable that you're feeling conflicted given the differing opinions from your consultations. Whether or not to get a breast lift (mastopexy) can depend on several factors, especially when considering long-term satisfaction and your goals.

Here are some key points to consider:

1. Current Breast Condition:
Do you have sagging (ptosis)? The main purpose of a breast lift is to correct sagging. If your nipples sit below the inframammary fold (the crease under your breasts) or point downward, this is a typical sign that a lift might be necessary.
Skin elasticity and volume loss: After breastfeeding for 15 months, your breast tissue may have lost volume, leading to deflation or mild sagging, even if it's not severe enough to require an immediate lift. Consider how much your skin has stretched and whether it has retained elasticity.
2. Implants vs. Lift:
Implants alone: If your sagging is mild and your goal is to restore volume, some surgeons may suggest implants without a lift, as implants can give the appearance of a more lifted, fuller breast. However, if sagging is moderate to severe, implants alone might not fully correct the issue, and you may still experience drooping over time.
Lift with or without implants: A lift can address sagging by reshaping the breast and repositioning the nipple, providing a more youthful appearance. Implants can be added for volume, but if you're happy with your breast size, a lift alone might be sufficient.
3. Long-Term Considerations:
Avoiding a second surgery: Since you're concerned about needing a lift in the future, it might be worth considering a lift now if you're showing early signs of sagging. If you skip it and rely solely on implants, there's a possibility that you could develop more sagging over time, especially as gravity and aging continue to affect your skin.
Personal preferences: If you prefer to have a single surgery and avoid future procedures, doing a lift now may provide more long-term satisfaction and prevent the need for corrections down the line.
4. Surgeon’s Expertise:
Since you’ve had mixed opinions, it could help to consider the experience and expertise of the surgeons regarding your case. Ask each one why they made their recommendation and how they see your breasts aging over time. Some surgeons may take a more conservative approach, while others might be looking to achieve a more long-lasting result.
5. Test at Home:
One easy way to gauge if you might benefit from a lift is the “pencil test.” Place a pencil under the crease of your breast. If your breast tissue holds the pencil in place without it falling, it’s an indication of sagging that could be corrected by a lift.
Conclusion:
Given your concerns about potentially needing a lift in the future, you might lean towards having it done now if you already have noticeable sagging. If the sagging is mild and you're happy with your current appearance, implants alone might suffice for now, though they won't prevent future sagging entirely.

Ultimately, the decision should be based on your personal aesthetic goals, how much correction you want now, and how much you're willing to commit to potentially more procedures in the future.

Thanks for your question. From you pictures, you seem to be a good candidate for a breast augmentation. I recommend you schedule a consult for a proper evaluation. Please always consult with a board certified plastic surgeon. Take care, Dr. Moises Salama, board certified plastic surgeon.

I would recommend an implant with a lift. This will provide a better long term result. I would recommend seeing a board-certified plastic surgeon with experience in breast aesthetic surgery.

Your nipples are located at your breast fold. For this reason, a lift would probably be recommended especially if you are going to be getting implants.

In person exam is essential. No one can predict what you will need in 5 years. It appears -based on limited photos- that at present- a breast lift is not indicated for you. Your asymmetry could possibly be improved with different size breast implants - if being larger is your goal . Hope this helps

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

From your photographs, I would guess you could get an excellent result without doing a lift. Your nipples seemed to be in good position when considering the fold of your breast. This is often the way we decide whether a lift is beneficial. You could always consider getting an augmentation first, and consider getting a lift after a year or 10 years or maybe never.

Although your breasts are not very saggy, they do have some ptosis and skin excess, and the quality of the soft tissue/skin envelope would impart a very different result. For you, breast augmentation without a lift would yield a result that would have a lower position of the nipple-areolar complex (with the entire soft tissue envelope) and more lower pole residual ptosis. In general, when looking at before and after photos of other people, if your breasts don't look like the model's breasts in the before photo, you won't have breasts that look like their breasts in the after photo, unless of course, a breast lift is also performed.

I recommend a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.